He had the TIPS procedure done yesterday morning, and everything went well, as far as we know. Nobody from the procedure team talked to us, so we had to go off of what the nurse told us. (and sometimes nurses just get treated on a need to know basis - so often they don't know either. very frustrating!)
Two different doctors at two different times explained the TIPS procedure and what it does by saying that they kind of "roto rooter" a path through the liver to allow more blood to flow through, to ease the pressure that is going on. Because most of the blood just flows through that "opening", it doesn't get filtered correctly, and the result can be encephalopathy. (http://en.wikipedia.org/wiki/Hepatic_encephalopathy) Like the article that I linked to says, they try to control the effects of the encephalopathy, which is displayed as confusion, with lactulose and certain antibiotics.
Last night, Bill did seem a little confused, so I made the nurse and the PA aware of it, and they kept a close eye on him last night. The nurse said that he didn't show confusion during the night, and I'm very thankful for that, but sometimes confusion can only be picked up by family members, since they know the patient better and realize when they aren't acting like themselves. I will go back up today and spend some time to see what I can see.
The second issue that was discussed yesterday is that Bill's cancerous tumor was larger than the docs had planned on, measuring 8 cm instead of 6 cm, and that they found some cancer cells in the renal vein, but not as far as the inferior venal cava. What that all means is that they are concerned that he has a higher than average of recurrence of the kidney cancer; they explained that kidney cancer can be found in many areas of the body, not just in the kidney, since it travels through the blood stream. The areas most likely for recurrence to occur is the brain, lungs, and sometimes in the bones.
Because of the higher than average possibility of recurrence, Bill will not be a candidate for transplant at this time. They want him to wait for 2 years and then be reevaluated for a transplant, looking closely for cancer at that time.
The issue at hand is if they gave him a liver right now, and there was even 1 or 2 cancer cells floating around, when they gave him the anti-rejection meds, the cancer would go full blown very quickly, since the anti-rejection meds lower the body's immune system and the ability to fight off threats to the body like colds, flu, and cancer are so low to none.
It has come as a hard blow, though, since we have planned on transplant being a back-up plan after surgery, since surgery is hard on the liver.
Another problem right now that the docs are working on is his kidney function, which isn't very great right now.
Assuming that a person has healthy kidneys, working optimally, they would say that person's kidney function was 100%. Take away one kidney (which is what Bill just had done on Monday the 18th to remove the cancer) and you are left with 50% kidney function. Bill's remaining kidney is struggling a little bit right now, and is only functioning at 30% on a good day. The nephrologists are working with him to help get that kidney functioning better and to ease some of the burden from the kidney with medication. They are hoping that once the newness of the kidney removal surgery "wears off", the remaining kidney will rise to the occasion and start working optimally; very often, the doc said, the remaining kidney will start functioning at over 50%, to try to make up for the lost kidney. That is the kind of recovery we are hoping for.
A lot has happened to Bill in such a short time. I hope that all of you will pray for him, or continue to pray for him if you have already been doing so. I hope that his body will heal from all of these traumas placed on it and rise above its obstacles and do well. I hope that in 2 years he will be cancer free and we can look back at this time in amazement of his progress.
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