Zoom Chat with Dr. Story from Idaho Gastro

April 14th, 2020

I talked to Dr. Story for the first time via Zoom for my initial consultation. I was referred to him by my Primary Care Physician's office. He had read all about my case and had gotten access to labs and scans from Utah. He looked specifically at my CT, MRI, and Hida scans. The hepatologists requested an intestinal biopsy to confirm Celiac. 

After talking with Dr. Story I felt a little more uneasy with my situation. While he was looking at the MRI, he mentioned something called "varices" and asked if I had been vomiting any blood or had blood in my stool. I said no, luckily. I remembered the hepatologist mentioning something about "portal hypertension" when they were having the liver biopsy done, but I didn't quite understand what they were talking about. Portal Hypertension: is abnormally high blood pressure in the portal vein (the large vein that brings blood from the intestine to the liver) and its branches. Cirrhosis (scarring that distorts the structure of the liver and impairs its function) is the most common cause in Western countries.

So, the hepatologists noted that there was some portal hypertension on either the CT or MRI and that's why they did the Hida scan. The scan showed that it was gone which suggested maybe I had a gallstone or kidney stone that was causing the pressure at the time but was relieved by the time they did the next scan. Also, if a duct was damaged (like what PBC does), it would cause a buildup of pressure as well. However, when everything seemed to flow just fine on the Hida scan, those theories didn't line up with anything. Everything was just inconclusive. 

Back to Dr. Story. Varices are enlarged or swollen veins. When they are located in the esophagus, they are called esophageal varices: Causes of esophageal varices include: Severe liver scarring (cirrhosis). A number of liver diseases — including hepatitis infection, alcoholic liver disease, fatty liver disease and a bile duct disorder called primary biliary cirrhosis — can result in cirrhosis. 

I'm not a fan of the fact that PBC was mentioned... again. Dr. Story said he will do an upper endoscopy to take the intestinal biopsy and will check on the varices that I have. The concern is that when the veins become too swollen, they can burst and bleed out - which is why he was asking me about vomiting blood or having blood in my stool. I guess while he is in there with the scope for the biopsy, he will get a better look at the varices but doesn't think there are any bad enough to need to be fixed. He would like to do the endoscopy in his office instead of the hospital due to all the Covid-19 drama. He said he office is a more controlled, cleaner environment. So, if he does find any varices that need to be treated, he doesn't have the ability to do that in his office and we would have to reschedule to have me in the hospital for the procedure. 

Side Note: When I was Googling varices after I talked with Dr. Story, I found this. I know Google is always the worst-case scenario. I have asked the hepatologists what "stage" of liver failure they would classify me as and they won't give me a clear answer. Since I have ascites and varices but no bleeding... I think that makes me about stage 3. Ah! That's a scary thought. 

My appointment for my intestinal biopsy is Wednesday, April 22nd. *crosses fingers*