Infection, nausea, Vancouver

6/27-7/13   

Hospitalized for disseminated infection, Extreme nausea @ home… Made it to Vancouver with the help of wheelchairs and golf carts.

Hospitalized from 6/17-6/29 on 4 IV antibiotics, 4 sets of blood cultures, CT of lungs, MRI of brain

Stem cell harvest.  Given daily Neupogen shots for 7 days to stimulate her bone marrow to produce new stem cells . On June 27^th, the nurse came in with an apparatus to pheresis (skim) her white cells for 4 hours through a large bore Mahuker catheter in her right jugular (neck) vein while returning her rewarmed red blood cells. Her entire blood volume of 3.6 liters (1 gallon) was run through the machine 4 times in order to collect the stem cells.  They collected 11 million exceeding the goal of 5 millilon stem cells.  “Cool” Teri says.   

IV antibiotics @ home 6/29-7/3

-       Amikacin 60 min infusion q. 8 hours (3 X/day) finished at 2:00 am

-       Imipenem 30 min infusion q. 6 hours (4 X/day) started at 7:30 am

-       Teri gets good at mixing up her Imipenum and using the elastomeric (pressurized bulb, non-electric) pump to provide a constant flow rate because of renal toxicity

The prolonged hospitalization due to unexplained fever was unexpected, a set back, after a smooth 4^th found of chemotherapy.  But from the oncologists point of view, totally expected and may have been prescient to find the infection before rather than during the transplant when it would be disastrous.  At first it was thought to be a PICC line infection, the line that spanned the vein in her right elbow to her large vein just above her heart and it was removed.  Because the IV’s had to be replaced and the multiple cultures in the face of no clotting ability from thrombocytopenia or lack of platelets left both her arms black and blue.  The CT demonstrated multiple nodules in the lungs as the disseminated infection had spread to her lungs documented by multiple new nodules in the lungs and possibly to the brain as found on MRI.  Fortunately, except for persistent fever and lassitude, she didn’t have any significant pulmonary or neurological symptoms.  Finally, on the day of discharge, on the 13^th day of hospitalization, they identified the bacteria as unusual opportunistic (occurs in immuno-compromised patients such as Teri who had only 300 white cells total) a soil bacteria Nocardia.  Where did she get this?  It is ubiquitous in the environment, including the mouth.  There was one day of potting plants when her count was normal …

Instead of continuing to keep Teri in the hospital, after putting another long PICC line in her left elbow (to heart), they sent her home, to carry on the round the clock IV antibiotic infusions.  Teri says “we entered another realm, a Twilight Saga zone, a whole other experience”.  She was discharged at 6pm and at 7:30pm a medical supply company delivered the IV pole, antibiotics, IV tubing, saline flushes and heparin flushes. Then at 9 pm, the home care nurse came before her next dose and spent 2 hours giving us a crash course on the technical approach.  Thank God I was somewhat familiar with the drugs and knew which one was potentially toxic …  But it is done. 

For the next week at home, Teri was felled by extreme nausea – couldn’t get out of bed for four days, couldn’t eat, couldn’t smile and lost 7 lbs over the 4^th of July.   She also couldn’t rest, compounded by the Summerfest (largest music festival in the U.S. – 7 stages going for 11 days – about two blocks from us) traffic (especially the revved up Harley-Davidsons) that rolled past our window at all hours of the day and night.  I was especially helpless as vomiting is my area of clinical expertise.  [Although I well know that there is no effective anti-nausea drug available.]  Zofran, Ativan, Prevaicid, ginger capsules, acupressure (C bands), Fermat-Branca liquor – no effect at all.  Gradually it dissipated about two days after the Imipenem was stopped (and Prevacid started).  We were on the verge of a throw back to medical marijuana.  She finally ate some food on 7/6!

Visited by Ron and Kari, Columbus friends and the kid’s Suzuki teacher and mentor.  Kari gave B a needed massage for his Father’s Day present from the kids.

Teri has an idea.  She calls it “The Team Teri Challenge”.  She would like the Organization of Chinese Americans (OCA) to help sign up 3000 people to the National Marrow Donor Program during the month of August.  With the help of B and our local chapter president Lorna, she sent off an application to the national office with her idea.  This challenge will ask each local chapter to do a live bone marrow drive to help not only Teri but also the 400 Asian Americans who are currently seeking a matched donor.  Within a few days and a couple of conference calls, the national office accepted Teri’s challenge!

Through 6 degrees of separation, an article in the front page of the local section of the Chinese World Journal Chicago edition (edited in Taiwan) spread Teri’s story on July 2^nd.  B’s dad was so excited that he called us at 5 am in the morning to tell us about it.  “Thanks” dad.  A big thanks goes to B’s old Princeton friend Bing whose parents had a friend in Taiwan whose daughter knew a reporter in the World Journal who called Teri to do a phone interview.

Left for Vancouver on 7/8.  Two wheel chairs in tow.  Face mask for Teri.  Help along the way.  Golf carts.  Expedited through customs.  And, ran into Rachel and John walking through the exit in Vancouver!  Yeah!  Ben arrived the next day and the whole family (3.5 generations, everyone took turns feeling little Jack kicking) is together for a wonderful, fun memorable well-deserved vacation. 

Richmond, British Columbia where we are is 61% Chinese but around the Aberdeen Centre where we stay is 95% Chinese, speaking Cantonese, Mandarin, English, often in the same sentence.  Eating and shopping are the two past times, just as if we were in Hong Kong.  The signage is all in Chinese.  The two food courts within walking distance include Chinese (Cantonese, won ton noodles, take out buffet, northern, dim sum, steam buns, dumplings, bubble tea), Japanese (sushi, udon), Vietnamese, Korean …  The grocery store is full of take out foods such as sticky rice rolls.  By contrast, there is no dairy section to speak of. 

To Steveston a fishing village cum tourist trap, Capilano suspension bridge and tree tom adventure, Grouse Mountain skiing (4000 feet above sea level), and sunset off the western coast of Canada.  And B is doing a fine job of driving everyone around in an 8 passenger Suburban van.