August 12, 2024
We were at Piedmont Fayette this morning for the y90 mapping procedure. We had planned to have some ablation but Dr. B wanted to wait before having another procedure until the PET scan on Friday. We got to the hospital at 6:30 and they got David all settled into the interventional radiology suite, slapped the party hat on him and started the IV. Then we just waited. Much about having cancer is waiting. One of the NPs from Dr. K’s office came by to talk about the mapping process and explain they would access the artery in his left wrist and then have a Sunday drive through the scenic cardiac countryside in route to his liver. At least that would be how I would describe it to patients on my first and last day as an IR NP. The preparatory angiogram is performed to map out the veins and arteries of the liver and block those that leave the liver and go to other organs. This is done to prevent radioactive resin from traveling to other organs when the treatment dose is given at the actual treatment visit. He explained that Dr. K would administer a “fake dose of medicine” (Tc-MAA) during the procedure that would simulate how the real medicine would react. If the medicine stayed inside the targeted area, that was good. If the medicine traveled outside of that area into other parts of the body or other factors they may encounter, it may cause him to not be a candidate for the y90 procedure. We were not previously aware of that part and didn’t know there may be an option for NOT being a candidate. This caused us both a little additional anxiety, but we decided it will be what it will be. They took him for the mapping procedure around 8:22 and he was back at 9:20. He was given a light local anesthesia, so he was awake during the procedure and alert when he returned. He was sporting a trans radial band covering a bandage that was put under pressure to stop any possible arterial bleeding. At certain intervals, one of the nurses released air from the band to gradually decrease pressure and check for bleeding. That is what I taught us while we were waiting, and I was doing my daily medical research. I took some pictures of the band because he thought it was cool and after that he took pictures because he didn’t like the way I framed it in the shot. After about an hour and a half, Nuclear Medicine came to take him for scans. Images are taken of the liver and of the lungs and the Interventional Radiology Team will perform an analysis of the images. Ideally, the radiologist wants to ensure that 80% or more of the Tc-MAA is localized within the liver and does not shunt to the lungs. Pulmonary shunting can cause radiation pneumonitis My unsolicited but continued investigations into this procedure taught me that if more than 20% of the administered mapping dose goes to the lungs, patients may be required to undergo further embolization to ensure that the Y90 will be directed to the intended location within the tumor. The type of camera used is important. An issue with traditional gamma cameras is that data may be missed on the images. A camera such as the Ergo with its digital technology captures all data without any holes and provides a more accurate picture. (No idea what camera was used and the report didn’t specify exactly) After he came back from Nuclear Imaging, the radial band was removed and a new gauze bandage was wrapped around his wrist tightly in plastic. We were instructed to leave this on for 24 hours and if there were any signs of blood, to go immediately to the hospital because once arterial bleeding starts it doesn’t tend to stop on its own. I was dismissed by the nurse around 12:30 and ordered to go and get the vehicle. Too bad if David needed help dressing himself. I met him at the curb in his required wheeled chariot, and we headed to get breakfast at IHOP. He said he had been dreaming of pancakes and he had not eaten since the evening before. Then he produced the plastic radial band they had removed from his wrist and tossed in the trash. Oh right. Have I not mentioned he likes to keep the “supplies” that are used on him that he finds interesting? He has a collection of all sorts of caps and all of the hospital wrist bands and a few port lines, some kind of string, a beard cover, and now a radial band. After his huge brunch, he slept the entire way home, got comfy on the couch and sleep the rest of the evening. He said it was a good sleep, and we were definitely exhausted.
We received the reports from the procedure and scans later in the evening but they were a little too technical for our understanding. We will wait to hear from Dr. K or read further reports as they are available, and I will continue to apply my research skills to figure out what in the Sam Hill they are talking about.
Fun Fact: Who is Sam Hill exactly and why is his name invoked in such a fashion? (invoked or evoked? Had to look that up too) https://en.wikipedia.org/wiki/Sam_Hill_(euphemism). Well…that was interesting.
Additional Fun Fact: David’s shirt today says
Dad, what are clouds made of?
Linux Servers mostly.
