Post Transplant Day 9
Yesterday was the calm before the storm. I might as well use cliches to start and finish.
We were so upbeat yesterday when Karl was feeling so much better. I posted the blog early, but shortly after he started feeling some nausea. He was given some maxeron via iv and shortly after the diarrhea returned with a vengeance. Karl says it was every 5 minutes or so until around 2am, and after that it was every 20 to 30 minutes, but never longer between bathroom runs. Might as well use puns too. Last night and today is definitely the sickest he has been through this whole ordeal.
Dr. MacIntyre is the hemotologist on call today. She came in early this morning. She said the Flagyl wasn’t working as well as she would like, so she wanted to switch him to Vancomycin. We reminded her that Karl’s chart lists an adverse reaction to Vancomycin from his last hospitalization. She said she knew, but before Vancomycin was given through iv and was filtered through the kidneys, causing the creatinine rise. Now she wanted to give it in pill form, which would go through his digestive system and stay in the bowels. We had to trust her judgment because when you have no neutrophils you can’t fight an infection without antibiotics, and the Flagyl isn’t working.
Yes that last sentence means that there was no stem cell happy dance today. Neutrophils still measure as 0.0. His platelets are 22, so the blood thinner lovenox was held for the second day in a row. Charlene told us yesterday that they won’t give him platelets unless the level drops below 10. His potassium is also still down, and the bag of iv potassium just finished and another bag of fluids to combat dehydration was just hung on the iv pole.
Dr. MacIntyre also recommended that they bring in a commode so that he wouldn’t have to try to get to the bathroom with his iv pole.
I try to find some positives, and there are some. Neutrophils are just part of the overall white blood cells, so the neutrophil level is always lower than total white blood cells. For instance, when Karl given the high dose chemo malphalan on November 30, his neutrophils were 2.0, and his overall white blood cells were 3.5. Both of these measures are low normal. Yesterday and on Thursday Karl’s neutrophils were 0.0, and his overall white blood count was 0.1. Today the neutrophils are still 0.0, but the white blood count is 0.2. I may be reaching for a positive, but I’m choosing to take that as a good sign.
Hemoglobin is another positive. Yesterday it was 83 and today it is 91. Charlene told us that neutrophils would rise first, then platelets, and then hemoglobin, so it doesn’t really make sense, but at least they didn’t fall today.
Another positive is his vitals. Despite being very sick, Karl’s blood pressure has remained fairly constant between 100/70 and 110/70. Both low, but not alarmingly low. Also, he has not had a high temperature at all this time in hospital, and his Hickman catheter hasn’t given him any problems. Fingers crossed.
Finally, he is more settled now and hasn’t had diarrhea in 45 minutes or so. Fingers crossed there too and for a better tomorrow, because...it’s always darkest before the dawn right?
We were so upbeat yesterday when Karl was feeling so much better. I posted the blog early, but shortly after he started feeling some nausea. He was given some maxeron via iv and shortly after the diarrhea returned with a vengeance. Karl says it was every 5 minutes or so until around 2am, and after that it was every 20 to 30 minutes, but never longer between bathroom runs. Might as well use puns too. Last night and today is definitely the sickest he has been through this whole ordeal.
Dr. MacIntyre is the hemotologist on call today. She came in early this morning. She said the Flagyl wasn’t working as well as she would like, so she wanted to switch him to Vancomycin. We reminded her that Karl’s chart lists an adverse reaction to Vancomycin from his last hospitalization. She said she knew, but before Vancomycin was given through iv and was filtered through the kidneys, causing the creatinine rise. Now she wanted to give it in pill form, which would go through his digestive system and stay in the bowels. We had to trust her judgment because when you have no neutrophils you can’t fight an infection without antibiotics, and the Flagyl isn’t working.
Yes that last sentence means that there was no stem cell happy dance today. Neutrophils still measure as 0.0. His platelets are 22, so the blood thinner lovenox was held for the second day in a row. Charlene told us yesterday that they won’t give him platelets unless the level drops below 10. His potassium is also still down, and the bag of iv potassium just finished and another bag of fluids to combat dehydration was just hung on the iv pole.
Dr. MacIntyre also recommended that they bring in a commode so that he wouldn’t have to try to get to the bathroom with his iv pole.
I try to find some positives, and there are some. Neutrophils are just part of the overall white blood cells, so the neutrophil level is always lower than total white blood cells. For instance, when Karl given the high dose chemo malphalan on November 30, his neutrophils were 2.0, and his overall white blood cells were 3.5. Both of these measures are low normal. Yesterday and on Thursday Karl’s neutrophils were 0.0, and his overall white blood count was 0.1. Today the neutrophils are still 0.0, but the white blood count is 0.2. I may be reaching for a positive, but I’m choosing to take that as a good sign.
Hemoglobin is another positive. Yesterday it was 83 and today it is 91. Charlene told us that neutrophils would rise first, then platelets, and then hemoglobin, so it doesn’t really make sense, but at least they didn’t fall today.
Another positive is his vitals. Despite being very sick, Karl’s blood pressure has remained fairly constant between 100/70 and 110/70. Both low, but not alarmingly low. Also, he has not had a high temperature at all this time in hospital, and his Hickman catheter hasn’t given him any problems. Fingers crossed.
Finally, he is more settled now and hasn’t had diarrhea in 45 minutes or so. Fingers crossed there too and for a better tomorrow, because...it’s always darkest before the dawn right?
Comments
Post a Comment