Dr. Arias, our new hepatologist at CHNOLA, is a pretty amazing doctor and he quickly made it up the ranks to one of our favorites. He's that doctor that gives you his contact information and asks you to e-mail him anytime. And when you do e-mail him, he calls you back personally within 24 hours. After today's appointment he went as far as to give us his cell phone number and asked us to call/text him with any questions about labs or ultrasound. His bedside manner with Parker is awesome and he explains things to us in terms we understand. He has trained at some of the top facilities in our nation so he is knowledgeable, but he still tells us like it is. So when he called recently asking to see us immediately we knew something was up.
Parker has always had portal hypertension, it comes hand-in-hand with his diagnosis of ARPKD/CHF (Autosomal Recessive Polycystic Kidney Disease/ Congenital Hepatic Fibrosis of the Liver) Portal hypertension means that the blood cannot flow through his liver properly because his liver is hardened. When the blood cannot flow properly, it backs up into the spleen. We've monitored it closely with blood work and ultrasounds regularly, and while his labs have always been slightly off, it was nothing to draw concern about. His spleen has always been enlarged, due to blood flow backing up, but we were told his spleen wasn't large enough to worry about yet. The problem is that any little thing can cause more damage, including infections and viruses, and Parker spends a good bit of time sick because of his immunosuppression. Throughout March and April we fought Norovirus- a particularly ugly stomach virus, for over 30 days. Unfortunately this virus did a number on his liver. Since then, his platelets have dropped significantly, his liver enzymes (AST, ALT, INR) are all elevated, and his spleen has grown a good bit, and the blood flow in his veins are showing resistence now, which is a new occurance. Since it's been well over a month since our last hospital stay, all of these things should have fallen back to their "norm" by now, yet they haven't. They've progressively declined further, and that progression has them worried. The team here believes it's time to make a plan. Things aren't emergent, but we need to tackle this before it becomes an emergent situation. It's better for him if the evaluations and procedures are done while he is well. The procedure will be less invasive that way, and recovery much easier. However, the plan that we think will be best for him is not something that CHNOLA or any surrounding hospital has the technology or the training to do.
Parker will need what is called a Distal Splenorenal shunt- IF he is a candidate. Essentially what this will do is bypass the portal vein that is backing things up from his liver to his spleen. During surgery they detach the splenal vein from the portal vein and reattach the splenal vein to the renal vein. This allows blood flow to go around the liver, relieving pressure from the swollen veins in his stomach and esophagus, without taking blood flow away from the liver. It also helps to control bleeding and clotting issues that portal hypertension can cause.
In order to find out if Parker is a candidate for the procedure, and exactly how soon he will need it, there are a slew of tests and procedures that need to be done. Once again, CHNOLA doesn't have the machinery, technology, or training to even evaluate him for this procedure. In fact, it doesn't exist in the state from what we are told. So off to Philadelphia we go again in the next month or two. Dr. Rand's team at CHOP performs these tests almost once a week, so they are very well versed.
Our doctors here will begin coordinating information with the teams at CHOP on Monday. We expect it to take a while for the teams to consult, formulate a plan, and obtain insurance approval. Insurance approval will likely take the longest as it's not easy getting approval to cross state lines, and coverage drastically decreases when you do that. The transplant team at CHOP will also want to see Parker at this time since we are nearly 4 years out from transplant, so we have been told to expect to be there for at least a week. At this time there are still a lot of unknowns, but we know that we will be in the best hands possible at CHOP. The care there is truly unbelievable! In the meantime, please keep us in your prayers, specifically that the team comes up with the best plan available for Parker.