Home Again

We had hoped that Shirley would get released on Wednesday, but because Dr. Glavan wanted to make sure her blood levels stayed normal for another day. Hence, Shirley was treated to another near sleepless night at the hospital.

The doctor came by with good news early in the am:  blood levels look good and discharge was being processed.  So after four days in the hospital we have discovered that a urinary tract infection was likely the cause of her nausea and fever and that some of her meds may have attributed to anemia.  The doctors also discovered a mild viral infection (CMV) that is prompting a change in another one of her medications.

Thanks to all for your thoughts, prayers and well wishes.  Shirley's next order of business is to catch up on the sleep that it seems impossible to get while hospitalized.

A Working Theory

Shirley got a 2-for-1 deal today with both an Endoscopy and a Colonoscopy.  Neither procedures found anything of concern that would be a cause for her anemia.  With internal bleeding ruled out, attention has focused on her medication list.

A consultation between her local pulmonologist, Dr. Glavin;  her transplant physician Dr. Lease; and a hemotologist, Dr. Li who was called in to provide insight has resulted in a theory that potentially two of her medications are to blame.  One, Dapsone, which is taken to prevent a particular strain of pneumonia, is being stopped as of today.  There is an alternative, once-monthly treatment that will provide the same protection.

The second medication, Mycophenolate, is one of her anti-rejection drugs. They are going to cut her dose by 50%.

Following yesterday's transfusions, her crit level went from 20 to 29. They will monitor her levels daily to ensure that they don't take another precipitous drop. With any luck, this will resolve the anemia issue and we can get back to her regularly scheduled rehabilitation.

Back in the Hospital

Shirley was readmitted to the hospital last night.  In my last post, I mentioned that she needed a transfusion a week ago Friday.  She was feeling poorly after that and made an ER visit on Tuesday where she was treated for dehydration and released after a few hours. 

Over the weekend, she continued to have abdominal issues and ran a low grade fever.  She also started throwing up, which is one of triggers for calling the doctor. He advised to go to the ER again, and after a round of tests, it was decided that she needed to be admitted.

Only ten days after a two-unit blood transfusion, her crit levels were again too low and another two were needed.  It is the "why" that is going to keep her in the hospital for next several days.  There are several potential causes for anemia that need to be investigated:

1. The fever that she has had may have slowed blood cell creation.  But this is unlikely to be the source, as the fever only started recently and was not evident ten days ago when the first transfusion was given.
2. Internal bleeding is another potential cause. But Shirley hasn't been exhibiting any signs that this is the issue. They have decided to do both an endoscopy and colonoscopy to make sure there are not any G.I. issues that are contributing.  
3. Drug reactions.  Several of the drugs Shirley takes--including her anti rejection drugs--can interfere with blood cell creation.  A Hemotologist who met with her today suspects this is the most likely issue and the hospital is reaching out to the transplant team to see about at least temporarily suspending one of the drugs to see if it resolves the issue.

They are also doing some additional tests to rule out some more exotic and rare potential causes. 

I'll be doing daily posts until Shirley is released and we have some answers to these questions.

A Quart Low

While in the hospital, there were a couple of times that Shirley needed blood transfusions due to low blood cell counts.  Since her release, she goes in each week for a blood draw so they can monitor her blood chemistry.  On Monday, they noted that her hematocrit level was low and she was asked to take another test to verify.  Low crit levels are commonly referred to as anemia, where you just don't have enough cells to sufficiently carry needed oxygen to your body.

Friday she got a call confirming that her count was around 19 (normal is about twice that) and that meant a trip to the ER for another transfusion.  While we were told this would be a procedure they could do in the ER, it turned out that due to the  lead time to get from the blood bank, length of time to transfuse and time on the back end to test and monitor her before release, that they ended up admitting her overnight. It takes over two hours per unit and she took on two units of packed red blood cells.

She was released early Saturday morning, but still feeling tired.  Stay tuned. Another update is likely in the near future.