At 8:30am, Debbi is resting comfortably in her hospital room. Last evening, around 7pm, the time I like to refer to as Debbi’s witching hour, Rea perceived that Debbi was running a high temperature. After confirming a 102.7 reading, Rea coordinated with the VNA nurses and brought her mother to the ER. Debbi recognized Dr. Ecker who had assisted her in the ER during our visit over the Xmas vacation. Dr. Ecker, in coordination with Dr. Lovett, Debbi’s oncologist, got Debbi started on Vancomycin IV and this powerful antibiotic went to work on Debbi’s fever which finally broke around 2am. Debbi got an uncomfortable clammy feeling. When that feeling went away, so did the fever. Rea went home once the fever broke and I simultaneously headed up from NYC arriving here at 6:15 to find Debbi coming around from the Oxycontin baseline pain management drug. Debbi’s temperature is now 97.8 and she is fielding calls from family and friends.
One nice thing about this hospital stay is that the “ice has been broken” as far as Vancomycin is concerned. It seems that the VNA nurses are able to dispense IV antibiotics right in our home BUT will only do so with medicine that has previously been administered in the hospital so as to mitigate the risk from an unknown drug reaction. Now that this antibiotic has been given here, the nurses on call should be able to dispense the drug at the Cape house possibly obviating the need for a hospital visit.
A blood sample was drawn at 7:45 the results of which will determine our schedule today. The key variable being examined is the Hemoglobin component of the CBC which normally has a range of 12.0 to 16.0 G/DL. (That is grams per deciliter, in case you were interested). Debbi’s counts in this department have been running a bit low from the time she was receiving the Cisplatin/Gemcytabine combo. The Hemoglobin count (HGB) has served as the basis for the 13 blood transfusions that she has received. The medical staff usually considers HGB counts less than 8.0 as indicating the need for a transfusion. The CBC from 11pm last night showed a HGB of 8.4 which while lower than Debbi’s usual 9.1 count is still above the 8.0 threshold. Thus, we are awating the results of the 7:45 am sample and the determination of whether or not a transfusion is necessary.
It is interesting to note that with the first rounds of chemo, from 3/2008 through 7/2008, we watched the white blood cell counts and more particularly the Absolute Neutrophil count in order to gauge Debbi;s potential to withstand infection. Absolute Neutrophils measure the body’s capability to fight infection by comparing components of the white blood cells, namely the neutrophils. Neutrophils, simply are like the emergency response team because they are the first component of the white blood cells to rush to the site of an infection through the blood stream. The Absolute Neutrophil count measures the proportion of matured neutrophil cells to immature or developing neutrophils. Anyway, we use this count as a measure of infection fighting ability. With a normal range of 2.1 to 8.7 K/microL (thousand per micro liter), through the early chemo Debbi was often in the 1.2 range. Today her Absolute Neutrophils are 4.53 solidly in the center portion of the normal range. Given this solid reading, I want to understand the reason that it takes such a strong antibiotic to fight the infection. Maybe the Vancomycin works by stimulating the neutrophils. Or maybe the nodules produce a different type of infection that is not approached by the neutrophils. Oh well, I am probably boring you but I would like to get a handle on the procedure that is causing the fevers to spike and send us to the hospital when it seems Debbi has good infection fighting capacity.
I was just informed that even though there is excess capacity in the Absolute Neutrophil count, the infection fighting mechanism as manifested through the immune system is somewhat compromised in Debbi’s case. So, the numbers alone do not tell the whole story but are just one indicative measure in the body’s much more complicated immune system.
The blood test results just arrived and Debbi’s HGB actually rose to 9.0 meaning that a blood transfusion will not be needed. She is now being given an additional dose of Vancomycin IV over a two hour period and sounds and looks much improved even over the three hours that I have been here.
On that note, I just want to praise Rea’s actions in coordinating care for her mother, arranging and facilitating the hospital visit, and providing support during the early hours of Debbi’s stay. It just confirmed our decision making process that led us to transfer Debbi to Cape Cod in the first place to insure that she had constant continual loving care from now on.