Friday, June 26, 2009

Tommy came through the endoscopic procedure on Tuesday very well, except that he had a reaction to the anesthesia afterward and needed a catheter. That's working out okay and the plan is that it will be removed on Monday. During the procedure, Dr. Caruso got the endoscope down to where the common bile duct meets the intestine; he expected to find a 1-cm. gall stone that had shown up on the tests last week, but that gall stone was no longer there. However, there were numerous smaller gall stones, so Doctor Caruso made a small incision at the junction to allow some of them to pass through. On Tuesday, Tommy will again give blood for a liver panel, to see if the enzymes have come down. If not, Dr. Caruso will look more closely at the liver itself (possibly, a liver biopsy) for the cause of the problem. The good news is that the MRI and the MRCP showed no sign of liver cancer or cirrhosis of the liver. So, at this point, we know there is inflammation, but we don't know why. This weekend, Steve is hanging with Tommy, as I am attending the wedding of my godson Jesse in Michigan. I asked Tommy on the phone this morning if he's having fun with his son, and he said, "Oh yes...he's like an old wife." Steve says that the two of them had a good time watching wrestling on tv last night and that when Steve asked him if he and I ever watched it, Tommy said no. Ugh--that's for sure. So things are looking up for now.

Monday, June 22, 2009

Tomorrow is G Day--gall stone day--the day for Tommy's outpatient surgery at Milford Hospital. At 1:00 today I must call the hospital to get the official time for the surgery. Dr. Caruso's office said last week that it is scheduled for 3:00, but the hospital won't confirm the time until this afternoon. If all goes well, he should be home before dark tomorrow evening. Although Tommy is really tired this week (he hasn't walked for more than a week and his voice is very weak), he isn't in any pain and his appetite is better than it was last week. He was really happy to hear from his kids on Father's Day, even though he was pretty much whispering into the phone. So he's hanging in there, but it ain't easy.

Thursday, June 18, 2009

Due to booking issues, the date for Tommy's surgery has been changed from next Monday to next Tuesday. Yesterday, we spent the afternoon at Milford Hospital (an hour's drive north) for Tommy's preadmission appointments--three different meetings--first with the screener, then the o.r. nurse, and then the anesthesiologist, Dr. "Lisa". (Like Tommy's primary-care doctor, Rajshekar Narasimaiah, she has become known by her first name because her last name is hard to remember.) Last night was rough, as Tommy was tired and also had digestive problems; but today he rebounded, with fifty arm pulls on the wall pulley and 450 foot strokes on the pedal exerciser. Because the bile-duct obstruction is affecting his ability to process fat, his diet is heavy on soups and stews, with no meat but lots of seafood and beans.

Monday, June 15, 2009

Just got a call from Dr. Caruso's office; the surgery is scheduled for the afternoon of Monday, June 22.

Monday, June 15, 2009

Today, we should learn the plan for Tommy's surgery from Dr. Caruso's office. He is aiming for Friday, and his office is in touch with Tommy's neurologist, Dr. Peet, to make sure it's okay to stop Tommy's daily aspirin beginning this morning (so that his blood will not be so thin during the procedure). The diagnosis for Tommy's condition is Bile-duct obstruction; specifically, a stone about 1 cm. in diameter is blocking the common bile duct, which--among other problems--could result in damage to the pancreas if not taken care of quickly. The technical name for the procedure, which the health-care folks call ERCP for short, is Endoscopic retrograde cholangiopancreatography. After Tommy is anesthetized, Dr. Caruso will thread a flexible tube (an endoscope) into his digestive tract to where the common bile duct enters into the upper portion of the small intestine (the duodenum). There will be a cutting device attached to the tube. Dr. Caruso will insert the tube through the entrance of the bile duct, and enlarge the entrance to permit passage of the obstructing stone.
Tommy is unusually tired these days, and I'm sure it's because of the bile-duct obstruction; I am so eager for this surgery to get done so he can get back in the groove. I just hope that's the only problem in that part of his body and that there are no complications. He also has lost his appetite (very rare for him), which is another symptom of the obstruction, so I am trying all the time to get him to eat. I'll just be glad when all this is behind us!
On a brighter note, Tommy did some pedaling yesterday (he hasn't had enough energy to do any walking for several days now), and then in the evening, which was gorgeous, we sat on the couch on the back porch. I put his feet up on the foot-rest, and I stood at the other end of the porch, and we played catch for at least a half-hour with the big orange ball--Tommy was awake and a pretty good aim the whole time, and the dogs kept trying to horn in on the game which made us laugh. So that was a pleasant rebound on Tommy's part.

