Half the Energy, Twice the Spunk

I sure as heck hope so.

First I'll start with the great portion of this update. On Friday I was able to go home for a 2 day/overnight pass for Christmas with my family! We did the Christmas Eve thing, Had a blast with the boys who were totally wound up for Christmas (yet fell asleep fast and without complaint - I think the energy put into being excited wore them out!).

Christmas morning was a blast - the boys let us sleep in until almost 8am, then tore through their presents fairly quickly. The only complaint was from Brandon and it was that his DS was not pink. He's going through a 'pink' stage... He got over it pretty quick when he realized the DS had a camera and voice recorder built in - these are endless sources of fun for the boys.

After gifts and croissants (my Aunt Patti made them the day before, we left them on the counter to rise overnight and popped them in the oven when we got up - they were FANTASTIC... Patti makes the BEST croissants and they have become part of our Christmas morning tradition over the past few years!), we packed up and headed to my parents house around 11 (well Dave and the boys did - I had to make a pit stop at Gimli hospital for my IV antibiotic dose - the 'deal' I had to make with the docs to be allowed to go home for the night). at 12:30 we all had apple pancakes, smokies and ice cream (this has been my Christmas morning breakfast for as long as I can remember - its the only time of year we have them and the tastes and smells are full of nostalgia for me... I only managed a few bites of each, and paid quite dearly pain wise for them, but it wouldn't be Christmas without it. After presents at my parents house, (the boys again got spoiled rotten - as did I and Dave) we all packed up and headed to my Aunt Heathers for the family Christmas dinner... lots of extended family was there, the boys were playing in the basement with the bigger kids (and having a total blast) while the adults visited and hung out upstairs. It was precisely the way I wanted to spend my Christmas, and I left at about 8pm feeling completely content with how it went - it was perfect. :)


So that was the good part.


Unfortunately I left out last week and this week. Last week I ran fevers for most of the week - not terribly high, but high enough to concern them. The big worry of course is a central line infection so they ran blood cultures, but nothing grew. Since I was already on antibiotics for the C. Difficile infection I had a few weeks ago, they didn't expect anything to grow regardless. We waited a few days and on Wednesday I got a fairly angry looking spot about 2 inches above my central line site, right where the line tunnels under my skin. The docs saw it and had a fit. They drained it and culured it, and my line site, and my blood again - but again, since I had antibiotics in my system the cultures cannot be relied upon. They were all negative but they felt confident I had a 'tunnel infection' (an infection 'around' the tube where it tunnels through my skin). These are notoriously difficult to clear, and generally the only option is to pull the line (Arg!).

They gave it a good go to try and save the line, put me on Vancomycin (big gun antibiotic), and Cephtriaxone (also a big gun) to keep their bases covered. The fevers actually stopped on Friday and I was doing alright. The morning of Christmas day though I started running a temp again. I stubbornly ignored it and took tylenol all day, however by the time I got back to the hospital I was quite hot.

Sunday brought higher and more miserable temps (103-104) and my line site was looking worse so the decision was made to pull the line. That happened this afternoon. I now have no central line, and no way to get TPN - they are giving me sugar water through a basic peripheral IV, but they cannot run TPN through it, so Im basically getting nothing for the next few days.

After a few days they will put a PICC line in (the central line that starts in the upper arm and threads into the heart) and I will be able to go back on the TPN etc, so that's good at least.

Just to ice the cake, in the middle of all this I was re-diagnosed with C. Difficile, the intestinal infection I had a few weeks ago has come back with a vengance. So I am now on a THIRD antibiotic to treat the C. Difficile.

My discharge date went from last Friday to maybe this Wednesday, to 'who knows' at this point. I'm pretty discouraged and frustrated that every time we seem to be making progress to getting out of here something happens to set things back a bunch.

All of us are pretty discouraged. The boys are sick of mom not being home. I'm sick of not being home. Dave is tired of being a single dad (a role he has filled incredibly well I must say - he has not only 'managed' to be a single dad for 3 months, but he has managed to make it 'fun' for the boys, kept the house in order, and overall has just done an amazing job of holding down the fort. I am so proud of how well he is doing, and how lucky I am to have married a man I can leave completely in charge of the kids and the house without an inkling of concern over how he would do.

So at this point, discharge has been pushed to 'who knows'. Im on 3 IV antibiotics that will hopefully get things in order. Im still anemic and I suspect well on my way to another blood transfusion. My gut is a total mess from this infection. I'm needing higher and higher doses of narcotics just to manage the pain. My temperature is still spiking very high tonight. I have no line to get nourishment into me, and now have to face another procedure in radiology to place another line (something that is always difficult for me as my blood vessels are evil).

The good news is I am cultivating some mad Crocheting skills - I have mastered hats (made a good 2 dozen so far), tank tops, and now I am onto animals - Brandon has a new moose and Tyler has a new alien... they are pretty slick if I say so myself.

