Wednesday, March 26th

530PM Mario had his breathing tube removed. Israel called to report that he is doing just fine breathing on his own. This is a nice step, and means Mario is much more comfortable and can use his vocal cords again. They also started his TPN (this is IV nutrition). More tmrw...

NOON: Other than the limbo around his liver blood flow, Mario is doing pretty well. He's doing really well on urine output, his liver numbers are great, his blood pressures and heart rate are solid, he'll get started on some IV nutrition this afternoon and he's doing well on breathing. He was running a bit of a temperature but his white blood count has dropped so not too concerned about infection. His hematacrit (red blood lab) is a bit low for my liking, but the docs/nurse all said this is fine. We've heard varied opinions on the rest. It is impossible to predict the long range impacts. We just have to wait and see. I'm going to go eat and rest and Israel will stay tonight. More updates as we know more...

1000AM Dante wrote about a place between heaven and hell, purgatory. That's the feeling at the moment. The blood from in the hepatic artery is not ideal, it is there, but not ideal. So, we have to wait and see. He has been relisted. We knew this yesterday, but were still hopeful that it was just a precaution, so didn't share that detail. Today, it appears more like a necessary back-up. This is all very difficult to explain, but I'll try. Mario's liver is functioning well, very well. The issue is blood flow to the organ. Two possible problems...1st the temporary loss of blood flow could have caused scarring to his bile ducts, 2nd since the blood flow is not ideal, over time there could be issues with the bile ducts. If either occurs, Mario will be faced with infection, frequent hospital visits. It does not appear that his liver will "fail" but he could have continued issues caused by the potential compromised blood flow.

So, next steps are to continue to get him off the ventilator, add some nutrition, monitor him and keep him stable. It is possible to walk out of here and keep an eye on him over time, waiting.

The other scenario would be sometime in the next few days he gets a "great" liver offer. In this event, we will look at all factors and make a call whether or not it makes sense to replace the liver. Since he is already in the hospital, stable, etc. this might make sense to do now...only if we got an offer obviously.

Finally, Dr Reyes indicated he is happy with Israel's liver as another option. This seems more like something we would look at to schedule in the future if we don't get a great offer in the next few days and end up being able to go home.