Things can change in an instant

Good evening, all.  It's Kelly.

For those of you who've imagined worst-case-scenarios where you would read an unexpected blog update from me and not Kiara - No, this isn't that.  Although, some of the following is not for the squeamish.

Kiara wrote at some point that Dr. A warned us about a "sentinel bleed" or "herald bleed".  Head and neck cancer will sometimes work its way through the tissues of the neck and eat a hole into the wall of a major blood vessel.  When this happens, patients will experience sudden and profuse bleeding.  This bleeding usually stops on its own when the body forms a clot and seals the hole.  But, if things are left at that point, the patient will typically experience a second bleed from the same spot that cannot be stopped.

We experienced a sentinel bleed this morning.

Kiara and I were having a conversation in our room before she got up for the day.  She wasn't coughing, didn't seem in any discomfort, and generally felt pretty good.  I turned away for a second, heard a slight cough, turned back, and saw blood pouring from her trach tube.

Hello...911.

The paramedics and ambulance came.  Yes, it was some of the same personnel that responded to Kiara's fall a few weeks ago.  Luckily, there were more people in the house than just Karissa.  They took Kiara to the Riverbend ER and I followed by car.  By the time I got to her curtained trauma area, there were ten doctors and nurses working on her.  They gave her platelets and clotting factors and stopped the bleeding.  I called Dr. A before I got to the hospital, and he was already on the phone with the Riverbend ENT.  Verdict - Get her stable and get her to Portland.  We agree.  Call the helicopter.  Room at OHSU secured, flight paramedic and nurse get Kiara strapped in, and off they go (into the wild blue yonder).  I run to the house, pack a bag, and drive to Portland.

Note: Portland police do, in fact, give speeding tickets (just in case you were wondering).

On my drive up, it was decided that they would take Kiara into the cath lab and do an angiogram to locate the bleeder.  Once found, they would patch the hole with a stent sleeve.  Things were, as told to me by those who were there, generally stable at that point.  Then, they removed Kiara's stainless steel trach to put in one made of plastic.  The plastic trach won't disrupt the scans used during the angiogram.  Once the trach tube came out, the bleeding started again in force.  According to Dr. A, it was touch-and-go right then.

They located the bleeder in Kiara's left common carotid artery and patched it as anticipated.  The doctors can't tell if the cancer ate through the artery wall, if the radiation damaged it, or if the trach tube itself was rubbing on the wall enough to weaken it.  In the end, it really doesn't matter.

The primary concern is that Kiara lost a tremendous amount of blood before and during the procedure.  They pumped in several units of "blood product" including additional platelets.  But, they have to walk a very delicate line.  They want the blood to clot enough to seal up woulds and stop the ongoing seepage.  But they need to keep the blood thin enough that it won't clot up in the stent, close off the artery, and give Kiara a stroke.

There was also concern that that a large, quick infusion of blood can cause damage to the liver or kidneys.  According to the lab results, Kiara's liver is doing fine.  Based upon the nurse's observation that "She's making great urine!" Kiara's kidneys are also functioning well.

So, here we are.  Kiara is in the ICU, a steady stream of propofol (yes, the Michael Jackson drug) keeping her sedated, and a respirator tube in her neck breathing for her.  The doctors want to keep her still and cough-free in order to give the wounds time to start healing.  They will start slowly easing off the sedation tomorrow.

Many thanks to Karina and Mary for holding down the fort at home.  Many thanks to the Stand for Children group that came to the house yesterday.  Kiara said she felt incredibly "energized" by your visit.  Many thanks to the medical professionals at OHSU who have saved Kiara's life several times over.  And many thanks to those who continue to send prayers, positive thoughts, and good vibes.

Either I or (hopefully) Kiara will post an update tomorrow.  Much love from all of us to all of you.

-Kelly