Not Completely According to Plan #1

Here we go again with another "Good News, Bad News" scenario.

Good News: Johnny did receive chemo today.

Bad News: Not through his newly acquired Hepatic Artery Infusion Pump.

If we put a positive twist on this, it really isn't all bad. When we got to the infusion center today, they drew labs first thing, as always. Good news: they accessed his port with no trouble whatsoever and they were able to draw labs from the port, so no extra pokes were necessary.

While we waited for the lab values, they hung some fluids to hydrate Johnny. Always a good thing.

Then the labs came back and they showed that the liver enzymes were elevated. This meant that we couldn't add the chemo agent to the pump today. It would be a little too much for the healing liver to handle. The elevation probably came from the fact that Dr. House had to root around in there when he took out one of the tumors for biopsy. Also, in reading about the pump placement and chemo procedures, it says that chemo should begin 6-8 weeks after pump placement to allow for proper healing. Obviously, due to the fact that Johnny's tumors are aggressive we wanted to get chemo going as soon as possible. He is only 2 weeks post-op, so it stands to reason that the enzymes would still be elevated. We will try again next Monday.

While we were there, he did receive the systemic infusion through his port. The initial infusion went in quite slow (to watch for reactions) and we were there for about 3 hours. I feel better knowing that at least we have something in there attacking the cancer.

Johnny was very nervous about the whole process today. I felt really bad for him. Keep in mind, the MHO office hasn't cared for a HAI pump patient for over 5 years. This was the first pump placed at IU Hospital. EVER. So there was a little apprehension that the staff would be able to handle filling the reservoir. I should add here that even though he couldn't have the pump filled with chemo agent, they still had to "flush" the reservoir so that it doesn't clot off.

It really didn't help that of the two nurses accessing the pump, one has done it before (albeit 5 years ago) and the other was learning. I had the most recent experience with it by watching Dr. House do the nuclear medicine test while we were in Indy.

They had everything set up and Johnny's belly prepped and draped and the "learning" nurse was holding the "How to Access the Codman Hepatic Artery Infusion Pump" instruction sheet. Seriously. The other nurse was scrubbed in and explaining things as she went along. She did have to reference the instruction sheet to figure out if there were any differences in the two needles supplied in the access kit. I had to explain the difference between the "bolus" needle and the "access" needle. Good thing I paid attention in Indy.

To Johnny, this was completely overwhelming and he felt like quite the guinea pig. At one point he said that he almost told them to hand me the needle and let me do it! Wow, that is huge for him. He usually doesn't like me to participate in the procedures that are being performed on him, much to my dismay.

From my perspective, which I later explained to Johnny, this in no way meant they weren't prepared for him. In the cath lab there are procedures that are performed so infrequently that it is easy to lose expertise with that one procedure. There are many times that we have to ask someone else to come in for extra help, or to reference packages and such. Once we get going, it is like the old "riding the bike" thing. You remember and move on.

In the end, the two girls accessed his pump with no problems whatsoever. As a matter of fact, they did it quicker than Dr. House did in Indianapolis. (Although Dr. House did draw a bullseye for them, so there wasn't really any fishing around.) they drained the remaining saline from the fill in Indy and then refilled it again with more flush. The procedure, although stressful, was not painful for Johnny at all.

Tonight Johnny is feeling the initial nausea from the new systemic chemo (agent called CPT-11). We have loaded him with the anti-emetics and anti-nausea meds and are hoping that the firerhea (my newly created word for fire and diarrhea) is kept at bay. We have supplies at the ready for that, too.

We are going to take out the staples tonight, too. That will have to be a blog entry all on its own, I have a feeling. :)

We now come to the point in tonight's blog entry that I start the prayer request thing. Please pray for his liver enzymes to come down so that we can use the pump next time. Also, for the nausea/vomiting/firerhea to be kept to a minimum and that he will be able to get up and around quickly.

You might send up a prayer that the staples come out easily tonight, too. We had a test run last night (he let me take out the lowest 7 staples that were right at his underwear line) and he acted like I was killing him. Then afterwards was all, "Oh, that wasn't really painful it just made me nervous." Such drama. Only 49 more to go!