A live textbook for the resident doctors

I went in to work today, so I didn’t see it, but Beth said that one of the doctors came around with a whole group of residents who all took a look at Beth’s mouth sores (Those very ones in the photos below). The mouth sores are very uncomfortable for her – they’ve contributed to a bad sore throat that prevents her from eating. She’s still got lots of bone and muscle pain – “your whole body was burned from the inside out”, and she continues to have elevated blood pressure levels, though they are giving her Norvasc to bring that down.

It seems as if she will be going home tomorrow. We’re still waiting to hear from another doctor tonight, but she’s been off the antibiotics, and she hasn’t had a fever. Her white blood count was 4.57 this morning, which is somewhere near the normal range, and her hemoglobin was hanging out around 10.0 – both of these numbers are stratospheric for her, but only the white cells are hers (the hemoglobin is left over from some transfusions she had over the weekend).

Seems as if the fever has broken

I just got back to the hospital (6:30) – I had left around 12:30 when Beth wheeled down for her CT scan. Among other things, our refrigerator has died, and a new one is being delivered tomorrow. So I had to go home and clear a path.

Meanwhile, it seems as if Beth’s fevers have broken. The nurse said so, and all of her temperatures were in the 37s C (less than 100 F) and in some cases, in the low 37s. I don’t yet know if that’ll mean that she can come home for Christmas – it would be great, but we really can’t count on it, and in fact, we’re still planning on how to do the weekend in the hospital.

She is just now waking up from a nap. She had a good turkey dinner, and she believes that all the sweating she has done today is an indication that the infection has really broken. We’ll see.

 

“Rigors”

While Beth is having her fevers, the doctors and nurses are saying the word “rigors” a lot. Turns out this is a synonym for “chills” – but in this case, they mean the violent kind of shaking that she does when the fever is going back up. It’s 6:00 am; she has been resting peacefully since about 2:00 am.

Rigor is defined as “shaking occurring during a high fever. It occurs because cytokines and prostaglandins are released as part of an immune response and increase the set point for body temperature in the hypothalamus…. The increased set point causes the body temperature to rise (pyrexia), but also makes the patient feel cold until the new set point is reached. Rigor occurs because the patient’s body is effectively shivering in a physiological attempt to increase body temperature to the new set point.”

Solu cortef, which I mentioned in my previous post, “is an anti-inflammatory glucocorticoid, which contains hydrocortisone sodium succinate as the active ingredient”. She has also been given morphine for the pain and Demerol for the pain. And of course, they give her good old-fashioned ice packs as well.

Fever up to 103 again

Beth’s fever just now (just prior to 7:00 am) was up again to 39.4 C (103 F). She seems to be resting comfortably. We had some hope of being able to have her come home today, but that seems not to be the case at the moment. The nurse said they’d probably want to watch her at least today, and maybe again tomorrow. Yes, it’s possibly a neutropenic fever, as the doctor said yesterday, but the persistence of this fever is continuing to be a worry for me.

Infection

While I was home, the doctors stopped in to see Beth. It appears as if she has a “gram-positive” staphylococcus infection, which may very well have come in with the stem cells. It could also have come in through her skin. She could be growing it in her blood. (I’m just reporting what I’m hearing). It seems as if they’ve ruled out that this infection was associated with her port.

Her fever now is 38.2 C (or 100.8 F) — it’s a slight fever, but not alarming. But at any rate, the antibiotics will be able to handle it.

Hot babe

Just now, Beth’s temperature was 39.2 C (102.6 F). This is not atypical for what transplant patients go through, I hear. Some folks have wild swings at first, and then the swings level off after time. She is being medicated, and they have already taken her for a chest x-ray (to check for pneumonia); they are taking cultures to see what else might be causing the fever. She seems to have come through the worst of this for now, but she was definitely surprised by the reaction and very much frightened.