Saturday, November 10, 2012

Day 147 - the marrow wakes up!

So today I woke up to a note from my night nurse than my ANC was 20. This is incredibly good news. Even better, the fellow wanted to recheck my platelets (8) because I think he didn't want to transfuse me and in the afternoon, he was happy because they were 11 and I was happy because my ANC was 40! I don't think it's unreasonable to hope for 80 or maybe even triple digits tomorrow. This is what I really need to make the stupid fevers go away so grow, grow, grow little marrow garden!

As for the fevers, 102.6 seems to have been my max today, a little lower than 103. I let one escape in the early afternoon to see how high it would go and most annoyingly, it will not come down, hours later, I am still 102. Arg! I don't really feel bad; in fact, I keep feeling like it's coming down, I get super hot, and it just doesn't do much.

In other news, Terry came to visit me in the morning and Ana and Shelley came to visit me in the afternoon. Nice chit-chats were had.

The worst part of today was that for my platelet recheck, my port seemed very sluggish. No on felt it was the port, because it has always worked wonderfully (thank you, Dr Mahon!) and since it had been accessed in the ED with a type of needle that they stopped using here because it fails so frequently, everyone felt it was the needle. My afternoon nurse tried to draw blood cultures--it would not allow a single red blood cell to leave after the first tube which took about five minutes. So, IV nurse, reaccess. She accessed both sides and it works (surprise!) perfectly. I suggested to the nurses that they have their supervisor write or call CMC (and all the other hospitals that send them very many patients) because there is no way the ED would know that that particular needle was prone to failure because it doesn't fail in the first 8 or 10 hours, it takes a few days. Hopefully, no one spends a few days in the ED!

The other news is that a few days ago, when I had one of my nearly infinite set of blood cultures, one of two bottle came back positive for coag negative GPCs. The doctors in the audience know this is probably a contaminant, but because I was still having fevers, they decided, wisely, I think, to cover me for it. Of course, it didn't come back initially as coag negative, so they wanted to cover MRSA. uh-oh. I bet you remember what happens with vanco. I was actually a very good sport and said I would try it if they wanted, but they decided they did not want and put me on daptomycin. I know absolutely nothing about daptomycin except that it is given once / day and does not seem to cause any side effects in addition to the zosyn I'm already on. I like both of those features. Terry says not only do I have princess blood, but I require princess antibiotics now. As soon as the other bottle comes back final with no growth, they'll stop it.

I wish I understood why I am still having fevers on zosyn and daptomycin. It seems like I should be pretty well sterilized--OK, I just wikipedia'd it. It is active against some GP's, in particular MRSA (which I find it hard to think I have--given that one culture is coag negative and one is growing nothing--for me to have MRSA, two mistakes would have had to be made in the lab or two "one of those things" events would have had to happen simultaneously). Ooo, more googling and the Merck Manual says that not all enterobacter are susceptable to zosyn or ceftaz. Geez! It's a riot sometimes to be a doctor with a big diagnosis. I really don't want my doctors to think I'm second guessing them (or to be embarrassed), but I really want these dumb fevers to go away. I'll have to stew on this tonight.

Well, I am hoping for three things overnight, wisdom, white cells and afebrileness. Do you think it's too greedy? I hope not. For you, I will wish for the trio that I think makes a good doctor "wise, kind and smart." For those of you who are not doctors, I think they are still a great trio and actually hope we all find ourselves with these qualities.

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