Tag Archives: esophageal varices

Home from the Hospital! Dealing with Mesenteric Venous Thrombosis

10 Replies

Dear Friends:

It’s been a few days since my last update, and I wanted to let you all know that I am now at home “safe and sound” after my week long ordeal at the hospital.  I arrived home here early Friday evening after being directly released from ICU at the University Hospital here in Edmonton.

In my last post I spoke about being treated for the latest clot through a method called TPA which is short for Tissue plasminogen activator.  The treatment is primarily used for stroke or heart patients in the very early stages (up to 4.5 hours) of discovery, and it is often effective, however in my case my hematologist did not even know of another person in the world who had the treatment for the type of clot I developed called mesenteric venous thrombosis.   My hematologist had recommended this procedure to an entire team of specialists at the time, because it was the only thing he thought they could do that would be less evasive then actually cutting me open!  When I asked him if this had ever been used before for this type of thing,  he only said that a young fellow they had admitted a few weeks prior had the procedure done for a clot that had developed on the entrance to his kidneys and that it was successful.  Initially my doctor had wanted a radiologist to insert a catheter directly over the clot location and target the actual clot from there, but that was ruled out as it again entailed opening me up and the risks of course are enormous.

At this point we are not sure if the TPA did what is was supposed to do, because it was administered almost 14 days since the onset of the pain I started having.  I am still dealing with some pain, but I will not know for sure if the treatment has worked until I do follow-up with my hematologist in a few weeks time, and of course if the pain has totally diminished.  At the time I was having pain it was thought that I was dealing with that from the thickening of my gall bladder due to the congestion of arteries from the existing clots, but that was not to be.  This latest clot caused swelling and distention of the bowel, and I was in considerable pain which increased in intensity since its onset a few weeks earlier.  After being admitted to the hospital early last Sunday morning, a CT scan revealed that a new clot had formed just below an existing clot in the mesenteric vein.  Click here for a diagram (black felt marks shows the existing clots I now have).

The danger for anyone having a TPA is that they could develop a clot in the brain, or bleeding, but in my case severe bleeding can occur as TPA is considered a clot buster with strong anti-coagulant properties.  Since my original diagnosis 10 years ago, I have always have been at risk to bleed, but more so now because I have esophogeal varices.

Thanks to many of you who prayed for me while I had the TPA, otherwise who knows what could have happened?   For those who sent emails, posted on my Facebook page, called me on the phone, stopped in to see me personally, brought food to the house, prayed diligently for me, or encouraged me through their words or hugs – I am feel so humbled by all your kindness!  Knowing that so many people from around the world were in the background cheering me on, made me feel special, and I cannot begin to tell you what that means to me.  You are a loved bunch!  Bless you for your faithfulness.  Not only was I blessed by all your love, but it was encouraging to my family that people were cheering me on in the background!

For the last several days I have had some thoughts I feel I need to share with you.  Many of you already know that I am a person of faith, but I have only touched the surface of that reality in prior posts of what that faith actually means to me.  In the past I  have shared with you concerning the peace I have, and that has always been evident, except for the occasional moments (being human) when I did have some pervading fear – even as recently as early last week when I was not sure what would happen to me upon learning about this TPA treatment and how it could affect me.  Last Tuesday, 2 of members of our pastoral team, plus a good friend and former pastor came up to the hospital to pray for me.  I had called them because of the scripture that says, “Is anyone among you sick? Let them call the elders of the church to pray over them and anoint them with oil in the name of the Lord”.  (James 5:14)  After they prayed for me and I myself prayed to have the fear removed that I had within me concerning the unknown, I overwhelmingly sensed “peace” and I can testify to that fact as it was real – all the way through the procedure until this very moment.  Whether or not I was healed at that moment is not known, but I carry on in faith that God goes before me and gives me the peace that I need to endure all obstacles.

