"I HATE That Spleen!!"

Ahhhh, not my words for once!!!  Once Steve has recovered fully, you can count on Dr. Altman chasing him down Superior Street with a dull dinner knife.  Actually, after today, Steve may roll over instead of running.

Since my last blog, his condition has been, at best, "even."  His labs have been on a slow decline, with WBCs going down to 1.2 from 1.7 at discharge on Labor Day.  Hemoglobin has been in the low 7's, but the platelets have become a huge issue.  He is receiving washed blood and platelets, with Benedryl, Tylenol, and hydrocortisone as pre-meds before each hang, which absolutely knocks him out.  Imagine waking up in the morning and getting Benedryl?  Dang.  Check out the pic of washed blood, reminds me of a cross between an old 45 record with the plastic insert thingy or perhaps a juicy whoopie cushion?  

Results on platelet lab results:  Sunday morning, FOUR, Monday morning SIX, and that is after getting bag after bag.  His b/p goes up when the platelets dive, and this puts him at risk for brain bleeds.  Not good.  At all.

The NW Lurie Hematology/Oncology group meets on Monday afternoons.  Yesterday, with a unified decision, they chose to have Steve undergo a splenic artery embolization.  It's not surgery, but kinda.  We were told about this being an option a long time ago.  He went to Interventional Radiology at 2:30 today.  He was given Fentanyl and Versed, along with a local anesthetic at the entry site (femoral artery, like a heart cath).  They guided a wire (?) up to his splenic artery, then "camped there" and "took a LOT of pictures" of his spleen after contrast dye imaging.  The docs told us before he went in that they were going to really take their time (THANK you) as this was a special case and they were very aware of what a bleed-out risk Steve was, due to such low platelets.  Once the pics were taken, they shot "Gelfoam" into the artery to essentially plug/choke off 40-50% of his spleen's function via distal capillaries.  This will cause sections of his spleen tissue to "infarct" or die from lack of blood supply.  It is permanent and a wonderful alternative to splenectomy when surgery is not an option.  Surgery has been discussed at length since this began, and was never a good option due to Steve's risks of infection or relapse of leukemia.

An embolization is done in a case like Steve's to keep the spleen from trapping platelets and other cells.  Mary's stem cells need to find their new home in his bone marrow and his spleen may have an appetite for those as well.  All the work that has been done is for naught if the spleen is killing and/or trapping good cells.  It was time.  

He came through the procedure with flying colors, vitals were good.  He had one of my favorite night nurses, Sophie, tonight, and I know she is fond of us and was keeping a good eye on him.  They put up his PCA with Dilaudid in case the infarct pain presented.   Bad news:  Could be intense pain for days.  Good news:  He had a splenic infarct in May and thought is was kidney pain.  We went to the ER and were sent home and told to take Tylenol.  If this is the same pain, he is darned good to go with Dilaudid.

Oh, I'm sorry, did I mention that today was ALSO his sister Mary's SECOND stem cell harvest??  God bless, her neck catheter was inserted yesterday, and today she was harvested.  Overachiever!!!!  Mary was able to donate 15 million stem cells for Steve.   She had a very, very rough go of it, even with all the meds they gave her, and we are very, very grateful.  Thank you, Mary!!  Tomorrow, 7.5 million cells will be infused into Steve, with his less functional, new-age tech spleen.  

We have no where to go but UP from here!!