My first taste of TACE (Trans-arterial Chemoembolisation)

August 25, 2016
UAB Hospital
Well, kids, today I made spent my first night in a hospital. Yesterday, they punched a hole in my femoral artery to run a little tube up into my liver and inject anti-cancer drugs straight into my tumor. The chemo is coated onto particles that block the artery so that the chemo won’t be washed away and the tumor will starve for blood. It’s the only way to prolong my life until I can get that darned liver transplant. And after that a night in the hospital ‘for observation.’

It was cool. An emergency came up that stole my anesthesiologist, so I was awake for the whole thing. They spent a lot of time trying to figure out where a mystery shadow on the x-ray was coming from (the whole this is guided by CT). It turned out to be a piece of adhesive tape. There was disco music coming from the speakers in the ceiling. And they were always asking me to “Breathe in, breath ALL the way out. Don’t breath…don’t breathe…don’t breathe…don’t breathe. Now you can breathe.” When you inhale, of course, your diaphragm pushes your liver down. I guess asking you to empty your lungs gets more reproducible results than asking you to take a deep breath and hold it. The radiology tech told me afterwards that I was ‘the best breath holder’ she’d ever seen. I bet she says that to all the pretty boys!

Of course, when you’re worried about surviving cancer, you get what you need and worry about the cost later. But as soon as I got home, I got a bill for the CT scan I got last month: $2,623.28! And I might still get more bills from physicians, etc. Damn! The $1,200 bill I got for the CT scan I got here in Winfield broke me. I had to get a loan and now my credit score is in the sewer. I’m busted! And that was just for a CT scan. What will they charge for the outpatient surgery I had today?

What a choice! Get treatment I can’t afford at a leading facility which is especially famous for its expertise with livers–the first liver transplant in Alabama was done there!–or get poked by medical students at some crummy public hospital. I used to work at Charity Hospital in New Orleans. What a roach motel! Indifferent clerks, half-baked doctors. I once spent an entire shift trying to get a bed for a man with a broken leg that was dripping pus. No one would take him because the admit order didn’t specify the Infected Orthopedics Ward, and the other Orthopedics ward wouldn’t take him. And no doctor who would answer his pages would fix it; they were all interns who were probably that a real doctor would yell at them for changing their order.

Now, I know you folks have troubles of your own, but I’m desperate! I’m doing everything I can to cut expenses to the bone. I’m even going to sell my beloved ’93 Cadillac Fleetwood Brougham! But if you can spare even a little money to help me out, please click the link to my FundMe page. I’ll dance at your wedding!

The story up to here….

HCV
By BruceBlaus (Own work) [CC BY-SA 4.0], via Wikimedia Commons

It all started innocently enough. I was working for a company that made fiberglass bathtubs in beautiful Hamilton, AL (world-famous for absolutely nothing!) and one day they announced a blood drive. A blood drive? thought I, I love blood drives!

And so I did. A few minutes off work, a cup of orange juice and a cookie, and the chance to give the Gift of Life! The cookie alone was reward enough for a little pinprick and a pint of the red stuff. As I had every time the opportunity arose, I lay down and filled a plastic bag with my beautiful, life-giving blood. Not afraid of needles–I used to donate plasma in my youth for a bit of pocket money.

A month or so later came a thick envelope of test results regarding my donation. There was also a cover letter explaining that they didn’t do this for every donor, only the ones that tested positive for Hepatitis C! I had no idea when or whence I’d gotten it. Maybe that filthy plasma lab with those badly-trained phlebotomists? I felt fine, though. The letter instructed me not to donate blood or organs. That was fine with me; I’d given the gift of Hepatitis C to enough people. My work was done.

On the slim chance that that blood lab was run by lunatics, I ran to my doctor here in Winfield, kindly wise Dr. Thomas, who observed “They did $600 worth of tests here! But if you’re worried, let’s repeat them.” They were also positive. I was referred to a specialist, who put me on a course of Interferon and Ribavarin. Weeee! Maybe I could be cured. For a few months, I did the interferon injection right before my day off, because I was sick as a dog the next day. I think the ribavirin was once a day. I took it fine, had none of the side effects I’d been warned about, was actually getting better! And best of all, my pharmacy insurance covered all but $100 of the $2000-a-month cost of the medicine!

Until they didn’t. Out of the blue came a letter from the insurer saying that my employer had switched to a plan that changed the maximum co-pay from $50 to 50%–nothing to do with me, of course, just a coincidence. I couldn’t afford $1000 a month, so I had to drop out. Later, I learned that that made me ineligible for almost all of the drug studies that were available at the Kirklin Clinic. Those darned researchers liked their guinea pigs to be virgins, treatment-wise. For the next ten years those nasty HCV particles roamed and played in my bloodstream, gate-crashing and trashing my healthy liver cells, playing hide and seek with my antibodies. Every time I bled I had to clean it up like nuclear waste! But I still felt fine.

Eventually, I wound up at the Kirklin Clinic, a part of UAB Medical Center and a mighty house of medicine. The first liver transplant in Alabama was performed at UAB Hospital! There are 4 liver specialists in the state, and all of them are at the Kirklin Clinic! For the next five years or so, all they could offer was ultrasound twice a year to see if I had cancer yet, and an annual chat with a perky nurse practitioner, and a thrill-filled drive on that Birmingham freeway, where the unofficial speed limit is about 70 mph. Once I casually mentioned to the nurse practitioner that I was glad I didn’t have cirrhosis–no liver cancer for me!

“But Dr. Whatisname says you do,” she replied, slightly bewildered.

“Oh… After my last ultrasound he did call me and say my liver was ‘more nodular than expected’. I guess that meant cirrhosis.”

“I guess we’re not always the best communicators,” she admitted. “But don’t worry,” she added happily, “If you get liver cancer, it’s super slow growing. All we have to do is do a liver transplant and you’ll be fine!”

Is that all, I thought, ‘just do a liver transplant.’ Didn’t sound like a small matter to me! But still, as the doctors had said all along, I was ‘well compensated’: I had no symptoms of liver disease, and my liver functions tests weren’t much outside of normal. And I felt fine! But it didn’t last. The liver is a tough organ, but it can only take so much. Finally there were twinges of pain in my right abdomen, fluid accumulated in my belly, shoving a chunk of intestine out of my navel, I started to bruise and bleed more easily. The old liver was starting to give out.

Finally, came the call. “There was something suspicious on your last ultrasound. We need you to come in for more tests.” One CT scan later and it’s tumor time. Just get a liver transplant, huh?

Stay tuned!