Before this latest clotting episode, I have had the following passage  swirling around in my head for many weeks which reads, “Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal”. (2 Corinthians 4:16-18).  Allow me to paraphrase this for you from my own personal point of view … The first part of this verse tells us not to lose heart, because we are wasting away (boy do I know this), yet on the inside (not physically but spiritually) I am being renewed day by day.  For our “minute” and momentary (fleeting) troubles are achieving for us an eternal glory (heaven) that outweighs anything on this earth (I love this). Eternity is forever, the here and now is just temporary.  If I/we fix our eyes on only what is seen, we lose sight of all that God wants us to be here on earth, and if we dwell (by God’s grace try to stay true or obedient to His word), we can have live on this earth with an eternal perspective which out does anything the world has to offer.  I know in my own life this order often gets turned around because I don’t always  put God before everything I do, therefore I fail and it keeps me from the beauty of the relationship and the peace that usually prevails which can happen when we trust Him for everything.  One of the main reasons I think about this passage so often is that I do not have perfect health, of which I have never blamed God for, but have always thought it was His way of showing me that I needed to trust Him even through the most difficult times in life.

Lastly, there is one more passage I would like to share with each of you that is one of the most comforting passages I know, and one of many favorites at that.  It is taken from John 14:1-4, and it is where Jesus is comforting his own disciples through these words, “Do not let your hearts be troubled. You believe in God; believe also in me. My Father’s house has many rooms; if that were not so, would I have told you that I am going there to prepare a place for you? And if I go and prepare a place for you, I will come back and take you to be with me that you also may be where I am. You know the way to the place where I am going.”  When you live your life with an illness such as portal hypertension or any other sickness of which the unknown is uncertain, it is comforting to know that when the end comes, full healing will take place because of a decision I made as a young child, to believe in all that Christ Jesus, God’s only son did for me by dying on a cross for my sin.  When I think of this and the sacrifice that was made on my behalf, and the gift of eternal life that was given, it is a tremendous comfort – and in reality it makes life worth living all the more!   As I look to the future, it may not be bright in many respects for me or anyone one of us, however I press on despite the odds!

To read the original story click here:  www.portal-hypertension.com/medical-update-on-portal-hypertension-condition

Medical Update on Portal Hypertension Condition…

12 Replies

Some of you may or may not know that I had been admitted to the University Hospital early Sunday morning with a new clot.  As you know any clot can be dangerous, but this new one is located below an existing clot in my superior mesenteric Vein is most troublesome.  This clot has restricted blood flow to the bowel region, causing it to enlarge and of course pain comes with that.  If collateral arteries do not begin to feed this area of the bowel, it would die and they would have no option but remove this section – and that would be dangerous for me also.  They have me on morphine and they are giving me antibiotics intravenously to stave off any potential infection. The actual terminology of this particular condition is referred to as mesenteric venous thrombosis. To be more precise the severe pain I was having is caused by swelling and distention of the bowels.

I was informed last night by my hematologist that he was going to speak with a team about a procedure commonly used for stroke patients in the early stages.  The procedure is called TPA and is performed in the early stages (usually 1 hour) to break down clots in the brain and also the heart.  For TPA to be used in my case, it is almost unheard of, but the alternatives for me not to go ahead do not look good at all.

The danger for me to have this procedure done, is that I could bleed from the varices in my esophagus or I could potentially bleed in my brain.  See link for details:  www.portal-hypertension.com/esophageal-varices/

The other downside is, even if it works, is that the clot could reappear and I would have to be reassessed for eligibility.  The doctor said I have age on my side (I liked hearing this) and I am relatively doing okay with my current treatment protocol so he feels confident this will work.

Earlier today I really struggled with all of this as I haven’t had much time to digest it all.  Right now I feel much more at peace because of prayers lifted on my behalf.  As I face this procedure sometime today, I am asking you for your prayer support as I believe the more people praying, the better the outcome in the end.

Thank you for your support!

Clint

(Note: After composing this message, 3 pastors from our church came and prayed with me.  I have a tremendous sense of God’s peace over me now and  my very life is in His hands – as it always has been for many years now)

UPDATE: The TPA was postponed by the ICU doctor until 8 am this morning. Apparently he wanted easier access to GI doctors in the event of a bleeding issue, and more of those specialists are available during the day. I was prepped early last evening here in ICU and I am spending the night here.

