Why is life always so crazy?

It just never slows down; not even for a second. I have been meaning to post for a while now and something always kicks in the door to trump card my thoughts.

I received some feedback several weeks ago now from the doc at UPMC who did the last Angiogram, and he told me somethings about how my Hepatic Artery was placed that i didn’t know. If you remember, there is a narrowing in my artery caused by the length of it so my RI values are a bit low. So I asked him about why it was left so long, and what could really be done about it. Rather than rewrite it:

If the narrowing continues to be troublesome and requires further action, what would that be?
If you begin to start showing signs of liver dysfunction (elevated liver enzymes, jaundice, or other problems) you would be brought back to Interventional Radiology and we will attempt a balloon angioplasty. If we get a satisfactory result, we would stop. If we get an unsatisfactory result, we would proceed to intravascular stent placement. Although the sharp angulation can make angioplasty and/or stent placement difficult and with increased risk to the vessel, it can usually be done successfully. Because your liver function was so good at the time of the exam, it did not seem reasonable to undertake a procedure with some degree of potential risk, but very little immediate potential benefit.

Is vascular surgery an option to shorten the length of it? Or would a stent be tried first to see if that is an acceptable corrective measure?
Well, surgery can be done, but this is a sizeable and complicated operation, and one which the surgeons would rather not perform if there is a safer or less invasive option, such as balloon dilatation with or without stent.

It also came to mind as to why the length of the artery was left so long? Could it not have been shortened during the surgery?
It is often difficult to get the length of the artery the perfect length. The surgeon will frequently make the connection of the artery to the most proximal portion of the donor artery using a technique called a Carel patch. This allows for a larger arterial connection, but does often make the whole artery a little longer and slightly prone to kinking. Also, as the liver settles into place after transplant, it is sometimes difficult to predict exactly how the artery is going to sit.

So that’s it in a nutshell. It was good to get this information and he has been great answering my questions quite quickly.

More recently, I have been off and on tired still, and was feeling a bit crappy the last week or so but have gone back to somewhat near normal. It’s still hard to find the energy to get back on the bike, and I have ridden to work once so far this year – and I tell you it was a workout. Makes a guy feel old….

I’m a bit more determined now to get back into some semblance of good shape, so I will be hopefully ridding to work 2 or 3 times a week – and getting in on some of the local rides. We’ll see.

NYC's new Rapid Organ Recovery Ambulance

A program coming from New York will allow the city to dispatch a special Organ Recovery Ambulance to secure the viability of the recently deceased while they obtain permission to have the organs donated. In an article on USA Today, the program is described as way to buy time to get to potential donors (22,000 annually in the US) who die outside of a hospital and are ineligible for organ donation. The basic scope would be:

1. Inject heparin, a blood thinner, into the IV started by paramedics, to prevent blood clots.

2. Continue ventilating the patient through the endotracheal tube inserted by paramedics into the patient’s trachea, to keep the organs oxygenated.

3. Continue chest compressions, using an automated compression device that squeezes the chest, to keep blood pumping through the potential donor and perfusing the organs.

4. Transport the body to the hospital, where further preservation measures would be taken as the family is consulted about the deceased’s wishes regarding organ donation.

Source: Bellevue Hospital, New York City Fire Department and New York Organ Donor Network

RORA is still in the proposal phase though, and could potentially begin next month some time if all goes well. I know the big issue here is patient rights and family consent, but I view it as a measure to ensure life – not really a medical procedure in the literal sense. I know, I’m biased.

There are a lot of issues revolving around whether or not the deceased person is a signed donor or not – because if they are, then the RORA team would be acting in accordance with their wishes as a listed donor. With only 1% +/- of people who die at hospitals being eligible, and 99,134 listed recipients people need all the help they can get. For more information there is a Q&A attached to the article.

I don’t usually use my blog for a soapbox, but I have to say that some of the comments for that article include several of the most ignorant statements I have ever read involving organ donation and transplanting. One comment even goes so far as to say not to sign the organ donation card because doctors will let you die. That’s the kind of stuff that I love about the internet. Well in the case of that one we know the brain is not a viable organ….

This is an excellent program, and will inevitably save lives – I don’t know how anyone who thinks about it logically could have a problem with that.