Update on Chris' Condition

I talked to Chris' doctor this morning so I could get a better understanding of what has been going on with him the last couple of weeks. I'll do my best to summarize what I found out for all of you. The bad news is that I think he has been sicker than any of us (or at least I) realized but the good news is that he seems to have stabilized for the moment.

After his fevers subsided in the hospital (the reason he was admitted) which was about 2 weeks after his myelotarg, they noticed that his liver enzymes has risen dramatically. This is the same thing that happened after the myelotarg in St. Louis as I think I mentioned before. There is an entity known as veno-occlusive disease (VOD) of the liver that is associated with myelotarg and also with bone marrow transplant and this is what he has. They did an ultrasound of his liver to diagnose this and this is when they coincidentally found the blood clot in his inferior vena cava. The treatment for both is heparin which keeps your blood from clotting. As we discussed before, this is not totally straightforward in Chris because he is already prone to bleeding because of the cancer. The clot in his vena cava has resolved but they still have him on heparin to treat the VOD. Also, he needs some sort of anticoagulation to prevent another blood clot but there is some question as to how long they will treat him with it because of the risk of bleeding.

So, let's talk about the liver for a few minutes. The liver is probably the most important organ in the human body. The heart is pretty important from a mechanical standpoint but the liver is responsible for many vital functions. First, it acts as a filter for chemicals and toxins. The blood from the intestines and spleen come together in the large portal vein that then empties into the liver. This vein splits up into tons of tiny veins that then basically go through little filtering chambers and the blood comes out the other side and the vessels come together to form the hepatic vein which empties into the vena cava. The liver is also responsible for all metabolism in the body (it metabolizes medications and all food and energy sources - breaks down fat to make sugar for your body to live off of, etc). It is also responsible for making clotting factors (so you don't bleed to death) and the proteins that are the building blocks of the body. VERY important organ.

So, what happened with Chris is that all those little veins in the liver got occluded or blocked which leads to a back up of blood throughout the system and increased pressure within the organ. That makes all the little cells in there mad and they get injured which is what causes the liver enzymes to go up (they release stuff when they are hurt). It also causes bile not to flow through the liver and that causes bilirubin to go up and sometimes for people to turn yellow or jaundiced. If the pressure gets bad enough, the system backs all the way up into the portal vein and causes elevated portal pressure (called portal hypertension). This is a common problem in people with liver failure and can cause several types of badness. First, you can think of veins as similar to garden hoses that are put together with a connector. Sometimes, if you turn the water on full blast, water will leak out where the connector is. Well, consider that each cell that makes up the wall of a vein is one garden hose and so there are millions of hoses and millions of connectors. When they are under increased pressure, they leak and that is why you get fluid in your belly or ascites which is what Chris has. So, having fluid in your belly is a sign that the portal system is under pressure. It also serves as a great swimming pool for bacteria. So, they will put Chris on special antibiotics to try to prevent him from getting an infection in the fluid in his belly. They drained a bunch of fluid off the other day to make him feel better but they will not continue to do that unless they have to because it just re-accumulates anyway and whenever they go in there with a needle they run the risk of giving him an infection. The way you treat it is with certain diurectics that make you pee a lot and medications to try to lower the pressure in the portal system. Chris seems to be responding to these medications. The other badness that can happen is that the vessels get all distended from the pressure and you actually get like varicose veins inside around your esophagus, stomach, and intestines. These vessels can start to bleed which would be very bad in someone who can't clot well.

So, to summarize, Chris has a very serious condition right now known as VOD. The reason the doctors quoted him some nasty percentages last week (which Ryan might have relayed to you) is that most people who get VOD progress pretty rapidly to liver failure. They are very pleased that he seems to have stabilized for the moment. There are still lots of risks with this new diagnosis (infection in the fluid, bleeding to death, progressing to liver failure). The good news is that his blast count in now 1% which is great. This particular doctor wasn't sure what the plan was regarding the cancer treatment but they are supposedly going to discuss that later today.

On a lighter note, Trevor was baptized yesterday. He did great - not a peep out of him while the water was put on his head and then he just smiled and looked at everyone as he was taken out among the congregation. I'll get Ryan to put up a picture or two in his cute little outfit.

Christy

PS - here is a link to a site that discusses VOD in a much more eloquent manner than I did:
http://www.merck.com/mmhe/sec10/ch138/ch138c.html