Posted by Becky
Today we got to see the inside of Leif's bronchial tubes. Which was cool, but it's not something I'd recommend someone do for fun. Sedatives don't work that great on Leif, so it was uncomfortable for him. They pour some wash fluid into the lung and then draw it back into the scope, in order to get a sample to test. The goal is to determine what, precisely, they saw on the CT scan, so they know how to treat it. Because his reflexes were working just fine when the wash fluid went into his lungs, he started coughing and they had to finish up rather quickly. They did get enough sample back to be able to culture and test, just not as much as would have been ideal. Fortunately, the sedatives they gave him prevent him from remembering the most unpleasant part. Hurrah for drugs.
He's running a fever, and is getting oxygen, a smorgasbord of antibiotics, an antifungal pill, Tylenol, etc. One more unit of blood is scheduled for this evening, and then with any luck they'll be done checking his vital signs so often for the night. I'm hopeful that he can get a good night's sleep rather than a series of interrupted cantaps like he's been getting. He's been holding up well considering, and earlier today was feeling alert enough to do something besides sleep. Now he's awake and drinking plenty of liquids, but feeling quite wiped out from the procedure, fever, etc. He is planning to eat some supper once his antinausea medication kicks in, since he had to fast all day today prior to the procedure. He fasted most of yesterday, too, because they were still hoping to do the bronchoscopy then.
Leif's main oncologist came by this evening about 6:45. She talked with the transplant specialist at Dartmouth, who has suggested another antifungal to give him. That they should know more about the best way to treat the lung situation tomorrow, once information from the bronchial sample starts coming back. Data will trickle in over a number of days, since some tests are cultures, which take time, and some are sent to other locations to be tested. The antibiotics he's been getting so far do not seem to be getting to either infection, either the one in his lungs or the one in his GI tract. The lung one has the doctors more worried, but the GI one is causing Leif more immediate pain.
He's been getting so many platelets to so little effect, that a couple of things might be happening. One is that his spleen is so large, the platelets they're infusing are getting sucked up by his spleen, which has been swelling as he's been getting all these transfusions. The other thing that is probably happening is alloimmunization. His body forms antibodies against the foreign platelets, and takes them out as fast as they infuse them. This is likely considering the huge amount of platelets he's gotten over the past two days, and the small increase in platelet levels in his blood. The transplant doc made some recommendations about how to infuse platelets that might get around that response somewhat. He thinks that Leif's spleen will continue to shrink on its own. Once his bone marrow starts making a decent quantity of platelets again, these two effects will diminish. But in the meantime, they need to do everything they can to keep his platelet levels up. Having blood that won't clot is risky for a host of reasons.
I mentioned a few days ago that Leif is having vision problems in his left eye. They've determined that it's from retinal bleeding (due to low platelet count). There is nothing along his optic nerve, and nothing wrong in his brain. Therefore, when his platelet count improves, his body should clear the blood away on its own with no lasting ill effects.
Today we got to see the inside of Leif's bronchial tubes. Which was cool, but it's not something I'd recommend someone do for fun. Sedatives don't work that great on Leif, so it was uncomfortable for him. They pour some wash fluid into the lung and then draw it back into the scope, in order to get a sample to test. The goal is to determine what, precisely, they saw on the CT scan, so they know how to treat it. Because his reflexes were working just fine when the wash fluid went into his lungs, he started coughing and they had to finish up rather quickly. They did get enough sample back to be able to culture and test, just not as much as would have been ideal. Fortunately, the sedatives they gave him prevent him from remembering the most unpleasant part. Hurrah for drugs.
He's running a fever, and is getting oxygen, a smorgasbord of antibiotics, an antifungal pill, Tylenol, etc. One more unit of blood is scheduled for this evening, and then with any luck they'll be done checking his vital signs so often for the night. I'm hopeful that he can get a good night's sleep rather than a series of interrupted cantaps like he's been getting. He's been holding up well considering, and earlier today was feeling alert enough to do something besides sleep. Now he's awake and drinking plenty of liquids, but feeling quite wiped out from the procedure, fever, etc. He is planning to eat some supper once his antinausea medication kicks in, since he had to fast all day today prior to the procedure. He fasted most of yesterday, too, because they were still hoping to do the bronchoscopy then.
Leif's main oncologist came by this evening about 6:45. She talked with the transplant specialist at Dartmouth, who has suggested another antifungal to give him. That they should know more about the best way to treat the lung situation tomorrow, once information from the bronchial sample starts coming back. Data will trickle in over a number of days, since some tests are cultures, which take time, and some are sent to other locations to be tested. The antibiotics he's been getting so far do not seem to be getting to either infection, either the one in his lungs or the one in his GI tract. The lung one has the doctors more worried, but the GI one is causing Leif more immediate pain.
He's been getting so many platelets to so little effect, that a couple of things might be happening. One is that his spleen is so large, the platelets they're infusing are getting sucked up by his spleen, which has been swelling as he's been getting all these transfusions. The other thing that is probably happening is alloimmunization. His body forms antibodies against the foreign platelets, and takes them out as fast as they infuse them. This is likely considering the huge amount of platelets he's gotten over the past two days, and the small increase in platelet levels in his blood. The transplant doc made some recommendations about how to infuse platelets that might get around that response somewhat. He thinks that Leif's spleen will continue to shrink on its own. Once his bone marrow starts making a decent quantity of platelets again, these two effects will diminish. But in the meantime, they need to do everything they can to keep his platelet levels up. Having blood that won't clot is risky for a host of reasons.
I mentioned a few days ago that Leif is having vision problems in his left eye. They've determined that it's from retinal bleeding (due to low platelet count). There is nothing along his optic nerve, and nothing wrong in his brain. Therefore, when his platelet count improves, his body should clear the blood away on its own with no lasting ill effects.
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