Well, regretfully, they have to pull his Hickman line today. This is Day 11. He has had positive cultures from his lines for three days in a row. I believe these are staph infection cultures but I'm not positive about that. I do know he has come up positive for the Staph infection in the myriads of tests they've been running on him the last few days. He also has something brewing under his arm for which I will post pictures here in a moment.
First, let me update you on his rash. His rash is definitely improving. They suspect it was a reaction to one of the drugs they've been administering.
This picture was taken yesterday. I would say this is 2 days into his rash. This side was later in breaking out than other areas. The original areas are definitely clearing up, including his face.
We had Dr Dummer come yesterday to look at it. He is the director of their Infectious Disease department and we found out this morning that he is, according to a NP here, world-renown. His advice is highly respected amongst stem cell transplant doctors all over the world. She said they are very fortunate to have him here. Wow! We didn't realize! We just casually conversed back and forth yesterday with this really nice man... he is definitely extremely knowledgeable. He seemed to agree with the thought that this rash was probably a reaction to one of the anti-biotics they've given him. They took Paul off of two anti-biotics and he's still on two. (Sigh. I realize that were Paul writing, you would now know the names of the two anti-biotics they discontinued...)
Yesterday (Day 10) he awoke with what looked like a painful boil in the armpit area of his right arm. A boil would require white blood cells to create puss and he doesn't have any. They did an ultrasound yesterday and confirmed no liquid. Just a mass. That looks infected.
As you can see from the picture, this morning it is definitely more red in the surrounding area. The red mass itself is also larger. They did a CATScan this morning to get a better look at it. I don't know the results from that at this time. I do know they are increasing his anti-fungal meds. They found small nodules on his lungs that could indicate a fungal issue of some sort. Not necessarily likely but they are increasing those meds as a precaution.
A doctor from the surgical team will be coming by today to look at this mass. They are considering cutting it open, removing whatever might be necessary and packing it closed. They will weigh this option against the non-invasive route due to low platelets and blood counts. They've also talked about biopsy-ing it.
He is having his Hickman line removed this afternoon. They will install a PICC line. That is a smaller portal inserted in the arm. He has had three in the past. All three have been removed due to infections. He's not crazy about PICC lines. As they are very slow to remove Hickman lines here, the fact that they are doing so indicates a strong need to. Personally I'm glad for the PICC line. The only other option is multiple IV lines in his arm(s) and that thought makes my eyes roll in the back of my head. (The wife's version is much less medical as you can see...)
Paul has a huge transition to make today. As of this morning he was wonderfully completely dependent on everything IV. I say wonderfully because it has brought him much relief. He has a continuous pain pump. Low dosage but continual. That will be switched over to long-lasting Oxycodone taken orally. As I mentioned in the last post, his food intake has also been IV, providing his GI tract a break during this Mucositus time. He'll have to go back on foods today. His mouth with its sores has shown great improvement so we're hoping this will work for him. Hopefully the severe diarrhea will not return. Lastly, they are switching as many meds as they can from IV to pill form. A post-transplant patient has to take a LOT of meds. Again, we're hoping he can swallow fairly easily.
Paul himself, though sleeping a lot, just looks GREAT! His energy is up. His moods are great. He just looks great! The doctor this morning was commenting on the contrast. While they are working hard on a possibly alarming infection, Paul, well - this video taken on Day 9 will show you what I'm trying to describe. Have a look...
I'm sorry the sound quality was poor there. I was saying in the video that he was receiving a bag of blood at the time this video was being taken. There's just no keeping this guy down! But no one really wants to! :-)
I suggested he purchase a couple of these if he can find them. What do ya think?
That's all for now. There's a lot going on but Paul seems do be doing really great. Thank you for all your prayers, support, and encouragements! I'm doing all I can to help him here on this end...