Probably won’t be home for Christmas

One of the resident doctors came in this morning and explained some of what seems to be going on with the persistent fevers.

They’ve done lots of tests and blood cultures, and one of the probable sources of infection — the catheter — has been ruled out (so far the “cultures” they took from the piece they removed are negative).

There seems now to be a higher and higher probability that the infections (and the fevers, which come and go with regularity) seem to be introduced through her gastro-intestinal (GI) tract. One of the major side effects of the chemotherapy is something called mucositis, which manifests itself in the form of sores in the mouth and evidently all through the GI tract. Since she has no current immune system, bacteria from the environment (food, drinks, etc.) are making their way through her GI tract, and into lesions caused by mucositis.

This is a pronounced-enough effect that a significant portion of pre- and post-transplant treatment involves the administration of “Kepivance”, which is supposed to cause the body to produce a coating within the GI tract, and it has worked — she really does have a coating, and no mouth sores, but that’s no guarantee of no small lesions throughout her stomach and intestines.

The primary symptom, I guess, is the fact that she continues to have fevers, even though they are continuing to administer the strong antibiotics, vancomycin and cefepime. And so, if this is the case, the fevers will continue to come and go through the next few days, until there is some “engraftment” and she begins to produce white blood cells, some 10-12 days after the transplant. (The transplant was on the 14th, so days 10-12 will, at this point, straddle Christmas). With the production of her own white blood cells, the fevers and infections should “resolve themselves”, but until then, we are here.

The bottom line is that she can’t go home until she has gone 24 hours “off antibiotics and fever-free”, which obviously, at this point, hasn’t happened.

But the trade-off, as the Doctor said, was that right now, she is giving up one Christmas at home, in order to have many more in the future.

“Gonna leave you on this bug juice”

My guess is that that’s doctor-speak for “we’re going to continue to administer these same antibiotics (Vancomycin and Cefepime) to you” – that’s what the Infectious Disease doctor said on his way out the door, after telling us that the more recent blood cultures have been negative for the past two days. That means that the infections in her blood have been cleared out. Her initial blood cultures, from right after her transplant, showed an initial MRSA infection; that the more recent cultures – those taken over the past two days – are negative, which means that the antibiotics have done their job.

Beth slept well most of the night, although she’s continuing to have symptoms – vomiting, body aches, and a low-grade fever (100.8). On the blood numbers front, Beth’s LDH (“the disease process”) has fallen to 232 on the most recent lab results – 212 is the high normal number for that , though we’ve been told that her old marrow will continue to die (and I would think, to be present in the blood for some time), contributing to that number not being quite normal. (And her white blood count – where the normal is 5.5-11, was 0.03 this morning).