Back on TPN again

Several things to update since my last blog post but the biggest change is that I am now on TPN once again.

Let's start off with where we were a week ago.  We had performed an ultrasound and that had some disturbing results.  They saw the celiac artery was cut off by 60-70% and the celiac artery's main function is to feed the stomach and the spleen.  They were also unable to image the superior mesenteric artery (SMA) whose primary function is to feed the small intestine and supplement the celiac artery's feeding of the stomach.

At that point, we planned on getting a PICC line, starting TPN and getting a Magnetic Resonance Angiogram (MRA) of the abdominal arteries.  The PICC line would allow me to get nutrition through TPN and the MRA would give a much better image of the abdominal arteries, hopefully identifying that SMA and seeing any other restriction.  So, I was scheduled for a PICC line on 4/14, TPN on 4/15, and a MRA on 4/17.

Well, around 2 hrs before the PICC line was to be inserted, the nurse that was to perform the procedure let us know that she still did not have approval from all of my doctors.  Another hour later, she called again, saying she still could not get ahold of my vascular surgeon and we started talking a bit.  The nurse discovered that I was near dialysis and said that they had a cutoff of creatinine above 3 for installing a PICC line so a PICC line was out of the picture and TPN was also going to get put off.

I then spoke with my GI's nurse and she said we would go for a central line which is a more involved procedure.  After some effort, she was able to get a central line scheduled for 4/16 at Memorial and we were back online again.

I got the central line installed with a port just beneath the skin on my right chest after a 45 minute procedure with just twilight sedation.  I had not expected how much it would hurt afterwards and was very happy that I had lots of percocet from prior procedures to help mute some of the pain.

Finally, on 4/17, the nurse came by and we got the TPN started with a rate of 1200 calories per day to begin.  As time goes on, we will hopefully be increasing the calorie count until we get to a much higher level, putting some fat and meat on my bones in addition to nutrition that I get orally.

Now, about that MRA.  We had the scan this morning and I just got a copy of the report and it is both good and bad.  The gross results is that there are "Widely patent mesenteric arteries".  So, this is new terminology to me and, from what I can understand, that means that they saw absolutely no decrease in blood flow in any of the mesenteric arteries on the MRA.  If anyone out there knows more, please let me know!

That is good news because it means that I don't need to have surgery to free up blood flow to either my intestines or to the stomach.  It is bad news because it means that we still don't know why I have gastroparesis.  I seem to tolerate a full liquid diet fairly well but am unable to consume a reasonable amount of full liquids to gain weight.  Any solid food that I eat seems to come back up a couple of hours later, even when I am taking Reglan.

So, I am going to stay on full liquids for a little while again and then try re-introducing solids with the help of Reglan.  Will it be successful?  I have no idea.  I do know that I will at least stave off this weight loss with the combination of TPN and full liquids.  I just don't want to live the rest of my life without putting my teeth to good use!