3/22 back from trips and spleen update

A lot has happened since the last update, all positive. First things first, as you probably guessed due to lack of writing, I chose to stick with the CAR-t cells rather than elect for transplant. Then a more recent summary of the last 3 months is: First, as far as I know, I am still in remission. Yay! Secondly, I have been working on my spleen issue, and things are going good, but probably more to do. Third, I had good times traveling to Hawaii and Oaxaca, Mexico!  Fourth, in the bird world I have seen 60 lifers (birds I have never seen before) on these two trips, taking my World list to 534.

Let’s dive into the spleen issue. A quick review of the situation follows. After meeting with Gastroenterology in December, we figured out my enlarged spleen (19cm, normal is 13cm)  was likely because of a blood clot in the splenetic vein caused by the pancreatitis I had in 2013 or 2015. Maybe both, who knows. I don’t know if I have previously explained the situation in detail, so this could be review. With the clot, blood has to find another way through the portal vein network. A common way it does this (like in my case) is to go through tiny veins surrounding the stomach, enlarging them way beyond what they were meant to hold, creating gastric verices. These engorged veins can get quite close to the surface of the stomach. And occasionally, these veins will pop or burst, creating a dangerous, and sometimes lethal stomach bleed. Much more serious than the stomach bleeds I have had in the past, so obvi trying to avoid that. The spleen also compensates for the backup by enlarging itself. Once enlarged, it eats even more blood cells from platelets to red cells to white cells. In theory, my blood counts across the board would be higher by removing the spleen. Spoiler alert: they are! To fix this problem I had 2 options. 1. Slurp the spleen out in a laparoscopic splenectomy which is a serious abdominal surgery with 4-6 weeks recovery and more risks. 2. Fight fire with fire: add a clot to the intake. This is called an arterial embolization, and an interventional radiologist adds an artificial clot to the arteries entering the spleen.  This reduces the blood flow to the spleen, thus reducing the spleen’s size, and in a way suffocates it, causing it to whither and eventually die. After talking with IR and the splenectomy surgeon, I decided to go the embolization route as it would be a bit safer, and have less recovery time. I also wanted to do something before our long-planned family trip to the Big Island because I was afraid of the verices popping on the plane or somewhere awkward. Quite nerve-racking to have gastric verices. Walking around in Jan and Feb, I felt like a ticking time bomb. A weird anxiety to have hanging over your head.

Embolizations are done in 2 procedures, with the goal of a 50-60% blood flow reduction in the first, and then a 90-100% blood flow in the 2nd.  I had the first “embo” on February 15th. I was definitely hoping it wouldn’t be as bad as the IR specialist said, but nope just like other spleens, mine did not enjoy having its blood reduced--and it let me know too.  After a foggy night in hospital on opioids and recovering from anesthesia, I went home. Then I started a 24-hour tylenol cycle for a week, up until the flight to Hawaii arrived. We were also moving everything from the top floor to the bottom because while in Hawaii we were going to have our floors refinished. Unfortunately, I couldn’t do much but watch, which pained me--not as much as my spleen, but close. Fortunately, Peggy and Byrne and Marian and Jonathan came over to help move stuff. And then a coincidental visit by our Portland friends Mark and Ingy who were coming up for a concert, helped close-out the move. We definitely couldn’t had done it without help! We eventually did get it done. By our flight, I could shuffle, but couldn’t fully extend my abdomen. It wasn’t ideal timing, but many things in life aren’t, and the relief of knowing that my gastric verices weren’t going to pop on the plane felt pretty good.  All in all, it worked out: I was still able to hike the 1 mile for our amazing, Hawaii bird tour of Hakalau NWR. Plus, being in a warm spot where I could sit by the pool or the ocean was a great place to be in recovery. We then came back for a week, before Briana and I headed down to Oaxaca, Mexico.

Oaxaca (wha-hock-a) was great. We left Alpen with the grandparents (thanks grandparents!) so we could travel quicker and do more hiking. It was amazingly easy to get back into the old routine of eating out and being independent. We spent the whole trip in the Oaxaca Valley and the Sierra Norte just to the NE of Ciudad de Oaxaca. Delicious food , delightful scenery, and friendly people sums up the trip. Highlights were fresh-squeezed orange juice at breakfasts, witnessing the flora/fauna of the 10,000 ft pine/oak forests, and birding every morning between first light and 8 am (yes, even our city hotels attracted action and lifers!).As things progress I’ll keep updating. - Derek

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