Internal Bleeding & Hospitalization

It all started on Tuesday, June 5th.  I awoke from a late afternoon nap to pretty bad discomfort and pain in my stomach region.  After a few minutes, I threw up the remnants of a late lunch that were still in my stomach.  I had opened and eaten a new bag of banana chips for lunch so I convinced myself the banana chips were bad and had caused the vomiting.  I got back into bed and surprisingly didn’t feel any better.  There still was pain in my belly.  I started popping pain pills (4mg dilaudid) and an hour later, they hadn’t even slightly reduced the pain.  This was bad.  Finally, I decided I had go to the ER.  I could barely stand up straight at this point and was nauseous from the pain.  At around 10pm, I shuffled into the all too familiar UW emergency admitting area complaining of severe pain in my midsection, to the point where I was short of breath.  They took me back to a room pretty quickly but then good ol’ process and disorganization took over, waiting over an hour to be administered effective pain relief.  Finally at 5 AM, I went for a CT scan of my midsection.  The CT scan showed significant internal bleeding in the area around my liver, with some of the blood leaking into the stomach.  This all causes severe pain in the midsection that can only be controlled with surgery and constant pain medication.

At dawn, I was admitted to the hospital and taken to a “regular” hospital room while a team of doctors discussed how best to treat me.  After a few short hours, I was moved to an ICU room at the top floor of the hospital so I could have constant RN supervision while I waited for an upcoming procedure to hopefully stop the bleeding.  Their hypothesis, based on the scan, was that the main liver tumor in my left lobe had begun to bleed.  This is not uncommon with liver tumors since they tend to be very vascularized (multiple blood sources/vessels attach themselves unnaturally to the tumor).    The procedure they planned to use to stop the bleeding is called liver embolization.  The surgical process of embolization  is similar to the Y90 procedure I had in September 2011.  The doctors insert a tube through the femoral artery, located in the groin (yes, gents my groin was “attacked” again), and with a variety of complex methods and machines figure out which blood vessels are connected to the liver.  They then use tiny coils to block the blood vessels from supplying any additional blood directly to the tumor. 

My embolization took 3-4 hours and the doctors felt they were able to block off 80-90% of the blood supply to the main tumor in the left lobe of my liver while also stopping the internal bleeding.  However, only time and future blood tests could confirm this.  It turns out they were definitely able to stop the bleeding because my hematocrit levels stabilized & started to head back up to a goal of 29-30. My hematocrit levels had been dropping (low 20’s) since I’d been in the hospital, despite the bags of blood they had been pumping into my IV, because the internal bleeding was unresolved.   I do remember going back to my room after the embolization and being (mentally) hungry because I hadn’t eaten anything in almost 2 days – I should eat something after going so long without anything, right?  I asked the RN who then asked the doctors if I could eat.  They both said yes so I was given a menu to order some food.  I tried to go bland with a grilled cheese and applesauce.  About three bites into the meal, I knew eating was a bad, bad choice.  Severe pain came screaming back at me.  It felt like my whole stomach was knotted into a severe cramp and that someone was stabbing me.  I spent the rest of the night battling the pain and can’t remember if I slept at all. 

In addition to the bout of severe pain from eating after the embolization and associated lack of sleep, this whole time, I had been receiving a pretty consistent high dose of pain medication.  Since my liver wasn’t functioning properly, my body wasn’t processing the medication as quickly as it was being administered.  As a result of that and decreasing vital signs, I have absolutely no recollection of what happened the next 36 hours so I am asking my wife, Michelle, who was lovingly by my side the whole time I was in the hospital to guest blog and fill in the blanks about what happened.

