Friday +249 (Evening)

Today was a long day. We began at about 7:00 AM and had hospital or doctor visits for most of the day. They conducted more blood tests, they performed another head CT scan, and she received a unit of fluids and another unit of sodium. They switched her C-Diff treatment from Flagyl to Vancomycin to eliminate the possibility that the Flagyl was causing her altered mental state.

So here is what we know...It seems she has an electrolyte imbalance. Her sodium is low. This is called hyponatremia. A normal level for her would be about 135. When we arrived here here level was 127. Today her level was 123. At 120 you get admitted to the hospital. Why is her sodium level low? Fortunately this is an easy answer. She has not been eating anything for more than a week. She has, however, been given IV fluids and has (on her own) consumed large quantities of water. This causes her to have an imbalance between her "free water" and the sodium in her body. The cure? Naturally to not drink as much water and to eat regular foods. Once the C-Diff gets under control this shouldn't be an issue.

Jackie felt really bad for most of the day. The IV fluid made her feel a bit better this morning but as the day went along she worsened. By late afternoon she needed a pain pill. I'm not certain if it was the pain pill or the IV sodium she received but she seems to be improved this evening. Her cognitive functions seem to be improved and she managed to eat some solid food (that I cooked - now THAT'S amazing) this evening.

We report to the hospital for checkup on both Saturday and Sunday. On Monday we meet with some of the doctors to plot the next course of action. If she hasn't improved over the weekend they will likely want to do both a spinal tap and a colonoscopy. If she has improved we will meet with the transplant doctor for a final visit on late Tuesday. If she is doing well she will be able to come home. If not....well it could be Christmas in Rochester.

I really think she is making small amounts of progress. Her white cell count seems to be responding to the new antibiotics and after talking to the infectious disease doctor today I found that even a single dose of Bactrim, which is a strong antibiotic can cause patients with C-Diff to relapse. Jackie normally takes a breathing treatment (Pentamidine) once per month to guard against lung infections and problems. Since we had not been here at the Mayo Clinic in over a month she could not get the treatment. We checked about doing the treatment in Tulsa but when asked the doctors in Tulsa basically said, "What's Pentamidine and why would you do that?" So Jackie called the Mayo and they put her on a prophylactic dose of Bactrim. This happened about 4 or 5 days before she got really sick. It is MY opinion that she already had C-Diff and her body was producing white cells and neutrophils at a prodigious rate that caused her to have the extreme bone pain of a few weeks ago. She was probably doing a fair job of battling the C-Diff and then.... she took the Bactrim and the C-Diff really flourished and her system was overwhelmed. So now she is off all antibiotics (except Vancomycin to treat the C-Diff) and she took a Pentamidine treatment yesterday. They will taper her Vancomycin over about a 6 week period. They've found this is more effective in treating patients with C-Diff relapse. They also have some other treatments as well. Once of these involves implanting donor fecal material into the recipient's gut in order to repopulate the growth of gut flora. Jackie is SURE hoping the Vancomycin works:) This is a transplant nobody could would want!

Until Later...

Bruce and Jackie
From Rochester, MN