Eddie’s status: back in the hospital; admitted for a high fever Friday evening; fevers seem to be due to a bacterial infection in his blood, an infection he is currently being treated for; meanwhile, docs are trying to sort out his lung situation
It’s becoming harder to write updates because things are getting a bit complicated – not necessarily worse, just complicated.
This post is going to be pretty lengthy so you’ll want to pull up a chair and make sure you’re comfortable. :)
Here we go…
I’ll first begin with the newest development. After exactly a week out of the hospital, Eddie spiked a 101.6 degree fever that instantly earned him a trip to the ER. If you’re neutropenic like Eddie is, you need to get on top of the fever stat!
Initially, the docs theorized that the fevers were due to the infusion of platelets he had received earlier that day. It is not uncommon for people to spike a fever or break out into hives after an infusion of blood products. However, they couldn’t be sure so they had to they quickly set him up on some strong antibiotics.
Per protocol, the ER docs had Eddie start on a trio of broad antibiotics: aztreonam, ciprofloxacin, and vancomycin.
Vancomycin. Eh, wait a minute, doctor.
Eddie’s been on vancomycin many a-times now, but we associate it with his nausea-ridden days, so we can’t help but feel a little nervous whenever he’s back on the strong antibiotic.
This time our nervousness prove to be founded…
We spoke to the ER pharmacist about our concern that it was vancomycin that had exacerbated Eddie’s nausea. She reassured us that nausea is not an associated side effect of the drug. Thus, they went ahead and gave him a loading dose of vancomycin through IV. About an hour into the infusion, he broke out into a faint pink rash on his upper body.
Another drug rash? Eddie was having none of that!
After what we experienced with the Zosyn drug rash, we immediately alerted the ER staff to the rash that was breaking out on Eddie’s upper body. They quickly paused the Vanco.
Later that evening (or I guess, technically, early morning), once Eddie was admitted into the Oncology unit, they determined that Eddie had experienced a known reaction to vancomycin called Red Man Syndrome. Given this new information, they decided to try the vancomycin, only this time at a much slower rate of infusion.
What do you think happened?
Yep. You guessed it. More rash.
We told you we don’t like that vancomycin.
The doctor reiterated the fact that the rash was a reaction to the vancomycin, not an allergy. However, given Eddie’s state, they decided to pause and find other alternatives.
Some overnight blood work revealed that Eddie has a staphylococcal infection in his bloodstream, a type of skin staph. The good news is that this type of infection is quite easy to treat with antibiotics. In fact, by my counts, this is Eddie’s third time getting this particular type of infection since being diagnosed.
In the past, Eddie was given vancomycin to treat the infection. This time, however, they decided to go with a combo of two other antibiotics called cefepime and daptomycin. So far, Eddie continues to spike fevers, but we probably need to give the antibiotics at least another day before we start seeing a difference. Meanwhile, the doctors have ordered susceptibility tests to figure out which particular meds get at the bacterial infection best.
And then, there’s the pneumonia.
If you’ve been following Eddie’s Aplastic Anemia saga, you’ll recall that in addition to this new infection, Eddie’s been grappling with a fungal pneumonia for the past three weeks, a pneumonia that is preventing Eddie from starting the BMT transplant process.
Prior to this recent hospitalization, we met earlier this week with the doctors at the SCCA, and we learned that the status of his pneumonia is unclear due to the accumulation of more fluids in his pleural cavity.
I created this graphic to help me illustrate the situation in his lungs. Please do not let the sophistication and the anatomical accuracy of my drawing fool you. This is simply my interpretation of what we the doctors explained to us. Nothing is drawn to scale.
On Tuesday (4.5), Eddie underwent a CT scan of his chest. As I mentioned above, the CT image showed that more fluids had accumulated in the pleural cavity and was obstructing the view of the pneumonia. The doctors had no way of knowing if the pneumonia in Eddie’s right lung was improving.
On top of that, they also noticed more “ground class opacification” (yes, that’s a technical term) on his left lung. The “ground class” has apparently been seen on previous CT images so the Infectious Disease doctors don’t seem to be overly concerned about the left lung. They do however, need to know what’s happening in the right lung, so their first course of action was to drain the effusion in his right lung through a procedure called a thoracentesis.
Eddie was scheduled to undergo the thoracentesis this coming Monday as an outpatient at the UWMC, but thanks to the unexpected skin staph infection, he was able to get the procedure done this weekend. The one perk of being hospitalized. The doctors come to YOU!
The long and the short of it is that the doctor drained about a liter of fluid from Eddie’s right lung plus a few syringes full of the fluid for lab testing. Eddie will undergo a CT scan at some point (probably tomorrow), but that has yet to be scheduled. We won’t know how the pneumonia is looking until that scan happens.
The good news is that the terrible cough that has been keeping Eddie up for the past week has gotten a little bit better. Thanks to the draining, those potent cough syrups they keep prescribing are actually making some impact. That means that Eddie’s been able to manage a couple of hours here and there, more than the 15-minute intervals of sleep he’s been subsisting on.
Also, today he walked over a mile around the hospital wing without feeling short of breath. That would have a been a near miracle just a day a go.
I think it’s too soon to say that Eddie’s pneumonia is getting better, but given these small feats, I’m cautiously optimistic that the situation in his lungs may be better under control.
To top it all off, he managed to eat half of a crunchy Supreme Taco.
From apple sauce to Taco Bell. Eddie sure likes to take risks!
All in all, it’s been a weekend of tiny feats! Keep your fingers crossed that we continue this positive streak.