Baby / Liver Update

Chantel met with her Obstetrician on Friday and discussed the MRI with her Oncologist. Everyone has agreed to postpone the MRI (or do a CT scan post partum). They are concerned that one of the chemicals involved in a Vascular MRI could do damage either to her liver or the baby. Our Obstetrician in pushing to have the baby at 37 weeks (which would put the baby out around March 13th. Chantel will be meeting with her Oncologist and the GI Specialist on Monday and Tuesday morning. At that point, we will know when we are going to have the baby. We are looking at either right away or at 37 weeks. I am sorry that we cannot provide more thorough info... hopefully, we will have a solid plan by Tuesday evening.

Liver complications with Chantel

Last week was one of waiting. We waited for test results... we waited for appointments to be setup... and we waited for a couple of our Dr.'s to come back this coming week to review next steps.

The abdominal ultrasound showed issues with Chantel's liver. Dr. Savage sent Chantel to see a Gastro-Intestinal (GI) Specialist (Dr. Yoshida) last week (Monday February 13th). Her case was briefly reviewed by Dr. Yoshida who requested more blood work and explained that it is likely that the mass that was discovered on her liver was not likely related to the lymphoma.

Dr. Yoshida then presented Chantel's case to a GI Conference where it was reviewed by Brian's Dad (Brian Scudamore is my boss at 1-800-GOT-JUNK? and his father is a liver transplant surgeon) among other GI specialists. Dr. Scudamore has taken over the as the GI specialist on the case. His office is now scheduling a MRI on her liver to get more info in conjunction with the bloodwork. We are expecting it to be schedule for the week of February 20th.

We are currently speculating on what the liver issue is (until we get the results from the MRI and bloodwork)? It appears that it could be Acute Fatty Liver of the Pregnancy or cholestasis . In fact, it may be a blessing that Chantel was diagnosed with Hodgkins as the tests for it have shown the liver issue and hopefully we will move quickly on this to solve it.

Here is more info on the Fatty Liver issue:

AFLP is "acute fatty liver of late pregnancy" a syndrome in which the clinical presentation is malaise, nausea, vomiting, abdominal pain in the 3rd trimester, elevated aminotransferases (AST, ALT), ultrasound findings, and the exclusion of viral or toxic hepatitis or biliary tract disease. It is considered a life-threatening condition, with an 18 percent maternal and a 23 percent fetal mortality rate. Note: Chantel is fortunate that if this is the diagnosis - we have caught it very early and reduces these odds radically.

Symptoms associated with acute fatty liver of pregnancy include anorexia, nausea, emesis, abdominal pain, jaundice, headache and central nervous system disturbances. Hepatic histopathology reveals pericentral microvesicular fat with minimal inflammation or necrosis. The laboratory abnormalities in acute fatty liver of pregnancy include moderate elevations of transaminase levels (AST and ALT less than 1,000 IU per L), prolongation of prothrombin time and partial thromboplastin time, decreased fibrinogen, renal failure, profound hypoglycemia and bilirubin levels of 1 - 10 mg per dL (17 - 17 µmol per L).

http://www.marchofdimes.com/professionals/14332_14543.asp

http://www.medterms.com/script/main/art.asp?articlekey=9404

http://www.aafp.org/afp/990215ap/829.html

More info on Cholestasis in Pregnancy:

Some women experience a very severe itching in late pregnancy. The most common cause of this is Cholestasis; a common liver disease that only happens in pregnancy. Cholestasis of pregnancy is a condition in which the normal flow of bile in the gallbladder is affected by the high amounts of pregnancy hormones. Cholestasis is more common in the last trimester of pregnancy when hormones are at their peak, but usually goes away within a few days after delivery

Pregnancy hormones affect gallbladder function, resulting in slowing or stopping of the flow of bile. The gallbladder holds bile that is produced in the liver, which is necessary in the breakdown of fats in digestion. When the bile flow is stopped or slowed down, this causes a build up of bile acids in the liver which can spill into the bloodstream.

