Day +22, Sunday, April 24, 2016

WBC: 2.86 k/uL LOW  H: 9.7 g/dL LOW  P: 11 k/uL LOW  BUN:  83 HIGH  Cr: 4.7 CRITICAL  Na+: 143 NORMAL

Mentation.  Dr. Ochoa-Bayon, inservice BMT, found Dad to be somnolent, but rousable.  At times, Dad mumbled and was able to follow some simple commands.  Dr. Baluch, BMT infectious disease, found Dad to be less anxious than the day before.

Epstein-Barr Virus, also called the Human Herpesvirus 4, is commonly known as “mono.”

Blood.  Dad had a low grade fever during the night. Planned to repeat test for Epstein-Barr Virus (EBV; Human Herpesvirus 4 (HHV-4)) and Cytomegalovirus (CMV; Human Herpesvirus 5 (HHV-5)) on Monday.  Set target to keep platelets above 50

A constant challenge is to keep the nurses and technicians, who change every 12 hours, keenly aware of Dad’s thin skin.  He has such thin skin as a result of his cancer (CTCL).  Nearly all of the medical staff under appreciate how thin Dad’s skin is.  They incorrectly assume Mom and I are warning them just because we don’t want a slight tug on his skin.  Nearly all types of adhesion (even paper tape) peels Dad’s skin right off.  Dad is often left with an open wound when adhesive remover is not used to slowly and methodically to remove medical tape and adhesives.  For immunocompromised patients, open wounds pose significant risk for infection.

Dr. Baluch monitored such open wounds on Dad’s chest (adhesive improperly removed during the procedure to remove Dad’s central line catheter last week).  She checked on a second open wound on his right, lower back.

No results returned yet from the HHV-6 test conducted the day before.

Lungs.  The chest X-Ray, taken the day before, showed an abnormal amount of fluid around Dad’s right lung (pleural effusion) with intermittent collapse or closure of a portion of the lung.  Dad continued to be supplemented with oxygen via mask at 3L.

Abdomen.   The day before, Dr. Ochoa-Bayona requested an X-ray to confirm the placement of Dad’s feeding tube since Dad had been confused and pulling on his feeding tube.  That X-ray prompted the need to further advance the feeding tube.  A second X-ray confirmed that it was in the proper place.  Dad restarted trickle feeds via his feeding tube.  He was monitored for diarrhea.  Discontinued D5 water IV and continued free water flushes.

Kidneys.  Creatine decreased from 4.9 to 4.7.  Dad had good urine output.  Dad’s urine remained slightly bloody due to the BK virus.  This prompted Dr. Ochoa-Bayona, inservice BMT, to reduce the amount of sirolimus (immunosuppressant) Dad received.