Thanks so much to everyone who left comments on the previous post. As you can see from the photo, my little bump in the road got a bit bigger and I am writing this from a hospital bed.
Shortly after I published the previous post, I got a phone call from Dr. Shaw with the results from the local lab. My liver enzymes, rather than going down, had now risen to more than four times their level on Monday. Essentially, my liver was being poisoned. There isn’t an antidote for hepatotoxicity, but Alice (Dr. Shaw) wanted me to come in for monitoring. Significantly elevated liver enzymes (ALT/SGPT and AST/SGOT) are a sign that rapid cell death or injury to the liver has occurred (as the cells die they lyse, or break apart, and release enzymes into the blood stream). However, even a severely injured liver can maintain function. My circulating levels of bilirubin and alkaline phosphatase were both within normal limits, which was reassuring. In the case of actual liver malfunction, they would be elevated as well. However, should the ALT/AST continue to rise, function could be affected as well.
So, off to the hospital I went. Initially I was assigned to a double in an acute care wing. Dr. Shaw checked in and then it was time for some tests. Around 10 pm my liver enzymes were tested once again and they were slightly lower than the one that morning but still quite high. I had a chest x-ray as I was still coughing (and the levaquin was now being held as well) but it came back clear for pneumonia. I was poked and prodded and asked if it hurt until it finally did. I was given an ultrasound of my abdomen, which showed no lesions (thank goodness for that). And, just to rule out anything else that could have instigated the elevation, I was tested for everything under the sun that could affect liver enzymes. Hepatitis, HIV, Epstein-Barr, drugs and alcohol (just in case the patient wasn’t disclosing!).
My roommate was a lovely woman, but anything other than a private room in the hospital is just really hard. Two people, both sick but generally not in the same way, a shared bathroom and a very modest space full of apparatus that is often beeping loudly, a parade of doctors, nurses and visitors as well as the inability to not hear everything that is being said and happening on the other side of the curtain which divided us. It is really not conducive to sleep or healing.
Fortunately, by late Friday, a room had opened in the Lunder building. It is a new wing of Massuchetts General Hospital which is devoted to cancer patients. It is located directly adjacent to the Yawkey center, where I receive my outpatient care. All the rooms are private, spare and modern and graced with large windows as well as pull out couches for visitors. It’s really nice.
So, that’s where I’ve been hanging out. Aside from a twelve hour period of diarrhea (unrelated to the liver, so more tests) I have felt under the weather, but not too bad. Each day my enzymes have been a bit lower; at first the change was incremental, but the downward pace is increasing. My appetite is coming back as well, and I’m starting to feel restless (a good sign).
It’s now Sunday. Half an hour ago I was handed my discharge papers. My ALT is still in the triple digits, but at this rate, I should be back to normal soon. Once home, I will resume the levaquin (now felt safe to reintroduce) as my chest infection has lingered. On Tuesday I’ll be back in Boston for more labs, a chest CT scan and a quick meeting with Alice. The big question will be, where do we go from here?