Monday, September 2, 2013

MEDICAL | I'm a stoner (Part 3)

(Continued from Part 2)

In August 2007 I had undergone an ERCP (endoscopic retrograde cholangiopancreatography) to remove the stones that were constricting the normal flow of my bile. The doctor opted for sphincterotomy to facilitate removal of the stones. And as luck--or lack thereof--would have it, I suffered from ascending cholangitis shortly after being discharged. It's a complication suffered by a small percentage of patients who had such a procedure. So I was back to hospital confinement.

Antibiotic treatment
Since there were no more obstructions in my CBD, what was left to do was just treat the infection with antibiotics. I think they gave me Unasyn (ampicillin/sulbactam) then. Administered in drip form, this is a much faster way of releasing the medicine into the bloodstream. It also does not strain the liver because unlike tablets or capsules, the liver no longer needs to break the antibiotics down into usable components for the body. After all, my liver had just been through a lot of stress because of the biliary stasis.

2012 08 09_122201
Antibiotics administered in drip form. One session takes anywhere from 15 to 30 minutes.

I was confined for a few days only and following my discharge, I continued my antibiotic treatment orally with its tablet equivalent. A full treatment cycle lasts between 7 to 10 days and it is a must that a patient stick to the regimen, else the infection comes back with a vengeance in a much more vicious form. I was also given Nexium and Motilium to aid in the normal functioning of my gastrointestinal system.

I lost weight as a result of this whole episode.

What about the stones in my intrahepatic ducts?
In my follow-up consults with my GI back then, Dr Galang, we've discussed about what to do with those stones that were high up in my biliary tree, the ones that could not be reached by ERCP. It was, of course, still a concern for me.

We've talked about lithotripsy, which involves the use of shock waves to blast those stones into smithereens but this medical procedure was more suited to kidney than biliary stones. Furthermore, the blasting may result in scarring of my bile ducts and only do more harm than good.

There's also this duodenoscope-assisted cholangiopancreatoscopy (DACP) that My Bibe and I have read about. Also called mother-daughter ERCP, it has a second camera inserted through the channel of the first endoscope, and can be used to administer direct electrohydraulic lithotripsy to break up stones. However, it still is not enough to reach all my bile ducts.

In short, there wasn't much that we could do other than have a liver transplant. Meanwhile, my liver function tests still showed elevated bilirubin, SGPT, and alkaline phosphatase levels, further validating that there were still blockages somewhere.

They've reportedly analyzed the biliary sludge collected during my ERCP and concluded that they weren't due to cholesterol and were instead classified as primary. Cholesterol stones are classified as secondary stones, which originate from the gallbladder and with which a person's diet usually has a factor. Primary stones, on the other hand, are formed within the bile ducts.

Being a primary stone former, my doctors have labeled me as a highly uncommon case (in the Philippines at least) although My Bibe and I suspect that there are other cases out there that are probably just left undiagnosed, especially given Filipinos' chronic disinterest in healthcare. It is quite common in this country to see people, the poor most of all, who tend to dismiss symptoms and quickly resort to self-medication, and who don't bother to see a doctor at all until it's too late. Most people who share the same condition as mine probably just die of sepsis without having the real culprit identified.

Reading up, My Bibe and I both learned that my condition is more common among Asians than Westerners. However, as to what really causes the formation of stones, studies have been conflicting. Just the same, unless I get a new liver, I won't stop producing stones. And yes, it sucks.

Second opinion
Used to having lived an active and rather carefree lifestyle thus far, My Bibe and I were suddenly thrown into a state of worry because of my condition. Because I was a primary stone former, there was always a possibility that one or two will end up blocking the flow of my bile again. Moreover, repeated biliary stasis, which irritates the liver, can cause scarring that may ultimately lead to biliary cirrhosis. I know very well that it wasn't a very rosy picture at all considering my grandma died of liver cirrhosis.

I don't know if it was denial or what but of course we wanted to seek other options, get rid of these stones and go back to the way things were before August 2007. Eventually I got my second opinion of sorts when I was referred to another GI, Dr Ernesto Olympia, section head of gastroenterology at Makati Med. My previous GI, Dr Galang, was not an accredited specialist of our company, and while our medical coverage allows employees to be attended to by non-accredited doctors during hospital confinement, follow-up consultations are limited to only one.

Seeing Dr Olympia was akin to lining up for a blockbuster film because he always has so many patients despite holding clinic six times a week. He opined that there wasn't really much that we can do except opt for a liver transplant, although he didn't recommend jumping straight to that decision. He was inclined towards a more conservative approach, towards managing my condition. He said having biliary stones shouldn't really be a problem unless they completely block the flow of bile, which made perfect sense. Nonetheless, he agreed to do another ERCP on me to remove as much stones as possible and give me peace of mind.

Dark days ahead
A few months have passed and I was fine. We even got to sneak in a short vacation in Maira-ira in Ilocos into our schedule. However, towards the end of November that same year, I started having fever and chills again, which usually happened in the afternoon or evening. I resorted to paracetamol and hoped it was nothing. However, the fever and chills kept coming back. I was still reporting for work then.

My Bibe and I enjoying our second time at Maira-ira in Ilocos. This was at the start of November 2007 before we were thrown into a really dark time in our lives.

On November 26, 2007 while at the office, I threw up. I was feeling full and couldn't really eat. So I went to see Dr Olympia again that same morning. I was pretty much in bad shape already. He thought of having me confined but I think we settled for a wait-and-see option first if the antibiotics would work. I think he also ordered some tests. I was just hoping then that this would all be behind us soon. I didn't want another confinement.

We went home and that afternoon my fever shot up to a little over 40°C before going down again after taking paracetamol. I ate very little. Everything else seemed fine, though.

The following morning I couldn't eat because I was feeling so full. Soon enough I threw up. I knew I had to keep myself hydrated but it was hard to take in water, let alone eat, because of that full feeling. I was feeling the pressure in my abdominal area and I tried to fight off the urge to vomit. But it was just too much, and I ended up in the bathroom again. I threw up real hard. It was nasty.

When I lifted my head, I couldn't see a thing. Everything around me was all white.

(To be continued.)

1 comment:

  1. Wow this is really serious...and interesting, my uncle and cousin had a condition similar to yours but not on that scale. I´ll definetely be on the look for the rest of this story.



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