Monday, August 28, 2006

A pain in the neck...with a purpose

Hi everyone:

Patty underwent a right heart catheterization this afternoon to measure the pressures in her heart. If I understand correctly, this procedure involves inserting a straw-sized sheath into an artery in the neck and then feeding a Swan-Ganz catheter through the sheath into the heart. While in the heart, doctors can explore the fluid pressures and assess the extent to which those pressures could be contributing to symptoms of heart failure. Based on what they find, doctors can then make adjustments to medications to focus on specific findings.

In Patty’s case, they discovered that she had pretty severe dehydration; this was really no surprise, since Patty has been taking in limited food or drink because of her nausea. They delivered two bags of IV fluids, and then measured her pressures, which were then much improved. Doctors also suggested that Patty’s cardiac output is pretty good, all things considered, and that perhaps she has compensated well enough that interventions like VADs and the like may be further off than we might have thought. Keep your fingers crossed...

At 5pm, Patty was transferred from the cath lab holding area to Room 503 in the Mitchell Building. She’ll hold tight for this evening and will likely begin rounds of plasmapheresis tomorrow. As I mentioned in previous posts, this process is similar to dialysis. Patty’s blood will be drawn out of her body through one line, antibodies will be removed, and then the antibody-scrubbed blood will be fed back into her body via another line. Sometimes, several rounds are done over a few consecutive days. Soon, doctors will draw more blood from Patty to see if her PRA (panel reactive antibodies) have declined. Plasmapheresis, in combination with Cytoxan, has been demonstrated to be successful in reducing antibodies, at least over the shorter term. There is some chance, however, that antibodies will come back, which means more rounds of plasmapheresis may be needed in the future.

Generally, our patient is feeling pretty good, although her neck is pretty sore from the procedure, as might be expected. The skin on her neck is blue from the disinfecting solution they use. If and when there’s more to report, I’ll be sure to be in touch.


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