|Angela pretending to watch tv, but really trying to think of more things to talk about to keep the male nurse in her room longer.|
Angela was in the cath lab MUCH longer than she was the last time she had a hepatic venogram done. At 3 1/2 hrs I was starting to get worried. What could possibly be wrong? As it turned out, her doctor had been called to an emergency case immediately after Angela's, and somehow nobody came to talk to me until Angela was already awake and talking the nurses ears off.
So here's what we found out:
When Angela's last ultrasound was done in July, her liver looked awesome, and the bypass that had been placed was open and functioning well, with good blood flow. Based on that the doctor stopped Angela's blood thinners (yay! No more shots!) in preparation for yesterday's procedure. Well, when the doctor tried to get the catheter into that shunt, the access was too small, plus there was a sharp angle she couldn't get the catheter around. "The access was too small" because it is starting to close, ON ITS OWN!!!! This means the blood flow and pressure in Angela's liver has normalized so its no longer needing to force blood through the shunt!!! This is pretty amazing, actually!!! Angela's body is trying its best to normalize the liver vascular system. Also, this doctor couldn't get over the difference in the size of Angela's liver now that it has adequate blood flow!
The plan is that in one month we'll do another CT scan to look closer at that shunt. If it is the same size as now, they will go in from a different angle (remember that sharp angle she couldn't get around?) and close it off. If the CT shows the bypass has gotten smaller, then we will leave it alone and continue to watch. However, all of her doctors suspect that it will be completely closed by then. This would be absolutely amazing!!
Angela's doctors are to be commended for coming up with this fix! Its now being written about in journals (which, I don't know) as a new option for others who have Abernathy malformations.
But, it just wouldn't be a surgery day with Angela without a little drama, would it? So in the cath lab an catheter is inserted through a vein in the groin that is run up into the liver (or the heart, or wherever they need to get to) Just one tiny incision in the groin vein is the only evidence anything was done. That hole needs pressure kept on it for awhile so it will close off, then they put a pressure dressing on it. Depending upon what organ was accessed the patient lays flat for 1-2 hours, then slowly work their way to sitting up all the way.
Angela had been laying flat for nearly two hours. Near the end of that time she was drinking juice and eating some crackers, which, being flat on her back was a bit tough for her and she coughed a couple of times. A couple minutes later her blood pressure took a little dip. Not a lot, but it was odd. She had been flat long enough so over the course of 15 min or so we let her sit up. She was ready to go home so I signed discharge papers and we had just slipped her shirt on. I pulled back the blanket so we could put her pants on and OH MY GOD!!!!! She had a fountain of blood coming out of her leg!!!! "Uh oh! Problem!" I said.
Suddenly there was a big flurry of activity. Two nurses putting HEAVY pressure (as in all their body weight) on that hole in her groin, time noted, doctor paged...again and again...IV restarted to push fluid (thankfully we hadn't pulled it yet!) They gave Angela some pain meds because it HURTS to have that pressure on one spot for so long, plus she needed to relax because she was really scared at the sudden activity. Someone pulled the blanket back further to get an idea how much blood she had lost. Holy crap!!!! She had lost a fair amount. Of course we don't know how long she had been bleeding, but the nurses suspected it was the cough that caused it. They held heavy pressure for 20 minutes then gently lifted the bandage to check again and it started right back up. It is really hard on the nurses hands to hold that pressure for so long so they switched nurses, and had to hold pressure for another 20 minutes. All I could think of is what if this had happened in the van on the way home? I wouldn't have known and she could have bled out!!
Then one of the nurses went to the cath lab and got a newly designed pressure dressing that allows you to see the wound without removing pressure. It was pretty cool! They put that on the wound. It had to stay in place for two hours, then they could remove half the pressure, then another half hour the rest of the pressure but leave the bandage in place.
Angela was finally discharged at 10:00 pm. I was a bit nervous about bringing her home but she did fine. She slept well all night, but I was up frequently to make sure she wasn't bleeding to death in her bed.
So now we wait to see what Angela's liver looks like in one month. Yay!