Transplant Monday +5

Well, Jackie is now in-patient. She had a rough day today. She began the day with high fever, vomiting, and nausea. She didn't have the energy to walk to the hospital for her morning appointment. She required a wheel chair.

Upon returning from the doctor's appointment she spent most of the day sleeping. The anti-nausea meds make her sleepy. Before infusions they pre-medicate with Benadryl which makes her VERY sleepy. Her fever continued and she often had uncontrollable shivers. Tylenol helped and about 4:00 PM she began to feel better. Her fever was still high (about 102) but the shakes disappeared and she felt like walking to our 5:30 appointment.

The doctor's examined her at the 5:30 appointment and decided to change her antibiotics. Unfortunately the new antibiotics are a three-a-day regime. Rather than having her come to the hospital at 8AM, 3PM, and 11PM they decided to admit her. They will likely give the new antibiotics until her counts begin to return. With a mini-allo transplant this could mean 10 days to 2 weeks in the hospital. The good news is that her blood cultures have (so far) not shown any problems. This is a common problem. Sometimes the cultures don't show anything, yet an infection exists. Many times the problem is neutropenic fever. I discussed this in last night's blog. The docs take the cautious approach and throw every antibiotic they can think of at the problem, "just in case".

Her counts continue to deteriorate as expected. Her RBC was 11.1 (actually still good). Her WBC count was 0.3 (soon to be zero). Her platelet count was 25 (good for this point in the transplant). She received a transfusion of platelets this evening as well as an infusion of magnesium and at least 3 different exotic antibiotics. At one time I counted five bags hanging on the IV tree with a 3-pump infuser running into both of her central lines. She also received IV fluids to raise a low blood pressure.

This all sounds serious...and it is. But it is not totally unexpected. This is a fairly standard situation. The nurses feel this isn't really an unusual situation. From what I can gather, probably 90% of the transplant patients go through these types of difficulties. In Jackie's case where the transplant is allogeneic (someone else's stem cells) probably 100% of the patients see these types of difficulties.

For those who were worried about our tiny, uncomfortable loveseat that Jackie was complaining about I managed to get it changed to a sofa today. A trip to Linens And Things provided an ugly sofa cover and a big, nice, fat, comfortable pillow. She was able to spend part of the afternoon stretched out asleep on the couch instead of the bed.

If anything changes I'll keep everyone posted through the blog. While she is in-patient I may update the blog several times per day depending upon her condition.

Until tomorrow,

Bruce and Jackie
From Rochester, MN