My Hepatic Arterial Infusion Pump

One of the hard things

I just finished the course of treatment that used my Hepatic Arterial Infusion (HAI) pump and I want to tell you more about this interesting piece of technology that lives in my abdomen. 

It’s a titanium disk about the size and shape of a hockey puck, meant to treat liver metastases caused by colorectal cancer (I had those). It delivers chemotherapy directly to the liver to avoid systemic side effects. It is more often used to shrink tumors on the liver to make a patient a candidate for resection. In my case, it was placed after my liver tumors were resected. The treatment it delivered will help prevent a recurrence there. It can be used again in the future if I need it. 

The reason this device works is because of the liver’s dual blood supply. The portal vein supplies the majority of blood to the healthy liver tissue, while the hepatic artery supplies proportionally more blood to the diseased tissue. Taking advantage of this anatomy, the HAI pump supplies chemotherapy (FUDR) directly to cancerous tissue through the hepatic artery. Because the liver can clear FUDR efficiently, the HAI pump can deliver up to 400x the concentration of FUDR to liver mets than they would otherwise be exposed to by 5-FU dosed systemically. I’ve learned that livers are complex and robust.

Colontown University DocTalks Optimal management of colorectal liver mets & HAI discussion: Dr. Padmanabhan

The story of Prometheus tells us that we’ve known about liver regeneration for a long time. 

In Greek mythology, Prometheus defied Zeus to bring civilization to humankind, and was subsequently subjected to eternal torture: Every day, an eagle came to eat his liver. Every night, the liver grew back, only for the horrific pattern to repeat again the next day.

Rubens - Prometheus Bound 1611, Philadelphia Museum of Art

I can assure you that the process of accessing my HAI pump is not as torturous as this, although it’s not pleasant either. I was especially anxious going into it because a long needle into my abdomen every two weeks to inject chemotherapy sounded horrific to me. And I could never skip an appointment because the reservoir inside the pump, which dispenses the liquid using body heat and pressure, should never empty. This means I needed to travel to Penn every 14 days to have it filled with either chemo or saline. It’s all a lot! But those treatments went off without a hitch. And if this is one of the tools that gives me some longevity, then I only have gratitude for this thing I had never heard of and thought I could never do. Last week I had it filled with glycerine so that I can go 12 weeks between fill appointments.

When Isaac and I decided that I needed to go big (undergo major surgical resections) or go home (plan for me to stay on chemo for life, without attempting a cure), we knew I’d need this HAI pump because without it, the chance of a recurrence in my liver was very high. We found one doctor (at University of Pennsylvania) willing to operate even though I still had cancerous lymph nodes. 

Because we found such a skilled surgeon who could remove affected lymph nodes around my aorta, and because I recovered from those surgeries without complications, and because I started both systemic chemo and HAI treatments so soon after surgery, and because my body could handle all these treatments without interruption, and because I have supportive family who was willing to make it all work, and because Isaac made such a well-informed plan to get me to this point…

I’m still processing how and why I’m cancer free and doing well today. I remember all the steps, but I don’t yet understand how we made it all happen successfully. It’s hard to believe that God wasn’t involved in keeping things moving smoothly along and guiding us to making correct decisions. I’ve become increasingly confident that we made the right choice to pursue surgeries last year because now my liver is whole. I grew it back faster than any cancer could take hold. And at the very least, I have this summer off treatment to enjoy with my family. I’m hopeful, though, that I’ll have much more than just this summer to enjoy. Because this saga continues with my next scans in August. Until then I’ll be processing what’s happened and planning to make the most of this beautiful life.