Be Very Still

Roy had phase 1 of the Y-90 treatment on Monday. It was a very long day – for him it was mostly about being very, very still and holding his breath when told to do so and for me it was primarily driving and sitting in the radiology waiting area.

They took Roy into the procedure area, issued him a lovely gown, got an IV set-up, processed all the consent paperwork, confirmed that we have his living will and medical power of attorney, etc on file, and reviewed his medical history. After the doctor came by to go through the process again, nurses wheeled him away and I returned to the waiting zone.

They gave Roy a lovely sedative but kept him awake because he had some tasks during the procedure. They told him when he had to keep his legs completely still and when he needed to hold his breath. They made a small cut in his femoral artery and used a set of catheters, some dye, and some imaging to map the route to his liver. After they were happy with what they found, they gave him a little bit of radiation to test the situation. He got wheeled back to recovery and stayed there for an hour and a half before being sent for imaging.

They sealed up Roy’s femoral artery with a device called an Angio-Seal and we were later issued a pamphlet/card that Roy needs to keep with him for the next 90 days. The Angio-Seal allows surgeons to close up the artery without as much compression and it allows patients to move around more quickly – after 2 hours or so instead of 4-6 hours. Apparently, his body will eventually absorb these materials as they dissolve over time. The whole thing is covered up by sterile dressing.

While he was in recovery the first time, the doctor came to tell me he was out and that they were going to do imaging but he’d need to be in recovery again after that. Dr. Taylor mentioned that how the radiation spread in Roy’s body would determine if Roy could have the full Y-90 treatment that they’ve planned. If his body showed some secret pathways (shunts) from his liver to his lungs that allowed too much radiation to get into his lungs, the Y-90 would not be an option and other treatments would be explored. A nurse called to let me know when Roy was supposed to go to imaging; they would bring him by the waiting room at 2 pm so that I could see him as he traveled.

It will not surprise most of you to hear that I only knew Roy was going by and into the elevator when I heard him telling stories. I caught them just as they were wheeling him into the elevator and I have absolutely no idea what he was telling the nurse. It was at least 2:30 pm by then and he had told the nurse that since they were running late they did not need to go by the waiting room. He just wanted to get things done. They took him back to recovery after the MRI and came and got me a bit later.

Roy said they wrapped him up like a mummy to keep him from moving too much in the MRI, even wrapping his arms up against his body. The most difficult part for him was staying still for hours – still-still, leave your legs flat still. He ended up a little bit loopy from the sedation, too. By the time I saw him again, he had been fed a very pink sugary yogurt and some cranberry juice – he wasn’t allowed to eat anything until after the phase 1 had concluded. The nurse kindly brought me the turkey sandwich that Roy didn’t want to eat (vegetarian that he is). He was finally cleared to leave about 5 pm.

The surprise of our departure was that Roy was not supposed to bend over for at least 24 hours and the nurse instructed the transport person to recline the passenger seat entirely before Roy got into it. Roy rode home basically laying down; this did make it easier to see around my passenger in the I-10/290 evening traffic. We left without knowing if the Y-90 phase 1 had been successful or if Roy would get to proceed with the treatment. He’s required to take it easy for at least a week. At least now I know what to expect for bringing him home after phase 2 – definitely need to bring some pillows. We also learned that using the valet parking is both cost effective and more convenient than going hunting for a spot on our own, at least when going to the main hospital building.

While we were waiting for his discharge, Roy received a My Chart message saying that the Liver Tumor Center does want him to have his lymph nodes biopsied based on the most recent Chest CT. So he does have to repeat that process after all (he did this in November) and therefore we have another excursion to Houston coming for that. We are learning that what we might hope/surmise/conjecture about test results can be knocked aside when the team at the Liver Tumor Center do their reviews. It’s different than when we get test results locally; with this team, the test results are usually released 2-3 days later without comments but the MyChart often does include access to the actual imaging. I kinda like it when doctors’ provide a “grade” for tests, but as a good student, I will have to adjust my expectations to match how these “profs” teach. Every classroom is different.

Today Roy had a follow-up with our local gastroenterologist for the EGD that started this whole process in January. We are grateful that Dr. Stagg was curious enough to keep looking after the EGD, ordering the ultrasound and the first MRI, to determine what might be going on. He will continue to do the routine EGDs we think, but given the diagnosis of HCC, he said that would be completely up to the team at Methodist. Roy was feeling unsteady so he used his old hip-replacement walker to go to/from the appointment. By this evening, it had been relegated back to his bedside for the occasional grip when balancing in the night.

We did not see as many bluebonnets along Highway 6 as we hoped – instead this week it appears that the yellow pops of coreopsis have taken over with some of the fluffy yellow baby’s-breath looking stuff joining the bluebonnets too (I don’t know what that wildflower is, maybe a type of yarrow?). Paintbrush and Indian Blankets are not yet popping. The bluebonnets actually seem to be thicker up around College Station this go round. We did spy several hawks and a lot of turkey vultures along the way.

The test results showed up this evening. We were mostly hoping that the treatment would not be a threat to his lungs – if there are too many shunts that divert blood flow toward the lungs, the radiation can’t be used because it would damage the lungs too much. I’m not a medical doctor, but if I am reading these correctly, the Lung Shunt Fraction (LSF) for Roy is in the range that will allow him to go forward with the Y-90. The report says the LSF is 13% and the articles indicate that they usually say 20-30% is the cut-off for using Y-90. We’re going to hope that is correct and that he can go forward with the Y-90.

It looks like a path forward with the Y-90 but also a slight detour to retest those lymph nodes from the Chest CT. The latter puts a bit more uncertainty into the mix (as if there were not enough already) but we are going to focus on that Y-90 phase 2 as our next major hoop.

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