We got Monday morning's blood test results late Monday afternoon. Creatinine, 0.7 - wonderful. Tacrolimus level, 5.5 - not great but rising slowly so no change in dose. Potassium and phosphorus and bicarbonate - all better than acceptable. Liver function - oh dear.
When liver function panels are drawn there are six to eight tests depending on the panel. Babygirl had two test elevations, both well over three times the normal range. The nurse questioned me at length about her medical history (again) without shedding any light. Her liver is more than a bit irritated about SOMETHING. But what?
First, let me make it clear that there is no real connection between liver and kidney function. The kidney itself is functioning very well, so y'all can take a deep breath and relax about THAT. However.....
The liver function abnormalities could signal the start of some interesting problems. And for those of you not in the know, "interesting" is the very, very last thing you want to be to your physician. The list of potential problems ranges from the benign to the frightening, and I have had that list flying around in my head since Monday afternoon. The provider who called to give me the results told me that the entire team was meeting on Tuesday AM and that they would discuss Babygirl's labs and make a plan. She said they'd call if they needed us to come in early for additional testing. There was no second call.
I wish I had asked her to call me either way. It's very likely that it wouldn't cross her mind that I'd be MORE frightened than a non-medical parent. The team regularly assumes that I have more knowledge than I have, and I have to keep reminding them that I have never seen a kid like this in my practice, and my knowledge of the specialty is 25 years out-of-date.
Here's the list of the things that I know could be causing trouble with her liver:
1) The donor could have been in an undetectable stage of hepatitis and passed it to Babygirl.
2) Babygirl's old CMV infection may have reactivated.
3) Her liver may be unhappy with the antibody/white blood cell combo it has to clean up as a result of the meds they gave her in ICU.
4) Any one of the medications she is on for anti-rejection or infection prophylaxis may be irritating her liver.
5) Something happened to the blood flow to her liver during or as a result of surgery.
6) Something unique to transplant recipients that I am totally unaware of could be happening.
Doctors prioritize problems in two separate ways. We always have two mental lists, and both prioritization lists have the same items, but the order is different. Based on available data (symptoms, to start with), we order the potential causes of a problem from most likely to least likely on our first list.. On the second, we order the SAME items from most deadly to least deadly. For example, if you are having chest pain, your doc's first list might have bronchitis, pneumonia and heart attack. On the second list the order would be reversed, meaning the doc would have to make mighty sure that there was no possibility of heart attack before moving on to the likelier (and less deadly) diagnosis.
Sad for me is that although I can guess what's on the list, I don't have any idea how to prioritize it. I know what's terrible (hepatitis, CMV). I think I know what's likely (medication reaction). I'm pretty sure they eliminated the deadly (surgical accident) with her ultrasound prior to discharge, and it seems to me she'd be pretty desperately ill if that were the case, but I DON'T KNOW. And worse yet is the possibility that I don't yet know what I don't know (see #6 on above list!).
This entire line of thought is completely nauseating.
My brain needs an off switch.
DeeDee
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