The Saga Continues

Yesterday Guimauve went in for some more tests. Dr. Costa (the intern working on his case, she's awesome!) told me his second bile acid test was slightly elevated but not to the point of providing any direction. His cortisol baseline was also tested to rule out Addison's Disease. It was not abnormal so they put that aside for the moment. Normal baseline cortisol levels do not completely rule out Addison's, but it is a good indication.

Addison's is a disease where the body does not produce enough cortisol which is important in helping the body respond to stress, maintain blood pressure and cardiovascular function, slow the immune system's inflammatory response, maintain levels of glucose in the blood, regulate the metabolism of proteins, carbs and fats; etc.

There was still no specific indication whether or not his problems were GI or liver related. The next decision was made to do a focal ultrasound of his abdomen (focal is cheaper and they look at only specific areas). They checked his liver, bowel loops and mesenteric lymph nodes. The liver looked normal, putting shunt at the bottom of the differential list. The bowels looked normal. His mesenteric lymph nodes were slightly enlarged. Add another problem to the list.

This gave some more options for diagnostics. Aspiration of the lymph nodes which would determine whether they are normal or not. I declined because it would not lead to a specific diagnosis. The only way to specifically diagnose what is wrong with his lymph nodes is surgical biopsy, which is not an option. Plus, they could just be enlarged due to GI issues. The other option for enlarged lymph nodes is lymphoma which is at the bottom of the differential list.

After the ultrasound Dr. Costa and I discussed the next options. Surgical biopsy of liver, lymph nodes and intestine OR endoscopic biopsy of his intestines. The pros of surgery: we get to see more and get good biopsies of everything. Cons: His low protein means lower ability to heal and he would have to be under anesthesia longer. Pros to endoscope: Get to see the stomach and intestines from the inside. Cons: Biopsies are not the best and usually not full thickness of the intestine. Cannot get biopsies of liver and lymph nodes.

Based on pocket book I picked endoscopic biopsy. I fed him about 9:30 last night and then took him in this morning. And now for part deux....