Hospitalized again, this time for an infection

6/14-6/27  

Teri ran an unexpected (expected because of neutropenia) fever of 101.8 on 6/17 and her oncology team admitted her within two hours for blood and urine cultures, chest x-ray, and IV antibiotics.  This followed in the wake of her 6/7-6/12 admission for her 3^rd round (4^th round including induction) of high dose Ara-C that caused neutropenia and susceptibility to infection.  She is admitted from 6/17 to 7/1.

The initial blood culture drawn from the PICC grew branched rod bacteria.  Since the bacteria was presumed to be lodged on the inside tip of the indwelling catheter (extending from her right elbow to her heart), it was pulled out leaving her with peripheral (skin) IV’s.  Between attempts to replace IV’s and daily blood cultures and lab work with low placelet count of 20K, Teri’s arms became black and blue.  The bacteria has not been identified but is suspected to be Nocardia.  In addition to the Imipenem, she received antibiotics Gentamicin, Vancomycin, Primaxin and Acyclovir (anti viral), finally narrowed to Imipenen and Amikacin.  Her fever finally broke on day four thanks to everyone’s prayers and positive energy.

She also underwent a Infectious Disease and Pulmonary consult because of this unusual infection and a scan that showed multiple nodules in her lungs.  A head MRI is pending.  For a neutropenic patient, unusual infections happen when you only have 300 white cells (normal 5000).  It is part of the accepted if not acceptable risks of chemotherapy.

The good news is that she finally felt like a human being on 6/26. 

The further good news is that the Oncology team decided to forge ahead, despite the infection, with harvesting her stem cells for a possible autologous (self) transplant if all else fails.  She received 7 days of Neupogen to stimulate her white cell production and then on 6/28 and 6/29, she will get 10 hours of pheresis where they harvest her stem cells while giving back her red cells and plasma.  This involved placing a large Mahukar triple lumen red white and blue (all American) catheter in her jugular vein in her neck that she liken to having 3” plastic tassels hanging on the side of her neck.  Not the most chic jewelry to be seen in.  It will come out as soon as the SC removal is done.

The further help came from Lois (a college friend) and Dave who drove 15 hours through the night like we used to do in our 20’s and 30’s all the way from Long Island to help, visit, cook, and pray from 6/21-6/24.  Although Teri was quite tired, it was an important reunion and a much appreciated one.  “Hello Gorgeous” on a red robe will be remembered.

On my side, the daily help for dad is providing additional stability and he is enjoying their company and getting to know them.  Nevertheless, after eating with Teri and then returning to look in on him and making sure he takes his medicine, I don’t get back home until 9:00 or later.  It’s hard to keep up with the Gols of the World Cup.  The house is completely quiet and devoid of the energy that Teri infuses.  I still go on scavenger hunts at Teri’s direction finding to find files, origami paper, clippers, creams …  Yesterday, I was greeted with the fragrant smell of our pair of miniature jasmine trees that fully blossomed and provided a sweet scent throughout the house. 

Yesterday, I gave a talk at the Cyclic Vomiting Syndrome Association conference in Chicago.  It was my first business trip in 5 months (usually twice a month).  It was great to see so many patients and colleagues – especially as we bring in new blood into the fold.  What tired me out was the ‘speed consult’ akin to speed dating where each family was given 10 minutes to present their child’s case and ask questions.  I slept 9 and a half hours last night for the first time.