The Latest from G.I. Joe

Just got back from the Liver-ologist's office.  The fellow (verrrry likeable doctor) said,

"Did anybody call you about your MRI results ??"

Uh, no.

"Well ... we found something on your MRI.  They're calling it a "short segment, high-grade stenosis of the common hepatic duct, just distal to the bifurcation with mild central intrahepatic biiary dilation.  Recommend ERCP with brushings."

So ... you found something, where the better answer was you having found nothing.

"Well ... yeah."

Way, way WAY too soon to know what's clogging up the pipes, but ... as they were careful to point out, several times, they "can't rule anything out."

I get it, Doc.  It could be cancer.  Message received, loud and clear.

They're going to do something called an ERCP.  For those who don't know (yeah: me), that's an Endoscopic retrograde cholangiopancreatography:

    http://en.wikipedia.org/wiki/Endoscopic_retrograde_cholangiopancreatography

But what else COULD it have been ??? ;-)

They'll use a wire and a snake and a couple of ridiculously expensive attachments (julienne blade, coffee grinder, ice crusher, dough hook) to go from Point A (mouth) to ... the nether regions.  Along with getting a good look at What Lies Beneath, they may be able to get brushings (for cell analysis), a biopsy (a bite), and/or ... do a balloon inflation of the constricted part, and insert a stent, if not remove the blockage through the ERCP.

The samples will show both what the blockage is and .... what sort of cellular problems (disease process) might ALSO be affecting my liver.  As the fellow was quick to point out, it's USUALLY not two things, simultaneously, but ... it sure can be.

If they do put in a stent, to keep the duct open ... more likely than not ... the procedure would have to be repeated every three months ... forever.  Yippee Skippy.  That (stent.  Wash.  Rinse.  Repeat) ... looks far more likely than not, at this point.

By implication, the doctors were also clear that it could be Primary Sclerosing Cholangitis, and/but that I really don't want it to be THAT, either:

    http://en.wikipedia.org/wiki/Primary_sclerosing_cholangitis

Hey ... Doc ??  What's the really okay stuff that it might be ????

[crickets] [a lone tumbleweed bounces against the dusty landscape]

Oh.  I gotcha.

"We're going to get you in, to be seen by ... and have these procedures done by ... the head of the Department, on an urgent basis.  The department head revolutionized a technique called Endoscopic ultrasound that he'll also employ to poke around while we're all up in your grille:"

    http://en.wikipedia.org/wiki/Endoscopic_ultrasound

"This should tell us if we're looking at pancreatic cancer."

They drew another nine tubes of blood after that.  Along with a whole lot of Who Knows What, they're specifically looking for highly elevated CA-19-9 antigen levels:

    http://en.wikipedia.org/wiki/Ca-19-9_antigen

No.  You don't want THAT to be high, either.....

I picked up copies of the MRI images and report, and will schedule an appointment with the 2nd opinion liver-ologist with whom I met last week -- that would be the one who said, "Oh, no.  You REALLY want the MRI to be negative.  A positive finding on this MRI can only mean bad stuff."

I ate lunch at McDonald's.  Candidly, I just figured ... why not ?