Day +272: Another night in the Pole House

Another new wrinkle has developed in Mina Brigitta's ongoing recovery from her bone marrow transplant. She still has her Hickman central venous catheter, which they use to administer drugs during her every other week appointments. Dr. Horn had been talking more lately about the risks of having a central line, as Mina's need for it grows less. It turns out one of those risks is going to come back to bite us. We'd noticed lately that Mina had some very prominent blood veins between her left shoulder and her chest, and also that it was difficult to draw blood from one of the lumens of her catheter. Dr. Horn was a bit concerned and ordered an ultrasound. It turns out that her subclavian vein is 90% blocked at the junction to the jugular. This is right where the end of her catheter sits. The most likely scenario is that a clot has formed around the end of the catheter, although another possibility is that scar tissue and irritation has simply narrowed the vein. There's a very good article on deep venous thrombosis here: http://www.emedicine.com/emerg/topic122.htm. All the way down at the end is a little section on subclavian vein thrombosis, which is what they think she has.

They're going to pull the catheter tomorrow, but they'll have to watch her very carefully to make sure that the clot doesn't break loose and begin to travel in her bloodstream. I expect they'll use some thrombolytic agents to try to dissolve the clot, and then they'll put her on anticoagulants for several days to prevent any further clotting. The biggest risks are pulmonary embolism from the clot traveling to the lung (http://www.emedicine.com/emerg/topic490.htm), and hemorrhage due to anticoagulants. These risks are serious enough that she will have to be inpatient for at least a day or two.

Mina Brigitta also had an appointment with the ENT doctor today, and he said that whatever is in her ear has not gone away. So she was already scheduled to undergo sedation tomorrow so the ENT doctor can poke around in her ear. They will remove her catheter at the same time and keep her in the outpatient OR until she's ready to be moved across the street to Seven Long. She still isn't acting sick; quite the contrary, she has more energy these days than she's had in a very long time, so hopefully this ear thing is nothing major. But it's another night or three in the hospital, and just was Anta Teri, Nicholas and Kennedy are due to arrive. At least Mina will have good company in the hospital. And hopefully she'll be out at a reasonable hour on Saturday so we can go out and do something to enjoy the day.

They're not planning to replace the catheter at this point, so there won't be any more dressing changes or tube flushing for the foreseeable future. Mina seems OK with it, but I think she'll miss those tubes. She helps me flush them every night, then flushes Waah Baby's tubes and changes her dressing. But it will be a relief for everyone in a way to have them out. The downside is that they'll have to place an IV every two weeks when she comes to clinic for her pentamidine, IVIG and blood draws. Hopefully that won't be going on much longer as her immune system continues to recover.

The really good news we got from today's clinic appointment was that the results of her latest engraftment study came back 100% donor! Everyone was hoping and expecting to see that, since she's 100% since the very first test, but the possibility of relapse is still frighteningly real, and donor chimerism of less than 100% would likely be the first sign. So despite the unwelcome complication, the day's news was positive on the whole.