Elevated bilirubin post op

[finmb]

All went well with my left simple mastectomy on 1/14 and on 2/7 was scheduled for my port. The previous week I noticed several symptoms, although did not feel sick, just wasn't 'myself'. First a low grade fever for 3 nights and ONLY at night <101..loss of appetite and an odd feeling in the pit of my stomach that I thought at the time was nerves. But truthfully, couldn't figure why I was so nervous about the port when I had less anxiety going thru a mastectomy! Anyway, then I started to notice that my urine was extremely dark and concentrated and my stool was very light, almost gray. I didn't feel truly sick but mentioned it to my dr. before the surgery and he noted that my skin was yellow. I was jaundiced! Port cancelled and spent 3 days in the hospital with full testing of liver, pancreas, gall bladder etc. CT scans, MRIs and neuclear type testing too. All thank God were negative for cancer, blocked bile ducts, etc and all looked OK. My oncologist visting bedside said that the jaundice could be due to the general anesthesia given me during mastectomy and that my liver had difficutly processing it. Uncommon but it happens. The gastro Dr. concurred and said he's seen it although it happens to about 1 out of 1,000 pts (lucky me) I was told that if that was the case, my billirubin level would peak, and then start to come down which is exactly what it did. I went from 5.6 to 3.4 inside a week and a week later was down to normal at .6....I do not like process of elimination when determining my health  but it seems they could have been right on. I had no treatment or meds, so I would think if I had a liver disease or something else going on my levels would not have been back to normal. Since this seems to be an uncommon occurrance, have the Drs seen this type of medical issue or heard of it before? And, what in heaven's name will chemo do to my liver if it couldn't handle general anesthesia? Thanks in advance! MB
_________________
MB
Dx 12/28/04
DCIS and ductal carcinoma invasive
6mm tumor
lumpectomy 1/5/05 unsuccessful margins
left mastectomy 1/14/05
1 +/5 lymph nodes
ER+
Port scheduled
Chemo pending

[CCF-RN,MSN-rf]

Dear finmb:  Hepatitis (or inflammation of the liver) can result from a variety of causes including certain anesthetic drugs, other medications and infection.  It is reassuring the the abnormalities have resolved on their own.  While many chemotherapy drugs are metabolized (broken down) by the liver, inflammation of the liver is a fairly uncommon side effect of most of the chemotherapy regimens used today for early breast cancer.    Your oncologist will likely keep a close eye on the liver function tests throughout your chemotherapy treatment.

[surgeon]

As you've been told, it's not common, but it seems likely that anesthesia is the culprit: you've had quite thorough checking for other causes. Such a response in the liver is drug-dependent, meaning having entirely different drugs should have no more likelihood of causing a similar problem than the odds for anyone else taking chemo.

[finmb]

thank you for your responses.  I had my port put in yesterday and although I'm more sore than anticipated, all went well (when lying down to standing up gravity is a killer :-). The anesthesiologist that took care of me yesterday suggested that I find out what gasses were used to and carry with me to avoid them next time if possible.  Said there are alternatives.  He also mentioned something about having antibodies checked --?

Well, a few days of healing and then hope to get my chemo started.  I'm concerned that my mastectomy was Jan 14 and b/c of these bumps in the road I've been delayed.  I though that I needed to start w/in 35 days but have been told that is recommended if doing a clinical trial (I'm not) and that the earlier the better, but that I needed to start chemo w/in 3 months latest after mastectomy.  I'll be 2 months post op.

I just don't want that one cancer cell that might be there setting up camp somewhere.  

Any thoughts?