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COMPLICATIONS AFTER LIVER TRANSPLANT

The next few months after the liver transplant, my health improved and by January 2010 we were back home in Cayman. I was even able to manage a little running.

We planned our wedding.  I decided it would be really special to take our guests on a one week cruise out of Miami that would stop in Cayman where we could get married. We would then all get back on the ship and spend the rest of the week surrounded by love and friendship.

A few weeks prior to the wedding I returned to Tampa as I had a swollen abdomen. The local doctor in Cayman told me I just had gas and gave me something for it.

In fact I had several problems, starting with a partially blocked hepatic artery. This is a main artery taking blood to the liver. If the blockage got worse I could lose my liver and probably die.

They tried, unsuccessfully, to unblock it using balloon angioplasty. This is where a catheter is inserted into the groin area and moved into the problem spot in the artery. A balloon is then expanded against the artery walls and then deflated. This is repeated several times. You are half knocked out most of this time.

The fluid retention problems had also come back and I had to be drained almost every week.

The doctor expected they would have to do a surgical repair of my hepatic artery in a week time.  This would just give me enough time to recover before our wedding!  But they decided to hold off on the surgery until after our wedding cruise.

A few days before I was due to catch the cruise there was another problem. They tested me for the CMV virus and it was through the roof. I was immediately put back on the Valcyte tablets to hopefully control it until I got back.

The entire wedding party and guests boarded the ship on Sunday and I knew I was in trouble. I had lost my appetite and was having serious abdominal cramps. I did my best to hide my pain from my wife but she knew anyway.

I realized late that night I could not carry on. I told my wife and without a word of complaining she packed up all our cases. We would have to leave them on the ship as there was no "walk off" dock in Cayman. You got ashore in ship’s tenders that ferried passengers back and forth.

Despite the pain I was determined this would be a wonderful day for my wife and our guests.

Everything looked and was wonderful. We exchanged rings are were pronounced man and wife.

A little disco dancing and a couple of speeches then it was time for our guests to get back on the coaches to return to the port and continue the cruise. And time for us to change into regular clothes and get a taxi to the airport.

I had booked our flight back to Miami the night before as we needed to pick up our car. We then drove back to Tampa and straight to Tampa General Hospital.

We arrived at the emergency room at 3 am. on 17 March 2010 (Wednesday).  They kept me there until late afternoon the following day as they did not a private room for me till then.

Because of my liver transplant I have to be kept in reverse isolation. This means that I am not infectious to others but they could be to me.

I was tested and found to have a very high level of CMV. This is the virus described above. I started receiving four bags a day of the special viricide used to control it. As mentioned before, I am a hard stick for IVs. This was due to my collapsed veins, malnutrition and dehydration. They therefore put a PICC line through my upper arm into a main vein in my chest. Much less painful and more convenient as they could even draw blood from it four times a day.

The high level of CMV infection meant it would be risky to carry out surgery. It also tended to mask other issues. I had constant abdominal pain. Nine days after admission they gave an abdominal X-ray to check for a possible bowel obstruction. Shortly after the X-ray I was given an abdominal CT scan. This confirmed that I had a major obstruction of the small bowel.  I could in fact have developed and died of peritonitis while actually in a hospital bed!

To try to clear the blockage a nurse puts in a nasal gastric tube. This is a long plastic tube that is pushed up your nostril. They keep pushing till it goes down into your stomach.

The tube is then taped to your nostril. The free end is then plugged into a vacuum apparatus on the wall. Like the IV connected to your arm, this also restricts your movement. The intention is to suck out your stomach and deflate your intestines.

The nasal gastric tube was not working and I was made ready for surgery.

I was later told it was a six hour surgery. That previous surgery had left a type of scar tissue called adhesions. When they opened me up my intestines were wrapped in a cocoon. They had to carefully separate my intestines, then work the trapped fecal matter along the intestinal tract.

They also fixed my umbilical hernia.

I was then sewn up, stapled together and taken to the recovery room. When my wife was allowed in, I was just coming round. Hands tied down and a breathing tube down my throat. Plus a new nasal gastric tube, a urine catheter, a neck line going into a vein and my ankles were wrapped in a sort of compression device that alternately compressed and released lower calf in order to reduce the risk of a clot.

I went to a regular private room as soon as they thought I would be OK and the urine catheter was removed.

For the next few days the nasal tube remained in place. There were a terrifying few minutes when it somehow worked its way into the back of my throat and was curled there. I could barely utter a sound and felt that I could not breathe. There was no immediate response when I pressed the nurse's call button. When they finally answered they could not understand what I was saying. Luckily my wife was there and got their attention. Moments later a nurse came into the room but it took her a while to understand what had happened.

She immediately pulled the tube out, to my great relief. Sadly she needed to put another one in.

I was still being given massive doses of anti CMV drugs and other antibiotics by IV. They were also feeding me by IV to let my intestines recover from the abuse they had suffered. And I was beginning to pass the fecal matter that had been blocked for many weeks.

Finally I was put on a clear liquid diet, clear soup, apple juice and jello. Lots of jello. The IV feeding stopped, I went to full liquid diet and the nasal tube was finally removed.

My doctors decided to now have another try with the balloon arteriogram of the hepatic artery. This time they reported success. It appeared the artery had been opened enough to avoid the need for more surgery.

I progressed to solid food and more tubes were removed. I could finally walk around without dragging an IV pole along with me.

After admitted to the hospital for three weeks, at last came that wonderful news when I was pronounced well enough to go home.