March 18, 2012


     That presumptive UTI on Thursday?  It got worse.  By Friday morning, he had a fever over 103.  Needless to say, he was miserable.

     But then a rash appeared.  No pain or itching, fortunately.  Interestingly, it first appeared where his skin had already been agitated by the EKG electrodes.  It then spread around to his neck and back.  Both the urine and blood cultures came back negative for any bacteria.  That doesn't mean it's not an infection.  Maybe, maybe not.  If it is, you don't know which bug(s) you are facing.  Couple that with the rash and it shifted the possibility of infection towards drug reaction.  Maybe, maybe not.  When he started getting the urinary symptoms again on Thursday, they changed antibiotics to meropenem, which is a relative of penicillin.  Any of the the penicillin type drugs can cause allergic reactions.  So they stopped that drug.  They switched to cipro in case it is an infectious process.  And more steroids.  Can't forget those.  That quickly brought the fever under control.

     And on they charged with the last (hopefully) round of chemotherapy on the schedule.  SCT transplant is a bit like surgery in that regards.  Once the patient is cut open, you can't stop.  You react and deal with each crisis as it comes.  You can't just wait and see how the patient feels.  So it goes with SCT.  The cells have been injected.  The chemotherapies must continue despite the fever.  More steroids and rituximab and that was uneventful.  Saturday came and went and my dad actually felt good.  Good enough to actually eat.  Good enough to actually be able to watch TV.  Yes, even watching TV is a chore during this process.  It's probably a good benchmark to know how difficult something is if watching TV becomes too onerous and difficult.  His blood counts continued to look good which meant the engraftment was likely happening.  Usually it's around day 10.  Saturday was day 9.  Sunday was day 10.  There was talk of an early discharge if this kept up.
     But on Sunday, my dad spiked another fever back up to 103.  More steroids and tylenol.  Rash, too.  Only this one hurts.  And again, it gets nebulous.  Is it infection?  Is it drug reaction?  Is it graft-versus-host?  All of the above to some extent?  We'll probably never know definitively.  That's the art of medicine.  You treat empirically on your best guess based on experience and hunches about the patient.  Reassess and readjust the gameplan accordingly.  One thing is certain, though.  Any talk of him being discharged tomorrow is certainly out of the question. 

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