Holding Steady on Shifting Sands

Not much going on in the last few days that makes for either pleasant reading or writing and no significant progress either.

We are on the tenth day out from the second transplant and if luck is shining on us, then in the next 4 to 10 days we'll see Jim's white blood counts go up.  They are still at rock bottom.  That's the key to everything.

In the meantime, all the amazing care givers at City of Hope are doing a dance with Jim, his drugs, his infections, his organs and his will.  The dance is to an ever changing tune, with ever changing partners.  Sometimes there is a fever, sometimes a culture shows something of interest, or the bladder interrupts the kidneys then the lungs ask for a turn on the floor.

Enough with the metaphor already, I hear you say.  Right.

What is happening now, and for the last few days, is that Jim is showing various symptoms such as fever, rigor (shaking), bleeding, and clotting.  These are related to either his infections (fungal or otherwise- we keep checking to see what sort of bugs he may have) or side effects of the drugs, his lengthy bed stay or whatever.

So, who are the dance partners?  Sometimes it is the bladder and the Foley that is draining it.  Those Terpsichorians are rather dramatic and fall distinctly into the "no fun" category.  The kidney functions are reasonable, but there is blood passing through the urine, likely coming from the bladder.  Now and then a blood clot blocks the Foley line.  The nurses have been able to flush the clots through but doing that hurts.  Beyond what Jim's kidneys produce, the bladder is also being irrigated with saline solution to help dislodge the blood clots.  The amount of saline flushing the bladder is adjusted in an effort to find the best results.  That also changes the frequency for emptying the Foley collection bag- a task that cannot be delayed.  Try sleeping though the night when toilet is flushed every thirty minutes.  You can do it if you wear earplugs.

The numbers of platelets in Jim's blood ranges wildly.  That's good in that the transfusions are effective. Why are the platelets going down so fast? The platelets die off quickly; they are used up fighting infections and also run off with the bleeding   The nurses are measuring and transfusing platelets more often trying to even out the numbers.

He has had some high fevers.  They blast through- showy dance partners. Tylenol, cold compresses and sometimes airing and rubbing down his whole body lower his temperature.  The fevers could be reactions to the drugs, infections, or even engraftment of the second transplant or a combination of the three.  They don't last long.

The lungs are relatively stable- your basic fox trot.  The drain in the pleural space is working well, the flow through it is low.  Jim is not on any oxygen assistance, he's breathing well enough on his own, but does get respiratory treatments six times a day and argues significantly but with no effect at all, about using his incentive spirometer.

Another partner, one of the side effect dance group, is edema.  Water ballet anyone? Lots of bloating and water retention.  Lasix is the drug of choice for that, but as peeing is the only way to remove the fluids from a bed bound patient and Jim's kidneys and bladder are grumpy, the Lasix is not getting a full dance card.

We're not going to talk about poop, purple tootsies, productive coughing or excessive mumbling in one's sleep.  Know that they are all on the dance floor as well.

And constant through it all is Jim's will.  He knows what he needs.  He knows what he is fighting for and how long he has to hang on.  He's doing it and folks, it is not easy.