Two steps forward, one step back?
We started off the day with good news: the CT scan went just fine, and Mina Brigitta was a very good girl. More importantly, the scan showed that her lungs have improved since last Friday, and that there doesn't appear to be a locus for a fungal infection in her lungs or any of her organs. The sinus scan did show that one side is filled with some fluid, which could be an infection or just mucous.
Mina Brigitta also had a pretty good day today. She did still have fevers, but in the afternoon was feeling quite well, standing up on the bed, talking, playing, interacting with her brother. She had probably the best day she'd had in a week. We were hoping she might have finally turned the corner, but she spiked pretty high again tonight at about 9:00 PM.
Some frustration with the doctors today. They witnessed her spiking for the first time tonight, and were disturbed by the shaking and the chills. They had been thinking about removing some of the medications to see if she has "drug fever" (an adverse reaction to a drug), but after seeing her tonight probably won't. The frustration is that they seem to be making decisions based on what they observe in their five minutes in the room each day, rather than what the parents and nurses tell them happens every day. The way her fevers happen shouldn't have been a surprise to them; it's been happening like that for days. Also, I didn't go in to work today in order to meet with Dr. Loh, but she didn't really have any information for us, referring all specific questions to the transplant team.
Still no leading candidate as the cause of her fever. It doesn't present like a fungus or a virus, the infectious disease team doesn't think it's the RSV, and if it's bacteria, the question is why the antibiotics haven't taken care of it. A sinus infection is still a possibility; it can apparently be difficult to get the antibodies into the sinus cavity. Given that her clinical situation is improving, they would probably just let it go and expect her to clear it on her own. The problem is that she has a bone marrow transplant scheduled for March 17, and she needs to be really clean going into it. They won't do the transplant if she has an active infection. So they've scheduled an MRI tomorrow to get a closer look at her sinuses to rule out anything like a fungus that might still be a problem a month from now.
The other possibility, which no one likes to think about, is that the fevers are related to her leukemia. Leukemia does sometimes present with fevers, and it's true that Mina Brigitta did have fevers both times she was diagnosed. However, she also had respitory infections both times, and there is no evidence of leukemic cells in her peripheral blood. They've scheduled a bone marrow biopsy on Tuesday, so we'll get the word Tuesday or Wednesday whether she's back in remission or not.
Mina Brigitta also had a pretty good day today. She did still have fevers, but in the afternoon was feeling quite well, standing up on the bed, talking, playing, interacting with her brother. She had probably the best day she'd had in a week. We were hoping she might have finally turned the corner, but she spiked pretty high again tonight at about 9:00 PM.
Some frustration with the doctors today. They witnessed her spiking for the first time tonight, and were disturbed by the shaking and the chills. They had been thinking about removing some of the medications to see if she has "drug fever" (an adverse reaction to a drug), but after seeing her tonight probably won't. The frustration is that they seem to be making decisions based on what they observe in their five minutes in the room each day, rather than what the parents and nurses tell them happens every day. The way her fevers happen shouldn't have been a surprise to them; it's been happening like that for days. Also, I didn't go in to work today in order to meet with Dr. Loh, but she didn't really have any information for us, referring all specific questions to the transplant team.
Still no leading candidate as the cause of her fever. It doesn't present like a fungus or a virus, the infectious disease team doesn't think it's the RSV, and if it's bacteria, the question is why the antibiotics haven't taken care of it. A sinus infection is still a possibility; it can apparently be difficult to get the antibodies into the sinus cavity. Given that her clinical situation is improving, they would probably just let it go and expect her to clear it on her own. The problem is that she has a bone marrow transplant scheduled for March 17, and she needs to be really clean going into it. They won't do the transplant if she has an active infection. So they've scheduled an MRI tomorrow to get a closer look at her sinuses to rule out anything like a fungus that might still be a problem a month from now.
The other possibility, which no one likes to think about, is that the fevers are related to her leukemia. Leukemia does sometimes present with fevers, and it's true that Mina Brigitta did have fevers both times she was diagnosed. However, she also had respitory infections both times, and there is no evidence of leukemic cells in her peripheral blood. They've scheduled a bone marrow biopsy on Tuesday, so we'll get the word Tuesday or Wednesday whether she's back in remission or not.
posted by Arne Olson @ 11:52 PM
0 Comments:
Post a Comment
<< Home