Post TPA Update: IV is out but I still can’t move around for awhile yet. The pain I have still is milder in the abdomen, and the injection site but they still are giving me morphine to handle it. Dr Ritchie came in an hour ago and said that the clot may or may not still be there as it may have been there too long? The GI was also here earlier and said the truth won’t really be revealed until they take a scan – maybe tomorrow or Saturday. They will monitor me for at least a few more days. Thanks for your prayers!

UPDATE: Released from hospital late Friday August 31, 2012.  TPA went well and there is some residual pain.  Click Here for the Latest Status…

Portal Hypertension … Ascites and Splenomegaly

22 Replies

There are several complications of Portal Hypertension(PH), including one of the most precarious side effects called Esophageal Varices (covered in a previous post), and of lesser degrees are the conditions of  ascites, and splenomegaly.  

Ascites takes place when excess fluid accumulates between the lining of the abdomen and abdominal organs.  This area is referred to as the  peritoneal cavity.

Low albumin levels in the blood as associated with portal hypertension is also a contributing factor.  Albumin is a protein made by the liver and is measured in the clear liquid portion of the blood by a special blood test.

Beyond portal hypertension there are other causes of ascites and they are cirrhosis, congestive heart failure, hepatitis, and cancers such as pancreatic, ovarian, or liver.  Kidney dialysis can also cause ascites.

Upon examination the obvious signs of ascites are a swollen belly (abdomen).  At that point evaluation tests on the liver may be performed which include urinalysis, and kidney function testing.

Common treatment includes diuretics (water pills), limiting salt in the diet, antibiotics (if infection is present), not to mention the avoidance of alcohol.  If the patient does not respond to the common treatments, then the placement of a tube in the abdomen may be used to drain large amounts of fluid from the area.  Lastly a transjugular intrahepatic portosystemic shunt (TIPS) is a radiology technique that reduces portal pressure and may be the most effective treatment for patients with ascites that are resistant to diuretics. The procedure is performed with the patient under conscious sedation or general anaesthesia.  A radiologist places a stint through the skin from the right jugular vein into the hepatic vein.  A connection is made between the portal and systemic circulations.   This treatment from what I have been reading seems to be the norm in the treatment of ascites for patients resistant to diuretics.

Now on to the topic of splenomegaly or simply put an enlarged spleen.     The spleen is an organ that is part of the lymph system.  The spleen’s role is to filter blood and to maintain healthy red and white blood cells and platelets.  To clarify, your spleen acts like a spongy filter for your blood. As blood circulates through your body, some of the cells (in the form of platelets and red blood cells) get damaged or worn down.  The function of the spleen is to remove these damaged cells from circulation. The spleen also acts as a storage location for extra red blood cells and platelets newly formed by your bone marrow.  There are several other causes to splenomegaly which include diseases of the blood, liver, cancers, and infections but in the case of PH sufferers the cause is clotting to the portal and splenic veins.

From a personal standpoint I have been fortunate enough to not have any pain as related to the enlargement of my spleen, however the possibility does exist from what I have read and been told.  When first diagnosed with portal vein thrombosis(PVT), the first gastroenterologist I had wanted to remove my spleen (splenectomy).  Being only a few months since the discovery of PVT in 2002, I felt uneasy about a possible splenectomy so I consulted with my haematologist who practised at another city hospital.  His exact words at that time were, “anyone can remove your spleen, but ‘he’ is not touching it – come and see me”!  Looking back I realize this was a good decision, and it may have saved me from added or more serious complications.  All being stated, a person can live without their spleen, but from what I have learned recently is that the spleen is very helpful in maintaining one’s immune system especially when the liver and artery function is compromised by a clot.   Without the spleen a person’s vulnerability to infection does increase, so it is important to get regular vaccinations to prevent bacteria such as influenza and pneumonia from taking its toll on one’s health.  I might also add that even though a person still has their spleen, but has portal hypertension, it is important to be inoculated against influenza and pneumonia as either can cause varices (if present) to rupture and bleed with serious consequences.  Like seniors and small children, our immune systems are compromised and health care professionals consider PH sufferers as being “high risk”.

Lastly I want to say that if you or a person you know is experiencing symptoms such as mentioned above, you are more than welcome to comment or post your questions below.  There is so much more one can learn, and each of us has a story… maybe you can shed some light on the subject for the benefit of someone else?

Until next time,

Clint