3yr FS Lab. History of hepatic arteriovenous malformation that was ligated about 1.5yrs ago at a tertiary specialty hospital. She developed numerous acquired PSS post-op.
It seems she was otherwise doing well for a while, then she had a mast cell tumor removed in September and has gone downhill ever since. Post-MCT surgery, she developed what was suspected to be a GI bleed and became severely anemic to the point of needing a transfusion. Got a pRBC transfusion end of October.
Has developed progressive icterus (Bili got up to 7.0 about a week ago, but is now 5.4) and progressive anemia (now HCT= 13.4). Was Coombs + at some point in November/December, but is always a non-regenerative anemia. She has a huge left liver mass that has been present for months- IM thinks it's a giant portal thrombus. I did a fecal occult blood last week because her stool is dark & tarry, and it was positive, so I suspect there's at least some GI bleeding as well (she's not been on raw food). She's also been thrombocytopenic but plts now normal. She's had low albumin and BUN, high ALT (500s), ALP (>2000) and GGT, and more recently a progressive leukophilia/neutrophilia with a left shift (WBC now 49K). ER put her on baytril, clavamox, flagyl over Christmas and recommended another pRBC transfusion and a CT scan of her liver.
She's barely eating anything, currently is also leaking small amounts of greenish diarrhea, and her BCS is down to about a 2/9.
TCVM tongue/pulse since I started seeing her:
12/19/24:
Tongue: dry, pale yellow
Pulse: toned, fast, very thin & thready
Was very cool-seeking
Put her on XYS, Liu jun zi tang. Not cooling, but she seemed more stagnant at the time to me.
I had her on XYS and Liu jun zi tang, weekly acupuncture and Vit B12 aquapuncture, and continued the sucralfate she was on. She initially improved, but then regressed after seeing the ER and being hospitalized and put on the 3 antibiotics.
12/27/24:
Tongue: pale yellow, dry
Pulse: thin, fast, bounding/drumskin, really nice response to GB34
Less cool-seeking at this point.
Changed XYS to XCHT but her appetite seems to have decreased and we're not sure if it's the herb change.
1/2/25:
Tongue: pale yellow, dry
Pulse: jagged, a bit weaker, toneless, fast
Mild fever (102.6). TBili is better today (5), but anemia (HCT 13) & leukophilia (40K) are progressive.
Mom is understandably wary of doing a CT scan and we're both worried she won't survive anything surgical. I also added Biophotonic ozone today in case of infection and for presumed hypercoagulability, and gave Convenia since she's not eating and it's getting hard to medicate. She's debating repeating a pRBC transfusion. Overall, we're expecting poor prognosis but hoping to get her to turn the corner.
Questioning where to go from here if mom opts not to go forward with any other conventional care. Any thoughts are appreciated!