Posted by Becky
Thursday afternoon, the surgeon came by to check on Leif's butt. Other than the infection, he was pleased and enthusiastic about the amount of healing that has taken place. After Leif got a slug of fentanyl (strong painkiller), he drained a very small amount of pus, all he thought was likely to be in there due to Leif's neutropenia, and drew a line around the reddened area, so any changes would be noticeable. A resident came by later that evening to check it again, and the amount of redness was about the same. Leif got an MRI, to help decide whether the infection needed to be drained/cleaned up surgically, although the surgeon suspected that would not be necessary. By Thursday evening, Leif was feeling quite a bit better, sitting up and chatting. He enjoyed a big dinner, saved from Christmas.
On Friday, they drew a bunch more blood cultures, because the positive culture (of gram-negative bacteria) had been drawn from Leif's port. They always keep a sharp eye on anything that might indicate an infected port. The infectious disease doc came in and checked Leif's port for pain or any other sign of infection, and thought it looked good. He says that he thinks Leif quickly cleared the bloodstream infection, which likely originated from his troublesome butt, but could have originated from his port; at any rate, they will continue at least two weeks of IV antibiotics (Zosyn and Daptomycin) and do the aforementioned blood cultures.
Two infectious disease doctors visited again in the afternoon. Leif's bottom was hurting less, and the MRI did not show anything concerning, other than the inflammation we already knew about, so everyone agreed there was no need for surgery. They will give him a lot of antibiotics and watch and see what time brings, both in terms of an abscess and the blood cultures. The whole episode was not super-surprising based on Leif's suppressed immune system, but the infectious disease team will continue to watch Leif closely for the next few days. The fact that he hasn't had trouble with his port (clogging or anything like that) is one indicator that the bug in his bloodstream was more likely to have come from his bottom than his port.
Friday afternoon Leif got his second dose of Rituxan for this chemo cycle. In the middle of the dose, he had a sudden onset of severe pain in his abdomen, a feeling like a rash in his mouth, and sudden rawness in his throat. They stopped the Rituxan, gave him a dose of IV painkiller, and monitored him carefully. His vital signs (blood pressure, temperature, heart rate) were fine. The doctors discussed doing an xray of his belly to check for trouble there; but in an hour or two, Leif's pain simmered back down, his vital signs continued to look good, and they decided to restart the Rituxan. This was unlike either a classic Rituxan reaction, or Leif's previous Rituxan reactions. Leif was getting Reiki when the pain started; could this have been a side effect of that? There's no telling. At any rate, by the time the Rituxan dose was over, Leif was sitting up working on his computer, he was able to "pick away" at his dinner until the entire thing was gone, and his pain and energy levels were back to baseline for this week.
He looked so good, I decided to go back to the apartment for a good night's sleep and a shower, and did laundry and ran some errands this morning. The snowfall here has been crazy - we're getting a ton of really nice fluffy snow, and the weather is staying cold (high teens, low twenties) so the snow is piling up. It's gorgeous, although it makes for some slow traffic. Our new car and new snow tires are handling the messy roads great. I've been leaving the car in the parking garage, even though it's about a 10-minute walk through DHMC from the garage to Leif's room, because I'd rather spend 20 minutes walking to and from the car than 10 minutes digging the car out of a foot of snow.
Leif got two units of red blood cells today, and went for his usual walk. When I got here about 2:30, he was listening to music while getting his blood, and since then he's been napping. I expect that once the blood kicks in, he'll feel a bit more lively.
Thursday afternoon, the surgeon came by to check on Leif's butt. Other than the infection, he was pleased and enthusiastic about the amount of healing that has taken place. After Leif got a slug of fentanyl (strong painkiller), he drained a very small amount of pus, all he thought was likely to be in there due to Leif's neutropenia, and drew a line around the reddened area, so any changes would be noticeable. A resident came by later that evening to check it again, and the amount of redness was about the same. Leif got an MRI, to help decide whether the infection needed to be drained/cleaned up surgically, although the surgeon suspected that would not be necessary. By Thursday evening, Leif was feeling quite a bit better, sitting up and chatting. He enjoyed a big dinner, saved from Christmas.
On Friday, they drew a bunch more blood cultures, because the positive culture (of gram-negative bacteria) had been drawn from Leif's port. They always keep a sharp eye on anything that might indicate an infected port. The infectious disease doc came in and checked Leif's port for pain or any other sign of infection, and thought it looked good. He says that he thinks Leif quickly cleared the bloodstream infection, which likely originated from his troublesome butt, but could have originated from his port; at any rate, they will continue at least two weeks of IV antibiotics (Zosyn and Daptomycin) and do the aforementioned blood cultures.
Two infectious disease doctors visited again in the afternoon. Leif's bottom was hurting less, and the MRI did not show anything concerning, other than the inflammation we already knew about, so everyone agreed there was no need for surgery. They will give him a lot of antibiotics and watch and see what time brings, both in terms of an abscess and the blood cultures. The whole episode was not super-surprising based on Leif's suppressed immune system, but the infectious disease team will continue to watch Leif closely for the next few days. The fact that he hasn't had trouble with his port (clogging or anything like that) is one indicator that the bug in his bloodstream was more likely to have come from his bottom than his port.
Friday afternoon Leif got his second dose of Rituxan for this chemo cycle. In the middle of the dose, he had a sudden onset of severe pain in his abdomen, a feeling like a rash in his mouth, and sudden rawness in his throat. They stopped the Rituxan, gave him a dose of IV painkiller, and monitored him carefully. His vital signs (blood pressure, temperature, heart rate) were fine. The doctors discussed doing an xray of his belly to check for trouble there; but in an hour or two, Leif's pain simmered back down, his vital signs continued to look good, and they decided to restart the Rituxan. This was unlike either a classic Rituxan reaction, or Leif's previous Rituxan reactions. Leif was getting Reiki when the pain started; could this have been a side effect of that? There's no telling. At any rate, by the time the Rituxan dose was over, Leif was sitting up working on his computer, he was able to "pick away" at his dinner until the entire thing was gone, and his pain and energy levels were back to baseline for this week.
He looked so good, I decided to go back to the apartment for a good night's sleep and a shower, and did laundry and ran some errands this morning. The snowfall here has been crazy - we're getting a ton of really nice fluffy snow, and the weather is staying cold (high teens, low twenties) so the snow is piling up. It's gorgeous, although it makes for some slow traffic. Our new car and new snow tires are handling the messy roads great. I've been leaving the car in the parking garage, even though it's about a 10-minute walk through DHMC from the garage to Leif's room, because I'd rather spend 20 minutes walking to and from the car than 10 minutes digging the car out of a foot of snow.
Leif got two units of red blood cells today, and went for his usual walk. When I got here about 2:30, he was listening to music while getting his blood, and since then he's been napping. I expect that once the blood kicks in, he'll feel a bit more lively.
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