Posted by Becky
Today was a day with one answer and many questions. The answer is, the new bug in his bloodstream is Klebsiella pneumoniae, a gut bacteria. I'm not linking to the wikipedia entry, because that's mostly about how dire it is to have multi-drug resistant Klebsiella in your lungs, and Leif does not have it in his lungs, just his butt and his bloodstream. The "flavor" of microbe Leif has is resistant to Zosyn, but they expect it to respond to the doripenem. Doripenem also covers the other enterobacter (gut bacteria) that caused the infection of Dec. 26.
The concern now is his port. If the new blood cultures don't show the infection clearing, they will need to take his port out, because all the antibiotics in the world won't clear it up if there's a secondary infection in the port. Blood cultures over the next few days will guide the doctors in that decision.
Last night's nurse told us the blood bank did find that Leif has antibodies to some blood proteins, so they're doing additional screening on his blood now before transfusions. The screened blood should give Leif a better boost from each transfusion than he's been getting lately.
Leif got an ultrasound this morning on the painful knot-like spot on his back. Over the last couple of days, he's gotten a round lump there, not like a muscle knot, and it and the skin around it is rather red. The ultrasound showed there's something there, but not much information on what it could be. It doesn't look like fluid. The Infectious Disease team would like a biopsy; their concern is that it might be fungal. The Infectious Disease doctor who met with us today notes that it's a weird place to spontaneously develop an abscess, so she thinks it's less likely to be this same Klebsiella infection. She doesn't think it's lymphoma or a drug rash. She contacted the dermatology department to come take a look and do a biopsy.
Leif went out for a short walk about 3:45, and while he was doing some gentle stretching, he felt and heard a "pop," the muscle tension around that spot released, he felt increased blood flow into his arm on that side, and the pain level dropped. The swelling is still there, and it's still sore to the touch, but less so.
Late this afternoon, a guy from Dermatology stopped by and looked at the spot, poked and prodded it some more. He and one of the higher-up Dermatology docs decided that it's too deep under the skin to be a good candidate for the type of biopsy they would do. Also, Leif's platelets are low. They therefore recommended that someone load Leif up on platelets, and have General Surgery do the biopsy instead. They opined that it does not look fungal to them, and thought it was likely to be an infection that isn't forming a fluid-filled abscess because Leif's white blood cell count is so low (as happened with his butt the first time it got infected), or possibly a cyst. They feel like since the pain is less, maybe it's responding to the antibiotic Leif is on, and that the swelling will take time to resolve.
So, who knows. Meanwhile, the day was so busy that Leif did not get to nap at all. He's taking his third and probably final sitz bath of the day now and hopes to go to bed for the night shortly (6:30 pm). The nurses will need to come in and switch out his antibiotic and give him some blood, but he can somewhat sleep through those activities. He was able to eat a small breakfast, a nearly-normal size lunch, and a decent size dinner today, after two days of only having the stomach for two meals per day. He also got more activity today; although he doesn't hurt if he sits still, and hurts quite a bit if he moves around, he went for a couple of short walks today and spent more time moving around the room, doing personal maintenance and also playing with his fun new remote-controlled helicopter. He continues to feel a lot of soreness in his legs and butt. The leg soreness feels like he ran a long distance without training for it first.
Leif punked one of the nurses pretty well today. She was giving him a bunch of big yellow potassium pills, and one landed on the floor. When she went out to get another one, he slipped a nearly identical-looking yellow M&M into the pill cup. She was perplexed by the new pill, until she saw him grinning. It sounds like that story has made the rounds, out in the pod.
The attending physician (main hematology doctor) switched out today. The new doc assigned to Leif is one he's had before, who tends to do his rounds quite late in the evening. I was hoping to go back to the apartment after work today to take a shower and switch out the clothes in my overnight bag. But I have questions for the attending (about the leg cramps, and an explanation for some new minerals and vitamins Leif started getting today -- maybe they are related?), and after a pain-filled day that included discussion of port removal, peripheral IVs, and needle biopsies, with no naps, Leif is much too tired to ask questions or grasp answers. So it looks like I'll be staying here this evening, unless by some miracle the attending shows up before 9:00.
