Arthur Nelson Itchon Rex Medical Support

Updates:

• Arthur was transferred to National Kidney and Transplant Institute (NKTI) a week ago (February 16).
• Internal jugular central line has been inserted.
• Fungemia has resolved but still with ptbd infection.
• Scheduled for repeat EUS guided FNAB on Wednesday, Feb 27

Hoping old friends can help me and my husband, Arthur, get through this rough phase in our lives, as Arthur battles his medical conditions. We are seeking support in meeting the medical bills that have become due, and some help for the upcoming procedures and treatments that Arthur will need in the coming days. We would be forever grateful for your thoughtfulness and generosity.

September 2018, Arthur underwent laparoscopic cholecystectomy with intra-op cholangiogram because of gallbladder inflammation. He also had pancreatitis at that time due to gallstone obstruction of the common bile duct. Days after surgery he developed jaundice and this prompted the doctors to perform endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy. However, a few days after the procedure there was increased jaundice and he started to have fever. Abdominal ultrasound then showed distended common bile duct secondary to bile flow obstruction. Emergency percutaneous transhepatic biliary drain (PTBD) insertion was performed to save him from septicemia. He spent three weeks in the hospital and went home with a PTBD on his side. Two weeks after discharge, repeat cholangiogram was done and just a few hours after the procedure he again developed high-grade fever which caused him to be admitted for the second time. He was on IV antibiotics for a week. From November to December 2018, Arthur had regular check ups with his doctors. Blood tests showed resolution of his pancreatitis and gradual lowering of his bilirubin levels. He was regaining his appetite but at the same time he was very cautious not to eat fatty foods. During the last week of December he started to have episodes of vomiting and was complaining of bloatedness despite minimal food intake. Consult was done on January 8, 2019 and he was advised to continue medications for dyspepsia and was scheduled for PTBD replacement the next day. There was persistence and aggravation of nausea, frequent belching and sensation of abdominal fullness days after the procedure so we decided to consult and Arthur was then subsequently admitted (January 14) for fluid/electrolyte loss replacement and esophagogastroduodenoscopy (EGD). EGD done on the 3rd hospital day revealed a mass that almost completely obstructs the duodenal lumen. Biopsy of the said mass showed atypical lymphoid proliferation in the duodenal mucosa with concurrent focal mild active inflammation. Immunohistochemical staining done but results were equivocal. Repeat biopsy through endoscopic ultrasound-guided fine needle aspiration biopsy was performed which showed atypical epithelial cell proliferation. Considerations include hyper-reactive mucosal epithelium and adenomatous polyp. A tissue biopsy was recommended if his doctors have high clinical suspicion for malignancy. Arthur is to undergo Whipple procedure or pancreaticoduodenectomy once his fungemia (fungal infection of the blood) is resolved. He will also need a peripherally inserted central catheter (PICC) line and jejunostomy tube for post-operative feeding.