The next 36 hours or so are probably best left forgotten, however I’ll do my best to describe the events as much as my blurry recollection will allow!  Thursday was mostly consumed with pain management and monitoring basic functions.   The ICU team (doctors from the ICU itself, the gastroenterologists, the oncologists, the infectious disease doctors) is something like a Parade of Stars, with the nuance of the Stars often failing to be on the same page and the caregiver having to connect their dots to keep the patient as comfortable as possible.  Rhone’s vital signs and breathing became increasingly worse into Friday, and the GI fellow called me to say that they wanted to move forward with the ERCP procedure that had been scheduled for that week, but as recently as hours before had been deemed something we’d reconsider in a few weeks.  Fortunately, right around that time our good friend Dr. Bob had come by to visit and offered some amazing moral support as I weighed whether to allow the procedure to go forward.  The GI doctors felt it was urgent do to the procedure as some of Rhone’s symptoms that had to be addressed might be caused by the stents in the bile ducts.  The anesthesiologist pretty bluntly described going forward as ‘high risk.’  While I asked Rhone what he wanted to do, I knew he really was not in the state to properly evaluate the situation. So, after asking as many questions as I could – off he went.  It was a huge relief when Rhone’s parents, Bob and I were told that he had done ‘much better than expected’ and they considered the procedure a success.  He was on his way back to ICU.  That’s where (in retrospect) some of the more comical behavior began.  That night and the following, Rhone was hellbent on getting out of bed.  He came very close to being tied down and quite honestly I probably would have let it happen at 3 in the morning after several days of little to no sleep!  Fortunately for all concerned, with recovery underway and some adjustments to the meds Rhone increasingly gained his cooperativeness back, his vital signs improved, and he was ready to head to the ‘normal’ floor.  So, on Sunday the 10^th we headed to “7SE” and a week of further recovery.

After a week of recovering, trying to sleep, and waiting for my blood counts and vital signs to stabilize, I was feeling better and itching to get out of the hospital.  I hadn’t showered, I hadn’t gone outside or exposed my face to fresh or sunlight, and I was tired of the crappy food offered to patients who are supposed to be recovering.  My primary team of oncology doctors felt I was stable enough to return home on Sunday, June 17^th with a few conditions placed on my release.  I went home with a forced oxygen tube that wrapped around my ears and under my nose, I was to rest as much as possible, and get up to walk around my condo every once in a while.  Sold!  Those terms were completely acceptable to me, in fact, I would have signed on for a lot more regulations.  I felt like a fragile old man as I was placed in a wheelchair with my trusty oxygen container next to me.  The ride home was uneventful, I was just happy to be out of there, and I was eager to watch the final round of the US Open with my wife and parents. 

A few days later, I saw my new oncologist, Dr. Bill Harris.  We had a very sobering conversation about how sick I truly was in the hospital and how lucky I was to be out of the hospital so quickly.  Both he and the doctors treating me in the hospital were surprised.  Although I was out of the hospital, I’m not yet out of the woods.  The CT scan that was taken in the hospital showed that my lung tumors and my liver tumors, as well as the small lymph node tumors around the liver had all grown – the degree of growth was not discussed.  This meant that the chemo pill (lenollidimide) I started taking a few months back had been wholly ineffective on my cancer, which was disappointing since the side effects of that pill were the worst I’d experienced in recent memory.  I now have to find another form of chemo to treat my cancer.  First, I’d like the new chemo to stop the growth and give me more time.   As a bonus, I’d like to look for something that will elicit a shrinkage response.  The big problem right now is that my body, especially my liver, isn’t healthy enough to withstand chemotherapy in any form.  It’s ok to wait for 4 weeks from my hospital release (now ~2 weeks) so my body can heal, but waiting too long to “get better” from this recent episode might put me at a point where the cancer would be unchecked and have free reign to grow/spread further.  However, if I go with chemo too early, it could lead to liver failure which would almost certainly take me out quicker than the cancer would.  It’s a fine balance.

There are 3 main things that must happen: 1) the abdomen/belly area must decrease in size and pressure on other internal organ/areas.  I am trying to speed this along by taking 2 diuretics that hopefully will help flush the coagulated blood and other fluids that have built up in that region to be reabsorbed into the body’s blood stream.  2) My nutrition must improve, with an emphasis on a protein rich diet.  While in the hospital, my Albumin, which is a protein that measures liver function, dipped to alarmingly low levels because I was not getting sufficient protein or a balanced diet from the hospital food.  Michelle and my parents have been making meals stuffed with protein so I can eat 4-5 small meals over the course of the day.  Only blood tests can tell if this is improving.  3) My old nemesis the Bilirubin must also get better.  It spiked in the hospital and although my eyes are still somewhat yellow, the hope is that time resting will help it go back down.

For those of you who called, sent texts, visited, and offered to help in any way, Michelle and I want to express our sincere gratitude.  It’s always good to see or hear from friends and  loved ones when you’re stuck in a hospital for days on end. 

Post script……..I was about to the post this the evening of Thursday June 28^th since I was scheduled to see my oncologist Thursday afternoon.  In short, my oncologist was pleased with the recovery I’d made thus far.  The next post gives you an idea of what that didn’t happen.