Today was a day with one answer and many questions. The answer is, the new bug in his bloodstream is Klebsiella pneumoniae, a gut bacteria. I'm not linking to the wikipedia entry, because that's mostly about how dire it is to have multi-drug resistant Klebsiella in your lungs, and Leif does not have it in his lungs, just his butt and his bloodstream. The "flavor" of microbe Leif has is resistant to Zosyn, but they expect it to respond to the doripenem. Doripenem also covers the other enterobacter (gut bacteria) that caused the infection of Dec. 26.
The concern now is his port. If the new blood cultures don't show the infection clearing, they will need to take his port out, because all the antibiotics in the world won't clear it up if there's a secondary infection in the port. Blood cultures over the next few days will guide the doctors in that decision.
Last night's nurse told us the blood bank did find that Leif has antibodies to some blood proteins, so they're doing additional screening on his blood now before transfusions. The screened blood should give Leif a better boost from each transfusion than he's been getting lately.
Leif got an ultrasound this morning on the painful knot-like spot on his back. Over the last couple of days, he's gotten a round lump there, not like a muscle knot, and it and the skin around it is rather red. The ultrasound showed there's something there, but not much information on what it could be. It doesn't look like fluid. The Infectious Disease team would like a biopsy; their concern is that it might be fungal. The Infectious Disease doctor who met with us today notes that it's a weird place to spontaneously develop an abscess, so she thinks it's less likely to be this same Klebsiella infection. She doesn't think it's lymphoma or a drug rash. She contacted the dermatology department to come take a look and do a biopsy.
Leif went out for a short walk about 3:45, and while he was doing some gentle stretching, he felt and heard a "pop," the muscle tension around that spot released, he felt increased blood flow into his arm on that side, and the pain level dropped. The swelling is still there, and it's still sore to the touch, but less so.
Late this afternoon, a guy from Dermatology stopped by and looked at the spot, poked and prodded it some more. He and one of the higher-up Dermatology docs decided that it's too deep under the skin to be a good candidate for the type of biopsy they would do. Also, Leif's platelets are low. They therefore recommended that someone load Leif up on platelets, and have General Surgery do the biopsy instead. They opined that it does not look fungal to them, and thought it was likely to be an infection that isn't forming a fluid-filled abscess because Leif's white blood cell count is so low (as happened with his butt the first time it got infected), or possibly a cyst. They feel like since the pain is less, maybe it's responding to the antibiotic Leif is on, and that the swelling will take time to resolve.
So, who knows. Meanwhile, the day was so busy that Leif did not get to nap at all. He's taking his third and probably final sitz bath of the day now and hopes to go to bed for the night shortly (6:30 pm). The nurses will need to come in and switch out his antibiotic and give him some blood, but he can somewhat sleep through those activities. He was able to eat a small breakfast, a nearly-normal size lunch, and a decent size dinner today, after two days of only having the stomach for two meals per day. He also got more activity today; although he doesn't hurt if he sits still, and hurts quite a bit if he moves around, he went for a couple of short walks today and spent more time moving around the room, doing personal maintenance and also playing with his fun new remote-controlled helicopter. He continues to feel a lot of soreness in his legs and butt. The leg soreness feels like he ran a long distance without training for it first.
Leif punked one of the nurses pretty well today. She was giving him a bunch of big yellow potassium pills, and one landed on the floor. When she went out to get another one, he slipped a nearly identical-looking yellow M&M into the pill cup. She was perplexed by the new pill, until she saw him grinning. It sounds like that story has made the rounds, out in the pod.
The attending physician (main hematology doctor) switched out today. The new doc assigned to Leif is one he's had before, who tends to do his rounds quite late in the evening. I was hoping to go back to the apartment after work today to take a shower and switch out the clothes in my overnight bag. But I have questions for the attending (about the leg cramps, and an explanation for some new minerals and vitamins Leif started getting today -- maybe they are related?), and after a pain-filled day that included discussion of port removal, peripheral IVs, and needle biopsies, with no naps, Leif is much too tired to ask questions or grasp answers. So it looks like I'll be staying here this evening, unless by some miracle the attending shows up before 9:00.
The m&m hijinks made me laugh out loud and then cry, out of gratitude that in the middle of all that pain, fear and uncertainty, Leif's still full of humor (many of them, it seems, but the yellow-m&m-punkin' humor is my current favorite).
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