Irv Update - September 2011 #7

Dear All; Irv had a CT scan this morning that showed improvement! The bile ducts are a lot less swollen/engorged. He is definitely much less yellow/jaundiced. All of his liver function lab tests are improved. Irv himself is much, much improved. He is still in the cardiac unit. Still on a lot of antibiotics as gram negative rods (think E. coli, but that probably isn't what it is) have grown in the cultures of the bile fluid taken when he "crashed" yesterday. Blood cultures are not growing anything. His heart rate is still erratic, but acceptable. Dr. Biehl, the surgeon was in to discuss the future surgery. Unfortunately, Irv is such a puzzle that an exact surgical option still isn't clear. He suggested that Irv have another endoscopic ultrasound with biopsies taken probably tomorrow or Tuesday. (He is already going to have the drainage procedure repeated tomorrow to try and place the tube in a better position.) Even now, the team of doctors here at Virginia Mason think there is a cancer present somewhere in the mess! If a cancer is found, a Whipple procedure would be done. Look it up. It is a huge surgery and a major assault on the body. Dr. Biehl was concerned that if that has to be done due to the high dose prednisone and the azothiaprine Irv has been taking that it will be a very difficult and long recovery/healing process. OR, they could just do a fairly simple clearing of the bile and pancreatic ductal area with a "clipping" procedure that allows the bile, etc. to drain right into the stomach. We have been hearing this cancer information for over a year yet NOT ONE biopsy has ever shown any cancerous cells. Dr. Kowalski,in January, when he did the small bowel obstruction surgery biopsied everything and anything and no cancer was found. The only thing I can think is that perhaps Irv does have some buildup of fluid in his abdomen they haven't told us about and I didn't think to ask directly if it was there. That could signify a cancer. Also, he has not responded at all to the "standard" drug regimen for an autoimmune disease; his condition has just progressively gotten worse to the acute liver failure he now has. Does that mean cancer? We have heard from just about every doctor we've seen that NO ONE can pinpoint a diagnosis for Irv. By the way, we really, really liked Dr. Biehl. Irv's sister Dianne and her housemate Sharon were present when we met him and he discussed Irv's case and he drew pictures of possibilities, etc. They liked him as well. So, we still wait. At least Irv is feeling much better with the drain in place and the bile leaving his body instead of being blocked inside and further damaging the liver, and who knows what else? We will still go home to La Pine at some point before the surgery, whatever it is, will be done. BUT, within 3-4 weeks max, some surgical option will be done. I'm obviously still very upset. Why can't this be a simple answer? Penny