Day +14, Saturday, April 16th.
WBC: 0.06 k/uL CRITICAL H: 7.7 g/dL LOW P: 10 k/uL LOW Cr: 5.1 CRITICAL Na+: 152 CRITICAL
Blood. The atypical Gram-negative bacteria was finally identified as Achromobacter xylosoxidans. Looks like an extremely difficult spelling bee word. He Continued minocycline for MRSA.
Dad continued to receive blood support (platelet and blood transfusions & neupogen shots) as needed.
Graft versus host disease (GvHD). Dad was still unable to take sirolimus since he was restricted from all food and drink.
Mouth & Throat. Dad continued to have pain from mucositis and used magic mouthwash to treat.
Heart. Overnight, Dad had an episode of tachycardia, which is an abnormal heart rate. He received metoprolol to address. His heart rate improved, however his blood pressure dropped. Cardiology came by later.
Lungs. Mom was very stressed about Dad being fed and that he did not have a feeding tube. Later in the evening, they were able to finally successfully place Dad’s feeding tube. Continued voriconazole and acycolovir.
Doctor sought to wean Dad off supplemental oxygen.
Abdomen. Dad continued meropenem, an ultra-broad spectrum antibiotic.
Kidneys. Dad was put on dialysis last night. First, he had a central venous catheter, which is a catheter used for dialysis, placed in his right groin. The surgeon wanted to place the dialysis catheter in his upper right chest above his heart, but Dad’s central line catheter is already occupying that spot. The surgeon did not want to place it in Dad’s upper left chest since the tubing would require a curve to get to Dad’s heart. The groin was not an optimal location either for two reasons. A groin placement would make it painful for Dad to sit, and Dad would be at a greater risk for a blood clot. The surgeon suggested that in 4 – 5 days, Dad should have his central line catheter moved away from his upper right chest and have the dialysis catheter moved from his right groin to his upper right chest. It was clear that the surgeon did not want the dialysis catheter to remain in Dad’s groin for too long.
Before Dad could have his dialysis catheter placed, he needed to get his platelet count to 50. Dad required three bags of platelets. Without enough platelets, Dad would have had trouble clotting during the catheter insertion procedure. He also received a bag of plasma and a bag of blood. Thank you to all those who regularly donate these blood products. Dad is a large consumer!
Day +15, Sunday, April 17th.
WBC: 0.13 k/uL CRITICAL H: 8.7 g/dL LOW P: 79 k/uL LOW Cr: 3.4 HIGH Na+: 147 HIGH
Blood. Dad’s white blood cell count continued to rise. His central line catheter continued to test positive for the atypical Gram-negative bacteria, Achromobacter xylosoxidans. Continued minocycline.
Dad continued to receive blood support (platelet and blood transfusions & neupogen shots) as needed.
Graft versus host disease (GvHD). Sirolimus was restarted since the feeding tube was inserted.
Mouth & Throat. Dad continued to have pain from mucositis and used magic mouthwash to treat.
Heart. Dad blood pressure improved and remained stable.
Lungs. Dad continued to receive supplemental oxygen. Continued voriconazole and acycolovir.
Abdomen. Dad continued meropenem, an ultra-broad spectrum antibiotic. The prior day’s CT scan showed evidence of ileus, which is the inability of the intestine to contract normally and move waste out of Dad’s body.
Kidneys. Dad no longer had blood in his urine. He remained on continuous dialysis. The prior day’s CT scan also showed hydronephrosis, excess fluid in the kidney due to a backup of urine, and hydroureter, dilated ureter. Urology was consulted.
Day +16, Monday, April 18th.
WBC: 0.24 k/uL CRITICAL H: 8.9 g/dL LOW P: 41 k/uL LOW Cr: 1.9 HIGH Na+: 143 NORMAL
Doughnuts from the Mini Doughnut Factory for the ICU staff.
Blood. Dad’s white blood cell count continued to rise. Dad continued to receive blood support (platelet and blood transfusions & neupogen shots) as needed. Weekly testing of CMV and EBV showed positive with decreasing levels. Thus, no treatment prescribed, but will continue to monitor. Dad continued to receive minocycline.
Graft versus host disease (GvHD). Dad continued to receive sirolimus via feeding tube. Acute GvHD assessment resulted in an overall grade of 0.
- Skin = Stage 0
- Liver = Stage 0
- Gut = Stage 0
Mouth & Throat. Dad continued to have pain from mucositis, grade 1, and used magic mouthwash to treat.
Heart. Dad was in and out of atrial fibrillation. Continued metoprolol to address. Blood pressure continued its improvement.
Lungs. Continued voriconazole and acycolovir. Dad continued to receive supplemental oxygen, but lowered oxygen flow from 10L to 6L. Continued to have productive coughs. Kept Dad more upright in bed (no less than 30 degrees).
Abdomen. Began tube feeds to provide Dad nutrition. X-ray taken.
Kidneys. Dad remained on continuous dialysis. Doctor considered moving Dad from continuous dialysis to 4 hour dialysis.
Day +17, Tuesday, April 19th.
WBC: 0.55 k/uL CRITICAL H: 9.2 g/dL LOW P: 40 k/uL LOW Cr: 2.3 HIGH Na+: 145 NORMAL
Blood. Dad had his central line catheter removed. It was an extremely painful event. The surgical scissors/tweezer tip broke off and remained in Dad’s chest near his right, third rib. The broken piece was subsequently retrieved. Later another painful event for Dad was that the PICC team was unsuccessful in placing a PICC line in Dad’s arm.
He continued to receive minocycline.
Dad’s white blood cell count continued to rise. Dad continued to receive blood support (platelet and blood transfusions & neupogen shots) as needed.
Graft versus host disease (GvHD). Dad continued to receive sirolimus via feeding tube. Acute GvHD assessment resulted in an overall grade of 0.
- Skin = Stage 0
- Liver = Stage 0
- Gut = Stage 0
Mouth & Throat. Dad continued to have pain from mucositis, grade 1, and used magic mouthwash to treat.
Heart. Dad was in and out of atrial fibrillation. Continued metoprolol to address. Cardiology was following.
Lungs. Dad continued to receive supplemental oxygen, but lowered oxygen flow from 6L to 2L. Continued to have productive coughs. Continued voriconazole and acycolovir.
Abdomen. Continued tube feeds.
Kidneys. Dad had no dialysis. Considered moving Dad back to BMT (Blood & Marrow Transplant) unit from ICU.
Mentation: Dad was disoriented to place and time.
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