Symptoms include:

Itching, particulary on the hands and feet (often is the only symptom noticed)
Dark urine color
Light coloring of bowel movements
Fatigue or exhaustion
Loss of appetite
Depression

http://www.babycentre.co.uk/refcap/552042.html

http://www.itchymoms.com/

Abdominal Ultrasound Results

We met with Dr. Savage today to discuss the abdominal ultrasound. Everything looks reasonably good. There were no lymph node growths below the diaphragm. Based on the tests done so far, Chantel would be staged as Stage 2 - Bulky. It's not bulky because of the baby ;-) It is bulky because of the significantly enlarged tumours in her neck and chest. However, by being in Stage 2, her prognosis is very good.

We have decided to follow a "watch and wait" regimen. Chantel will be visiting the Dr. every two weeks and unless some more symptoms appear (like night sweats, coughing, pain in her chest, etc.), she will not have to undergo any chemo until the baby is post-utero. If she becomes symptomatic, then she will undergo chemo with Vinblastin until the baby is delivered. At that point, she will start the full cycle of chemo with all 4 fun chemicals - ABVD.

Based on the size and amount of enlarged lymph nodes that are known at present, the Dr. assumes that Chantel will need 6 cycles of treatment (which will be over 6 months) starting after the birth of Marcus (Chantel has chosen a name that I didn't veto ;-).

Results from the X-Ray / Abdominal Ultrasound pushed up to today

Yesterday, Dr. Savage walked through the results of the x-ray. It shows that Chantel has another malignant tumour in her chest. This one is 10cm high by 8cm wide (much larger than the one on her neck). The doctor feels that we need to complete some more staging (all this week) and see if it has spread further. All of these results will alter the choices we have for when the baby is delivered and when Chantel should begin to have chemo.

Chantel had the Abdominal Ultrasound completed today. She is getting one other test done on Thursday early in the morning and then we are meeting with her doctor. We are researching information on pregnancy and chemo to better understand the effects on the baby and how difficult it will be for Chantel to have the baby once undergoing chemo.

Chantel and the baby are both doing well. Chantel feels great and the baby is kicking up a storm.

I want to thank everyone once again for your kind words/prayers/thoughts. It has been amazing to see how much support we have received from everyone.

Chantel's case reviewed by Panel

On Friday morning, Chantel's Doctor presented the initial data from her tests to a group of Doctors. Chantel was first interviewed by a group of Lymphoma specialists who then took their results to the conference. Chantel and I waited for a couple of hours while the Oncologists/Pathologists/Radiologists/Lymphoma Specialists reviewed her case. Later, Dr. Savage returned and presented the opinion of the group. They believe that based on the results gathered so far, Chantel is in a very good position so far. She will likely be able to postpone delivery (perhaps even up to term).

After the meeting, Chantel was scheduled for some additional staging tests. She had an X-Ray done of her upper chest. They used abdominal shielding to protect the baby and we were told that the risks to the baby were nominal. We are awaiting the results of the X-RAY. In addition, she has been scheduled for an abdominal ultrasound on February 9th. Both of these tests will help confirm that she is in Stage 2.

The doctors believe that Chantel could undergo chemo while she has the baby inside. They use only a couple of the drugs that have shown not to produce complications in the baby. However, we are not convinced that we should go that route and will be seeing another Doctor for a 2nd opinion.

Chantel's first visit with Dr. Savage (great name don't you think?)

Today Chantel visited with a Lymphoma specialist who did a physical exam and reviewed all the data from blood work, ultrasounds, and biopsies to date. Dr. Savage feels that Chantel is early enough stage to wait a few extra weeks for the baby to be delivered. We have her first CT scan (used to view the enlarged lymph nodes) scheduled for March 16th. That means Chantel will need to have the baby in the first week of March.

Chantel's case is going to be assessed by the entire oncology department on Friday morning. This conference includes oncologists, lymphoma specialists, pathologists, and radiologists who will review the current data and assess next steps. They will be reviewing her case again post the baby's birth to assess things with more data from a myriad of tests that they are not comfortable doing while she is pregnant.

Dr. Savage also said that she will be receiving chemotherapy (although we do not know what the length of the series will be) post childbirth.

Well I will leave some material for Chantel to report. She plans on writing some info up tomorrow.