The Eighth Dwarf

Sunday, March 11th, 2018
​Richmond, Virginia

Health update

When we last left off, the plan was to:

• Wait for me to start bleeding again
• Inject radioactive material into my bloodstream
• Scan my body for radioactivity to see where the blood goes

That would identify the source of the bleeding. What to do about the source of the bleeding would depend on where it was located.

Since then, it's been decided that it doesn't matter much where I am bleeding because the next step would be the same regardless of the actual source (e.g. esophageal varices, gastropathy, anorectal varices): relieve my portal hypertension (high blood pressure in the veins leading into the liver). The current standard of care for my condition is the installation of a transjugular intrahepatic portosystemic shunt (TIPS). Despite the intimidating name, the procedure is simple in concept.

Just like a Brita...

Taking a step back for a moment, consider how a water filter (see diagram) works. Water flows in one side, through a filtering medium and then out the other side. The rate of flow through the filter depends on the characteristics of the medium. If the medium becomes clogged, for example, then the rate diminishes. In that case, if the water continues to flow into the filter at the same rate but cannot flow through the filter at that same rate, then  pressure will start to build. Eventually, any tube bringing water into the filter will bulge and potentially spring a leak.

Click to enlarge

...except for blood

The liver works just like that Brita filter except it filters blood instead of water. Following the analogy, if the liver becomes even slightly clogged then the veins flowing into the liver will increase in pressure (i.e. portal hypertension). If that pressure increases sufficiently, then the veins will bulge and potentially spring a leak (i.e. bleed). (For the curious, my liver is clogged from years of medical punishment: two rounds of chemotherapy and three rounds of radiation.)

To solve this problem (see diagram), the solution is to poke a small hole in that wall between the inlet and the outlet. Most blood will continue to flow through the liver normally, but some of the blood is allowed to bypass the liver and flow directly from the inlet to the outlet, thus relieving the pressure buildup.

Click to enlarge

It's all in the name

​Breaking down that mouthful (transjugular intrahepatic portosystemic shunt) explains how the procedure is performed:

• Transjugular — insert a catheter through the jugular vein, through which
• Intrahepatic — a hole is cut through the liver
  
• Portosystemic — connecting the portal circulation to the system circulation
• Shunt — and insert a tube to hold that hole open

When and where?

All of that explains why I need the procedure. As for when and where, the procedure will be done this Wednesday (March 14th) by the Interventional Radiology staff at Johns Hopkins. I will be monitored for a day or two and then sent home, barring any complications from the procedure.

That all sounds easy enough, right?

Music

My latest musical discovery is a group called Postmodern Jukebox (PMJ). They aren't so much a band as a rotating collection of entertainers: singers, musicians and tap dancers. The brainchild of pianist and arranger Scott Bradlee, PMJ has carved out a very entertaining niche for themselves performing modern pop music (e.g. Rihanna, Beyoncé) in the style of classic American genres (e.g. swing, jazz, soul, funk and such).

Below are the videos for three songs that represent their style:

• "All About That Bass" by Meghan Trainor
• "Umbrella" by Rihanna
• "Crazy" by Gnarls Barkley

On the left is PMJ's arrangement; on the right is the original. The first one, "All About that Bass," represents my initial discovery of PMJ and remains my very favorite. Your musical mileage may vary.

Birthdays

A slew of family birthdays have already been celebrated this year. Here are a few of them. Click any of them for more pictures.

Dave's 80th

Dad's 75th

Alison's 56th

Eli's 22nd

Becca's 21st

Photos

​Here are some photos that we've either taken or collected recently.

Tidbit

There are many idioms that we all use reflexively but don't necessarily understand their origin. Until now, I did not know the origin of the phrase "high on the hog," despite the fact that I just used it a few minutes ago when annotating a photo of Ian and his friends.

This one happens to be more easily understood than most: the best (and presumably, more expensive) cuts of pork come from the upper portions of a hog, while the lower portions of the hog yield the typically less desirable (but cheaper) ham hocks (a.k.a. pork knuckles) among other things.

Your gastronomic mileage may vary.

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