Friday, June 12, 2009

This morning Tommy and I headed out to get the tests done that Dr. Caruso ordered. We left the house at 6:15 for Beebe Hospital up in Lewes. There, in a single session, Tommy was given two separate tests--an MRI, and also an MRCP (similar to an MRI, and also non-contrast, but targeted more closely at the biliary system-and-liver region than the MRI). On the way home, we stopped at the Beebe system's walk-in blood lab for the blood test (to get Tommy's current liver numbers). When we got home, Dr. Caruso had already called and wanted to discuss the results of the MRCP, which had just been phoned to him (he is a really good doc). Dr. Caruso says the MRCP shows a significant gall stone (about 1 cm. in diameter) in the common bile duct, and he would like to remove it at the hospital at Milford Hospital late next week. His office is contacting Dr. Peet (Tommy's neurologist) to see if it will be okay to stop Tommy's daily aspirin tablet starting Monday, to minimize the chance of hemorrhaging during the procedure. Basically, Dr. Caruso will go down Tommy's throat and digestive system with a high-tech fishing rod and find the stone and somehow get rid of it. Tommy should be ok to go home later in the day unless there is a complication (pretty rare). So, by the end of Monday, we should have a plan in place.

Thursday, June 11, 2009

Yesterday afternoon, Tommy saw the gastroenterologist, Dr. Caruso, who ordered an MRI/MRCP (a pair of non-invasive tests) for first thing tomorrow morning up in Lewes ( we have to leave at 6:15 in the morning...that should be interesting). He also ordered more blood tests, also to be done tomorrow. I am relieved at least because Dr. Caruso is good and it was obvious during the appointment that he is focused on the case and has taken a good look at Tommy's history. Dr. Caruso says that the various indicators of Tommy's problem in the liver/biliary system region are very complex and the pattern is unusual and therefore difficult to diagnose. If the tests tomorrow don't make the problem clear, then he will order a liver biopsy. Dr. Caruso made it clear that he will see it through--all of which was missing for the past few weeks while the various doctors who are involved all saw something different in the tests, and the wheels were spinning.

Friday, June 5, 2009

Tommy is still not out of the woods; his liver enzyme numbers continue to climb. The doctors have been going around and around about whether the problem is with gall stones or with the liver itself. (If the problem is with the liver, it's probably far more serious.) Dr. Raj (Tommy's primary-care doctor) said for weeks that he thought it was a bile-duct obstruction. Then, Dr. Portz (the Beebe Hospital emergency-department doctor, who saw Tommy on Memorial Day weekend) said that Tommy had acute gall stone disease and that he should see a surgeon immediately. First thing after the holiday, I took Tommy to see the surgeon, Dr. Tatineni; but after reviewing the countless tests that had been done up to that point--numerous blood-work reports, MRI, X ray, ultrasound, diagnosis from Dr. Portz--Dr. Tatineni said no, Tommy may have gall stones but they're "innocent bystanders" and the problem is with the liver. Dr. Raj and the surgeon then talked, after which Dr. Raj called us to say that he now agreed with the surgeon. The surgeon referred Tommy to Dr. Caruso, the gastroenterologist; but when we got to that appointment, it was actually with Dr. Caruso's nurse-practitioner, Kelly. She ordered more tests, but this was clearly a situation where we needed the specialist, and I insisted that Tommy see Dr. Caruso as soon as possible. So, next Wednesday Tommy will finally see Dr. Caruso, and I'm hoping he will come up with a diagnosis and a plan as soon as possible.
Meanwhile, though, Tommy has no symptoms of stress in his liver or biliary system (no jaundice, elevated temperature, nausea, loss of appetite, etc.)--which is heartening. Yesterday and this morning, he has been right on target with his physical and speech therapy (we have been doing 30 minutes a day of speech therapy to help him get his voice stronger). Please, if you are reading this entry, give a call and talk with Tommy on the phone (late afternoon/early evening is best--302-539-8079). Talking on the phone, not to mention hearing from friends and family, is great therapy for him!