Sally
From Christine . . . . .
Just talked to Dr. Lee – the gastroenterologist – who had a long conversation with Dr. Giday (the gastroenterologist at Hopkins) and they have decided not to do the procedure today because of complications that can arise from trying to manipulate the stent. CT scan showed no evidence of perforation and the contrast flowed freely to the intestine so there is no obstruction there. They plan to put her on a full liquid diet for nutrition, let her recover from the trauma of the bleeding, and readdress the stent in a few weeks time (at Hopkins).
Both doctors agreed that at this point it’s better for her to completely recover from her initial bleeding episode and then do the procedure later when she’s stronger. There is no emergency threat right now. If she looks as good as yesterday they plan to transfer her out of ICU. The goals before releasing her from the hospital are to manage pain and get her strong. The moved stent is not what is causing her pain, it is most likely aggravating what pain already existed. Dr. Lee is not worried about internal bleeding again - he irrigated the area a lot when he was in there yesterday and often times that can cause a bleed, which it didn’t.
If there is continual pressure pushing the stent out there is a risk of perforation with time, however the risk of perforating her while performing the procedure is higher. Dr. Giday was surprised it had moved – both doctors agree the tumor in-growth within the bile duct had pushed it out. Fixing this issue will be a challenge wherever she goes to get it addressed. Right now she needs to progress well with a diet and get pain under control. Fixing the issue is really a timing issue – they need to find a window of opportunity to do this when she’s at her most optimal health – right now her platelets are low and she’s weak from the internal bleeding.
