Posted by Becky
Sunday morning we thought Leif was in for a quiet day, but we were mistaken. The attending hematology doctor for this week, Dr. Danilov, came in to discuss why he wanted Leif to get a CT scan of his abdomen and pelvis. The last one he got was over a month ago, and they wanted to make sure there isn't a hidden bleed in his belly due to the low platelets. His red blood counts are staying low despite the transfusions. The results of the CT came through late last night or early this morning, and do not show any bleeding.
They decided to give him the CT contrast solution via IV rather than in a beverage, which Leif was glad about since that stuff is gross to drink. They can give it IV if his kidneys are in good shape.
Unfortunately, after the CT, his port was clogged, and his temperature started going up. Although everyone's immediate concern was that his port had gotten infected, it appears that the CT people had not flushed it properly after infusing the contrast solution; Leif's nurse was able to get it working again. But, all that messing around with his port made it sore and left Leif feeling pretty beat up, not to mention feeling bad because of the fever. He also got severe cramps in his calves and what felt like gas or stomach pain (not on the spleen side); nobody knows why. I had gone back to the apartment for the afternoon, and returned to a sad and sorry Leif.
Overnight, his fever spiked to 102 degrees F (38.8 C), and his heart rate was also very high. At one point when he stood up to go to the bathroom, his pulse got up to 160 beats per minute and brought a nurse running (he was hooked up to a pulse and oxygen monitor). For much of the night it ranged between 130 and 140. He had some belly pain that came and went, and felt headachey. It was a busy night with nurses and doctors coming in to check on things and ask vague questions that were confusing to Leif in his sleepy, feverish state.
This morning Leif's temperature was down to 98.8 F (37.1 C) and his pain was a bit better, though now he has a gigantic muscle knot in his back. His leg cramps have eased, though the muscles are sore from having been cramped. He didn't think he was hungry. But a fabulous nursing assistant that Leif has made friends with brought him a loaf of fresh home-made bread this morning, and he happily ate three slices with peanut butter. As he was finishing up the third slice of bread, the colorectal surgeon, Dr. Holubar, stopped in to tell Leif they were putting a stop on his eating and drinking for the day so they could do another MRI and then, if necessary, drain any abscess they find in his backside. He said that yesterday's CT showed a small accumulation of fluid somewhere in there, and he'd like to check it out more thoroughly, since he thinks that Leif's bottom is the most likely source of any new infection, possibly an abscess deep enough that it's not showing symptoms on the surface (where the signs are that things are improving).
After his bread, Leif had the energy to do a sitz bath, wash up, and change out of his sweaty clothes. The nursing assistant changed his sheets while he was doing that, and now he's sleeping soundly while getting some platelets. As long as he has a fever, they will keep his platelet levels over 10; they keep them over 5 when his temperature is normal. After the platelets are done, they'll give him some more red blood cells. He also got a unit of blood very early this morning (around 4am, if my memory serves me - I woke up when it was almost finished).
Dr. Danilov and the new fellow, Dr. Mody, came in just now and outlined the plan of investigation. They think the two most likely possibilities for the fever are:
Sunday morning we thought Leif was in for a quiet day, but we were mistaken. The attending hematology doctor for this week, Dr. Danilov, came in to discuss why he wanted Leif to get a CT scan of his abdomen and pelvis. The last one he got was over a month ago, and they wanted to make sure there isn't a hidden bleed in his belly due to the low platelets. His red blood counts are staying low despite the transfusions. The results of the CT came through late last night or early this morning, and do not show any bleeding.
They decided to give him the CT contrast solution via IV rather than in a beverage, which Leif was glad about since that stuff is gross to drink. They can give it IV if his kidneys are in good shape.
Unfortunately, after the CT, his port was clogged, and his temperature started going up. Although everyone's immediate concern was that his port had gotten infected, it appears that the CT people had not flushed it properly after infusing the contrast solution; Leif's nurse was able to get it working again. But, all that messing around with his port made it sore and left Leif feeling pretty beat up, not to mention feeling bad because of the fever. He also got severe cramps in his calves and what felt like gas or stomach pain (not on the spleen side); nobody knows why. I had gone back to the apartment for the afternoon, and returned to a sad and sorry Leif.
Overnight, his fever spiked to 102 degrees F (38.8 C), and his heart rate was also very high. At one point when he stood up to go to the bathroom, his pulse got up to 160 beats per minute and brought a nurse running (he was hooked up to a pulse and oxygen monitor). For much of the night it ranged between 130 and 140. He had some belly pain that came and went, and felt headachey. It was a busy night with nurses and doctors coming in to check on things and ask vague questions that were confusing to Leif in his sleepy, feverish state.
This morning Leif's temperature was down to 98.8 F (37.1 C) and his pain was a bit better, though now he has a gigantic muscle knot in his back. His leg cramps have eased, though the muscles are sore from having been cramped. He didn't think he was hungry. But a fabulous nursing assistant that Leif has made friends with brought him a loaf of fresh home-made bread this morning, and he happily ate three slices with peanut butter. As he was finishing up the third slice of bread, the colorectal surgeon, Dr. Holubar, stopped in to tell Leif they were putting a stop on his eating and drinking for the day so they could do another MRI and then, if necessary, drain any abscess they find in his backside. He said that yesterday's CT showed a small accumulation of fluid somewhere in there, and he'd like to check it out more thoroughly, since he thinks that Leif's bottom is the most likely source of any new infection, possibly an abscess deep enough that it's not showing symptoms on the surface (where the signs are that things are improving).
After his bread, Leif had the energy to do a sitz bath, wash up, and change out of his sweaty clothes. The nursing assistant changed his sheets while he was doing that, and now he's sleeping soundly while getting some platelets. As long as he has a fever, they will keep his platelet levels over 10; they keep them over 5 when his temperature is normal. After the platelets are done, they'll give him some more red blood cells. He also got a unit of blood very early this morning (around 4am, if my memory serves me - I woke up when it was almost finished).
Dr. Danilov and the new fellow, Dr. Mody, came in just now and outlined the plan of investigation. They think the two most likely possibilities for the fever are:
- A transfusion reaction. This would be caused if Leif's body has started reacting to certain proteins in the blood products he's been getting. His fevers are somewhat synchronized with receiving blood products; therefore, they could be an immune response to the transfusions. A sign this may be the case is that his bilirubin levels are elevated, an indicator of hemolysis, which is the breakdown of red blood cells. Another sign this might be the case is that although they have given him a lot of transfusions, his red blood cell levels are staying the same or dropping, indicating that his body could be destroying the new red blood cells as quickly as they get transfused. The doctors will work with the blood bank to determine which proteins could be causing the transfusion reaction, and then Leif will only get blood that has been screened for those proteins.
- An infection (presumably in his bottom) that has become resistant to the antibiotics Leif's been on, necessitating a change in antibiotics.
Ughh. I haven't checked on the blog in a few days. These recent complications really suck. I hope he is having a better day today.
ReplyDeleteI agree with Craig. Am glad to hear your temperature is down this morning but sorry you have to have more tests, Leif, although if they help figure out what's up, it's all in a good cause.
ReplyDelete