Procedures, Vol 1.8: PSE #3: The Exciting Third Installment - With Photo Goodness!

So, if you've been following my story, you know that I've had not one, not two, but three (yes, THREE!) partial splenic embolizations within the last year. All have been part of a larger effort to boost my platelet circulation so that I'll be able to treat my disease as aggressively as possible. To recap,

#1 PSE resulted in a four day hospital stay to get my pain management under control and did exactly nothing to boost my platelet numbers. They continued to act erratically and would bottom out around 30K.

#2 PSE included an exciting dead of night emergency dept visit to stop a pseudo-aneurysm near my incision; my leg ended up deeply bruised from hip to knee - but my platelets did recover somewhat! My new floor was around 60K. Better, but still not great.
As the new year rolled around, my platelets, in an apparent burst of holiday celebration, shot up to 169K. Strange but terrific. The following week, they were still firmly in the 100K orbit, and this, combined with scans that showed stability in my disease, led my oncologist to suggest that the stars were aligning for a clinical trial. I wrote all about that here, if you want all the fun details, but the short version of the story is that in order to move ahead with the trial and treatment, I needed to have better platelet counts. So I went all in and had, yes, a third PSE.


By the time I strolled into the outpatient surgical procedure area of my hospital on February 10th, I was feeling pretty calm. I'd already had this procedure twice; I knew everyone who was going to be working on me; I was mentally prepared for some kind of weird complication or side effect. So, I was in good spirits. Such good spirits, in fact, that I snuck my phone into the surgical suite so I could offer you, dear reader, some exciting views of just what exactly goes on behind the scenes! Surgical procedure tourism!
So, of course, any person who is ridiculous enough to take her phone into a surgical procedure has to have a selfie. This is me in all of my uneven skin tone, untameable eyebrows, giant hair don't care, oxygen bar sipping glory. And of course, wearing the fashionable gown. I'm full of both steroids and benadryl here, because I'm allergic to the dye they use to follow the catheter through my arteries.  As you can see, I'm ready to roll and at this point, finding it all just a little absurd. They were two hours late, too. This is not fun when you are not allowed to eat or drink anything.

But we finally get moving. They trundle me down the hall and into the surgical suite. Here's what I see:

The first photo is the bright surgical light they pull over you while they're working. Dentists, you all have nothing on this light. Also functions as a bat-signal in a pinch, or so they told me.*  The second machine is the portable CT scan machine. They use this to take pictures of my spleen and to make sure they're going to all the right places once they get that catheter inside my artery. It's pretty amazing technology.  The third picture is the actual surgical bed (extremely narrow, neither fluffy nor cozy, but they do provide a pillow AND cover your legs with a nice warm blanket, so... one star for comfort). You can see a bunch of wires there - those are leads that will be stuck all over my chest and back so that they can monitor my heart during the procedure. That thing that looks like a pizza box or a giant envelope that won't close is a little shelf that they'll attach to the side of the surgical bed once I'm in it and rest my arm on during the procedure so that they'll have easy access to my port, which is located about two fingers down from the middle of my collarbone on my right side and is where all the medicine goes. Yay, medicine! The big board above my bed is how they navigate through my body during the procedure (remember the scanner?) and, since it has six windows, will also have my vitals and stuff on it for easy access during the operation. 

I meet the woman who is my anesthesiologist. She tricked me by also rolling me into the room, so I thought she was a nurse or technician. Surprise! As she gets all of the good stuff ready, she points out the actual technician who will assist if necessary during the procedure. Turns out he's also the DJ, and he's playing all these 90s tunes that make me really happy. It's a good vibe. I tell the anesthesiologist that I probably won't fall asleep - my brain does everything possible to stay awake during these "twilight" sedation procedures - and to please tell me what she's doing as she does it, so that I don't panic. She is friendly and understanding. She tells me I'll be getting some more Benadryl, both because of my allergy and also to help me chill. Then, she'll push the two drug combo that is used during the procedure. I'll feel nothing and shouldn't remember anything, but they keep you just conscious enough that you can follow directions, which comes in handy, apparently. Okay, then! I need to have a saline drip during the procedure, to help disperse the medication, so she hooks that up and then pushes the Vitamin B. It makes me super chill and happy. I continue to chatter like a monkey. I admit that I have my phone. She says that's fine and encourages me to get pictures of whatever I'd like before we get started, and then she puts it away for safekeeping. 

Here is my little IV drip stand. I'm all hooked up to the saline. There's an extra bag there (the procedure can take up to two hours) and the covered one is likely a medication of some kind, since there's not much of it and it's in that sleeve. That's about all I can tell you. But you can also see my DJ/technician! He's at the computer, prepping the tunes.  My surgeon walks in, we chat, he tells me that he has his fellow working with him today. He introduces him. I say hello, and keep chatting. Suddenly, the fellow gives me the eye. "Weren't you in the ED for a pseudo-aneurysm from this procedure, a couple of months ago?" YES! It's Mo, my valiant fixer of scary complications! I feel even better. I have such a good feeling about this! 

And suddenly, it's go time.  My medicine lady pushes the twilight drugs. I feel nothing but am still wide awake - and cognizant enough to keep quiet while they're doing things like cutting into my groin to find my artery and, you know, working. I do ask if they can adjust the board so I can see what they're doing. They say yes and explain what they're doing as they're doing it. My surgeon even holds up the container with the microbead serum in it (This is where I discovered it looked like unicorn tears - viscous, slightly golden, with lots of what look like teeny tiny champagne bubbles in it but are actually the beads! I wish I'd had my phone. Ah, well.) so that I can see. I reiterate what I told him beforehand - be aggressive. Let's block up that spleen and force the platelets out! He nods. I shut up. As far as I can tell, Mo does most of the procedure, but I can't really see and I'm busy looking at the board. I snapped this final picture after they returned my phone - my spleen is there, in several iterations, and the dark lines are from pictures taken as they injected the microbeads. Isn't it the coolest? 

They roll me back to recovery and then into my own little overnight room (in the outpatient suite - ha! That makes me laugh every time). Since my original start time was late and then they started late, I have to put up with vitals being taken every couple of hours instead of my serene spa getaway. But no matter! The night is uneventful, and they let me go in the morning, with all the right medicines AND with a new kind of closure used for my incision, so that it doesn't pop open again. I feel like saying, "Third time's a charm!" But I'm far too realistic - and paranoid - to actually to that.

But here's the thing: it WAS! I had NO complications from this procedure, and when they had me come in on Monday morning at 7am (why??), my platelets come back at 115K! I entered the study! And I don't want to jinx anything - I'm terribly superstitious - but all the subsequent platelet readings I've had (there have been three) have remained firmly in the six figure territory. Finally!

So, see? Partial splenic embolizations are no big deal. (*faints*)




*another lie!