It's a shitstorm that seems to have no end. At least that is how it feels.
What had actually happened was that the catheter dislodged from my husband’s artery. (We had been emphatically assured that that was a rare event by Dr. D'Angelica. Ugh.) He is so very lucky to be alive as when this happens people can bleed out and die. The interventional radiologists went in through his femoral artery and patched it up. Amazing that they can get into the hepatic artery and do what would otherwise be surgery. They drained the pump of chemo and left it empty during the procedure so the pump died. They turned it off yesterday so it doesn't beep. There is no resurrecting it, nor would we want it to be! His catheter is now free floating out from the pump around his small intestines. GREAT!
His hemoglobin bounced a bit after his procedure, from MSK arrival value of 7.9 (to high of 9.2) but then dropped to 7.7 and then up to 7.8 yesterday night. I was frantic to discover this as it did not make sense to me and called to see if I could get some information that would help me understand. The nurse said that they would keep testing and should it get to their threshold of 7, he would get a transfusion. This still didn't reassure me because it sounded like treating a symptom instead of a cause.
Dr. Kemeny believed that he could be experiencing hemodilution. They were supposed to lower the saline IV drip rate to try to counteract this but according to my husband, they did this for a short while, then put it back to where it was. He was confused as this was all happening in the middle of the night. He was/is completely exhausted so I don't really have a good picture of what went on.
After a night of very little sleep, I checked the portal and saw that it was now 7.1. I got a call this morning from one of Dr. D'Angelica's fellows who explained that this could be a natural variation given the circumstances. (Or could maybe not be!) What they do at this point is give a unit of blood and see how his hemoglobin and hematocrit responds. If it rebounds to 7.9 or above, they will be cautiously happy and will watch to make sure it steadies. However, if it only jumps to 7.3, stays the same, or drops, they will be concerned. He said that they would then do another CT with contrast to see if they can see what is going on.
I also found out this morning from a nurse that the interventional radiologist embolized his pancreas which was bleeding. (The radiologist DID NOT SAY A FUCKING THING ABOUT THIS AT THE DEBRIEF MEETING WE HAD AFTER THE PROCEDURE. Nor did Dr. D'Angelica when I saw him yesterday for his explanation of what was going on.)
Ok, so getting back to the conversation I had a couple of hours ago with the fellow, I'm always concerned about CTs not getting an accurate picture of what is going on with my husband, so I wasn't terrifically reassured. This is especially because what I really think has happened, despite both Dr. D'Angelica and Dr. Kemeny's attempts yesterday to assure me that chemo leakage could not have caused significant damage (including Dr. D'Angelica saying that FUDR is administered into the abdominal cavity as a chemo treatment), is that there was extra-hepatic perfusion into those liver lymph nodes that the post-implantation flow scan test radiologist said was present. (Dr. Kemeny overrode that opinion. Dr. D'Angelica deferred to her on this and in that conversation said that liver lymph nodes are not considered "blood vessels" when I asked him about the paper he and Dr. Kemeny authored on the subject of extra-hepatic perfusion.) I suspect that there was indeed leakage as his Hgb started to decline as of April 1st, the date he started his first round of FUDR. I think the FUDR entered those two lymph nodes and into his blood stream. The FUDR corroded the hepatic artery and weakened the connection to the point where it gave way on Sunday night when all this started. It probably also leaked into the pancreas.
Yeah, shitstorm is a nice way of putting this living hell.
There is going to be a huge price to pay.... and I am taking no prisoners.
Last edited by mpbser
on Mon May 27, 2019 6:07 am, edited 2 times in total.
Wife 4/17 Dx age 45
1st primary T3 N2b M1a
8/17 Sub-total colectomy
2nd primary 5.5 cm T1 N0
9 of 96 nodes
CEA: < 2.9
Lynch no; KRAS wild
Fall 2017 FOLFOX shrank the 1 met in liver
1/18 Liver left hepatectomy seg 4
5/18 CT clear
12/18 MRI 1 liver met
3/7/19 Resection & HAI
4/1/19 Folfiri & FUDR
5/13/19 HAI pump catheter dislodge, nearly bled to death
6-7 '19 5FU 4 cycles