Unfortunately, David started feeling worse after his ERCP and ended up getting a fever Sunday afternoon so we had to go to the emergency room at UCSD. His symptoms of fatigue, lack of appetite, and fever always indicate clogged stents or infection. We got there Sunday afternoon and his liver labs were very elevated so they started IV antibiotics and admitted him.

We immediately made contact with the team in Utah when he was admitted to the hospital Sunday, we spoke with the doctor and nurse coordinator several times about the best way to move forward. Their main concern is the bleeding risk when actually removing those stents. While inpatient, they added David on for another ERCP Monday afternoon to attempt to remove the stents again. He was prepped and ready for the procedure until we were able to talk with the advanced endoscopist that would be doing the procedure and trying to remove the stents. This was a different doctor than his usual doctor who worked on him Thursday, but it was another senior doctor who has exchanged David’s stents in other inpatient stays in the last couple months. So he is familiar with David’s complicated case. 

We were up in the pre op area prepared to talk about the risks with the doctor and we had a very good collaborative conversation with the team and decided to hold off on the ERCP to remove the stents. The doctor too was concerned about bleeding risks and the failed procedure just a couple days before.

David’s labs had improved slightly (although still very high) with the IV antibiotics and he didn’t have any fevers. Because of this, the doctor felt safe to continue with IV antibiotics since we had a plan to do the shunt surgery. He wanted to keep David overnight again, continue with the antibiotics, and discharge when we had a date with Utah for the surgery. 

We left the preop area around 4:30pm yesterday and immediately called the team in Utah to see when they could get David in. We didn’t have a date set yet. Their team has been amazing and really working hard to make things happen. The scheduler thought she could move quickly so we put in motion plans to get out there. 

A long story made short, David got discharged from UCSD this morning, came home for a short time to shower, pack, and see the kids, and we are at the airport now to catch a flight to Utah tonight. The shunt surgery is scheduled for tomorrow morning. Both surgeons are on call for transplant so his case time could get adjusted if they get a call with a liver, but they will accommodate David either way once we are out there. 

The plan is to do the shunt surgery (Splenorenal shunt), which will hopefully relieve the pressure in the system and then it should be safer to make another attempt to pull the stents while he is still inpatient in Utah. If anything doesn’t go as planned, they would move to transplant immediately. 

We are holding everything loosely as things can change quickly, but we do feel very confident in the care of the team at Utah. Thank you for the love and prayers! We apologize for unanswered questions, I’m sure there are many, but doing our best to represents tons of phone calls and conversations with lots of doctors and teams! Although things haven't been as we planned, we grateful for the way things are working out so far, praying for continued favor and successful surgery!