The Port Assessment Result: Total Failure

The good news: I needn't worry about blood clots.

The bad news: the port needs to be replaced.

The story...

Port assessment started with a chest x-ray. Based on the notes I saw in my file, I think there were other reasons to collect the chest x-ray, but it also served to provide an initial look at the placement and orientation of the port and the line. So I needed an x-ray.

If you haven't had an x-ray recently, it's a pretty cool process. You still have to stand in front of a plate, and position your body and your arms in a particular way, but there's no more film plates or any of that. Instead, it's all done digitally. The machine makes its little buzzing noise and then you immediately see the x-ray on the computer monitor. Snazzy.

The other thing the x-ray -- or rather the x-ray technician -- told me is that I have "long lungs." He had a hard time getting my entire lung to fit on the screen. After a couple of tries he got it sorted, so step one was completed.

Once the x-ray was done, I was taken back for the actual assessment. This would be a process of accessing the port, and then filling it with a contrast agent while a doctor examined its behavior under a scanner.

First new experience: the nurse did not take my weight, pulse, blood pressure or temperature. I would've bet money that nothing happens at SCCA without those four data points, but apparently not.

While the nurse was working on accessing my port, a young woman came into the room. Aside from the scrubs, she sort of looked like a refugee from a skate park: young, Asian, and pretty in a tomboyish way with a short spiky haircut. She of course introduced herself as the doctor who was going to be conducting the assessment, so I adjusted my estimate of her age upward by a decade and got the download on what the x-ray had told her about my port and what she was planning. 

There were no obvious problems with the port, save for the fact that the line was shorter than SCCA preferred.* Their institutional opinion was that a line as short as mine was more prone to scar tissue sheathing the line than a tube that ran further toward the heart. In her opinion, then, she thought that the likeliest problem was scar tissue surrounding the line, but they'd still run the assessment to make sure.

She also told me that if it did turn out to be the sheathing problem, there were two options for treatment. The first would be to run a catheter from a blood vessel in my leg up to the line, and then use a little wire to try to scrape the scar tissue off the end of the port's line. The second option was to replace the port completely.

And then she asked the question that earned her a place on my list of my favorite doctors: "Do you have any preference about which approach we take?" Yay! My opinion counts. So I explained that my Dad had died at least in part due to a wandering blood clot, and so I wasn't terribly excited about the idea of them scrapping scar tissue off the line to go floating down my bloodstream. She was good with that, and agreed that if scar tissue was what she found, replacement would be the chosen approach.

The doc then left to prepare, and the nurse and I headed down the hall to the procedure room. When we got there, things weren't quite ready -- some order had to be entered into the computer before anything could happen so they were waiting for that update -- so we were pointed to a spot in the hallway with some chairs to wait. After a minute or two the doctor came out to wait with us. This was when things got really interesting.

So the three of us were chatting when the subject of my upcoming trip came up. They asked who I was going with, and I told them the niece, and explained that she was graduating from high school and so was at the really interesting age when you start "getting on with life." The doctor looked puzzled and asked what I meant. So I told her that, in my opinion, it was fun to watch people at that stage where they're adults, but all they have is possibilities and have yet to make any dumb decisions.

So the doctor looks up at the ceiling and says, "Let's see... Eighteen... That was before I decided to go to med school, which was probably my first questionable decision, so, yeah, that makes sense." I have to say, this is about the most interesting thing I've ever heard a doctor say, and I'm thinking I'd just as soon skip the assessment and stand in the hall talking about how she wound up in med school, and why she regrets it, but at this point the door opens and we head in for the procedure.

The procedure room is basically just a flat platform surrounded by computers and weird scannery things. The check my last name and birth date about four times to confirm that we're all on the same page about who I am, and then they have me lie back on the platform. The technician swings one of the pods over my chest and tells me that if I look to my left I can see what they're seeing. 

It's amazing how entertaining it is to watch your insides doing their thing. You can see my heart beating in the lower right corner of the screen, and as I breath you can see the blood vessels sliding underneath the ribs while the ribs expand. So, of course, I start holding my breath, and then taking deep breaths, trying to see what I can influence. I take my entertainment where I can find it.

But quickly the screen stops moving, as the monitor holds the final frame when the scanner turns off. The scanner is basically just a big digital x-ray, and so to avoid microwaving me, they only turn it on when they're actively trying to see something. It goes on and off about twenty or so times during what couldn't have been more than a ten minute procedure.

After thirty seconds or so, the screen reactivates and zooms in on my port, which is a heart-shaped blob at the top of my lung, with a tube coming off it that runs up toward my neck and then down toward my heart, and what looks like a bent nail (the needle) sitting on top of it. The scanner stays on and the doc starts pushing contrast agent. 

It basically looks like squid ink, and I can see it come out of the needle, splash and pool against the bottom of the port, and then ooze through the port and accumulate underneath it. I don't need to hear the conversation to know that this is not what's supposed to be happening.

So the scanner turns off, and the doctor and the nurse have a discussion about whether the nurse accessed the port properly. It's decided she didn't. So the doctor asks me if I used numbing cream before I came in and when I explain that it was at home and I came from work, she says, "Sorry. This is going to hurt."

She's not wrong. I'm not exactly sure what she was doing, but it is not a small needle and I would swear it went in more than once.

In any case, now the doctor's placed the needle correctly and so we're ready to try again. This time, the squid ink hits the port, fills the central cavity, and then starts ballooning out in little clouds that float around the port. Ink never gets near the opening of the tube. 

I think it's fair to say that at this point everyone in the room is in complete agreement: the port is shot, and needs to be replaced. 

But I'm probably the only one lying there wondering how long it's been that way, and did they, by chance, pump my chest cavity full of Avastin at my last infusion. Admittedly, it's unlikely -- between the Avastin and the saline, I would've swelled up like a balloon -- but it's hard not to wonder a little bit. 

The other thought that occurs to me is that it could've been worse. It could've been a pacemaker that failed...


* Have you ever noticed that it's almost impossible to get a medical procedure done at location B without negative commentary on whatever was previously done at location A? Dentists are the worst. If you're lucky, you're just told that all your crowns and fillings weren't done the way the new dentist would do it, but they'll suffice; if you're unlucky, you're told that everything you ever had done previously needs to redone.