8:55pm Thursday
It is now 8:55, and Marie and I are waiting in the "Family Waiting Room" next to the ICU, an overcrowded, noisy, unpleasant place with loud conversation (most in Spanish) and unruly children. Austin is in room E260. I was able to speak to him for a moment. He appears calm, and his fever feels lower. The last I heard it reported was about 102. His room has a busy influx of nurses and doctors, so he is getting a lot of attention. At this point, his blood pressure is a matter of concern - it is in the vicinity of 80/40. However, his pulse is described as very strong.
The procedure as far as I know it now:
1. Install an arterial blood pressure monitor. This gives better BP monitoring.
2. Remove the Hickman catheter. This is what they suspect is causing an infection. When they remove it, there are signs they will be able to see easily indicating if an infection is underway. However, if they see nothing, that is not proof there is no infection.
3. Install a new port. This one will be in a vein near an elbow. (uncertain if I heard this correctly.)
4. Administer antibiotics - they have been doing so a couple of days already. Cultures are in progress, and if any are positive that will assist in optimizing the antibiotic.
5. Delay Cytoxan a day. Stay in ICU for at least a day.
We are worried of course. An infection for any patient with a near-zero white cell count is a serious matter. They have not said for certain that they believe this is a bacterial infection instead of a chemo reaction, but it appears that they must at least assume that is the case until proven otherwise.
Updates to be added, hourly if necessary.
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Update, 11:05pm Thursday
We were able to visit him finally. Status:
1. Hickman catheter is out. They saw no signs of infection on the catheter, but the site seems inflamed, so they feel that is likely the cause.
2. An arterial BP monitor is installed in his left arm. Doing this, they found his central BP to be normal. That shows that the fever was causing his peripheral BP to vary. That is good to know, and is presumably good news.
3. He has a new central port installed in his neck. Wow, that was fast. It is on his right side, and I get the impression that it is somewhat annoying for him.
4. His fever is closer to 101 now, going down slowly. He says he feels tired and wants to get some sleep.
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Update, 0900am Friday
It is frustrating trying to get through to the ICU by phone. Only on the 5th time did I get connected to the right room and the phone was answered. The nurse handed the phone to Austin. When I asked him how he was doing, he said "Not great." His temperature is 38.3C which is 100.9F. That is considered to be a low fever. He said his temperature went up again, but if it is 100.9 now, it must have fallen again - or I got the wrong temperature from him. It was a very short call. He also reports that he is uncomfortable and has not eaten anything.
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Update, 10:20am Friday
Phone call from Marie. She reports that the doctors have seen Austin, and that he is "doing much better" and that he may move back down to his BMT unit later this afternoon.
Thursday, October 30, 2008
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6 comments:
Thanks for the updates Marie and Barbara. We are waiting anxiously for good news that he has turned this awful corner.
Love and good bacteria-killing vibes coming Austin's way,
Laurie
11:30 PM. Thursday. I didn't notice I had a voicemail until a few minutes ago, I had assumed everything was going along well until I heard the message from Ole. I quickly read the updated blog from Barbara and Marie. I am confident he is in the best place. I'm praying for an answer to the infection so they can treat it right and comfort for Austin. Please call me anytime but use my cell phone so I'm sure to get the message right away (the 299 #). I'm waiting for better news. Love you, Nana
It gives me chills just reading this as I relive my husband's BMT experience - the Hickmann was the bain of Wullie's existence - they didn't act as quickly as they are with Austin regarding whipping the catheter out - Wullie had repeated infections in his line and each time they felt that they had 'dealt' with it, the infection just came back! Eventually they took it out - job done! The recovery after that was incredibly fast.
It is so hard to watch your loved one going through something so life-threatening but please take heart from the fact that the medical team looking after Austin deal with this on a daily basis and he is in the absolute best place to have every major and minor issue dealt with.
Thank you so much for your updates - much love to you all from Scotland............Vx
Thank you for the update. What an incredible 24 hours Austin has endured. He's a tough guy. Hopefully the worst is over and his vitals will continue to improve.
Marie and Barbara -- thanks so much for the frequent updates. I wish I were at Stanford right now, but as it is, I'm grateful that you're keeping me informed!
For the sake of the record, the cultures that were taken of Austin's blood and the catheter itself all came back clean. No evidence of infection. The only deduction possible is that the fever was caused by a reaction to one of the chemo agents. BCNU? Gemzar? Austin's symptoms were very close to those of Septic Fever (also called Sepsis nowadays...) Septic fever is when free bacteria are circulating in the blood. It is a life-threatening condition. But if all the cultures came back negative, are we left with any good explanation of his fever? This may remain a mystery. It was a very very bad episode, but it may not have had anything to do with an infected catheter after all.
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