Well sorry for the big pity party. It's hard to stay positive when all you get is crap thrown at you day after day. I know this will turn around and soon all of this will be a bad memory. but right now all I can see is what's in front of me, and I don't like it.

Tomorrow will be a new day.

Thanks for checking,

Keely

Well at 11am this morning things were looking fantastic. TPN training was going beautifully, and the nurse announced I could get discharged on Friday.
Supplies were delivered to the house for home TPN. Discharge papers were drawn up. Follow up appointments were being lined up. Life was looking pretty peachy.

Then by 12:30 pm I was diagnosed with a central line tunnel infection, plans were being drawn up to pull my central line and maybe try replacing it with a PICC line, they decided they have to start me on an antibiotic that I'm severely allergic to (IV Vancomycin), since it's the only one appropriate which means they would have to pretreat me with IV benadryl which according to my body is like extremely potent LSD and renders me a useless jibbering pile of nonsense for 6 hours.

Discharge plans turned to smoke.

Throw in the fact that Dave spent the day at home quite sick with a GI virus, and it just rounded out the day quite nicely.

So yea.

The infection I have is not in the blood yet (that we know of - blood cultures are pending), but rather is in the tunnel that my central line goes through from where it goes into my skin, to where it enters my large blood vessel. The point of a tunneled line like this is so that there is some space from the site where the line enters the body to where it enters the blood vessels, so if there is an infection, it has some space between the exit site and the blood vessel. So in that respect the tunnel did work well - it gave us time to catch and respond to the infection before it made it to my blood stream and got really serious.

The down side is the vast majority of the time, tunnel infections aren't treated in a way to save the line - usually the line is pulled and the infection cleared before a new line is placed (new surgery, new site).



So at about 2pm this afternoon I was prettty furious with the whole situation. It feels like we get 1 step forward and slide 2 steps back every time we try to make progress and it was getting very frustrating.



Since then things have gone a little smoother. My first dose of Benadryl and Vancomycin went very well and I didn't react at all to the Vanco. The benadryl, as usual, stoned me up good, and after a nice fun trip for an hour or so I passed out cold until a little after 6:30pm. Aside from horrible zombie dreams (seriously vivid... not cool) it was a good nap and I woke up in a bit of a better place.

the plan now is that Infectious Diseases will come assess me tommorrow hopefully and make a decision on whether or not to pull the central line. If they do pull it, I will likely have a PICC line placed tommorrow to take it's place. If they don't pull it, then we will hope the abx clear the infection and play it by ear.

In the meantime none of this necessarily writes off my chances of a Friday discharge. I will still need IV antibiotics twice a day, but I could theoretically go back and forth to the local hospital for those once I"m discharged.

At this point it's all very much in the air - which I don't do well with - emotionally I need a plan so I can just relax.

But I'm learning to be 'ok' with not having a plan. I realise sometimes there isn't one and that has to be manageable too.

Trying very hard to be 'Zen' about it all.


Any way I cut it, it sucks big time.

But it could always be worse.

K

I'll try to make this brief but informative.

1. I started my home TPN training yesterday and it is going great!
2. If training continues to go well I *MIGHT* (saying this sooo quietly) be discharged on Friday!
3. This weekend my doc gave me 'NPO' order - no food or drink by mouth. with the exception of lifesavers and jolly ranchers. This has resulted in 2 distinct things:

~ My symptoms (bloating (as in 'hey lady the maternity ward is 2 floors down' level bloating), pain and nausea) are improving.
~ I am turning into more of a food-crazed zombie than I was before. I've reached the point where the idea of a platter of raw onions and mushrooms (the 2 foods I despise the most) sounds positively mouthwatering. In spite of the simplicity of the concept (don't eat or drink... easy enough) this is one of the hardest things I have ever had to do... It is very very very hard to refuse myself food or drinks... it gets to the point that all I can think about is food. It makes me very sad to think that I may never be able to eat or drink again... While I am glad they have ways to keep me nourished and functional without my having to eat/get sick... I did not anticipate the sheer difficulty of refusing a body (however broken) of the joy of eating. I am able to suck on lifesavers and jolly ranchers at this point without too much trouble (though I think I may have reached even their limit today as I've been pretty sick tonight... apparently 'a few hard candies' does not mean 'go buy out the drug store downstairs of lifesavers and eat all 145 of them within 3 hours'. They could have mentioned that.

4. The boys Christmas concert was last night and thanks to some serious logistical fenangling I was able to make it and it was fantastic... Brandon had a blast on stage, and Tyler, our free spirit, was dancing up a storm (while everyone else stood stalk still... ) twirling and ducking and swinging his arms in the air.... cutest. thing. ever. That boy has no fear, and is completely at ease with himself... I find myself seriously considering homeschooling him next year because I loath the idea that he would have that spirit stifled by the harsh realities of elementary school social life. :(

5. I recieved a scholarship last week. Based on academic merit, and financial need, I was given a bursary to purchase a Macbook laptop that I had quoted and applied for back in the fall - it's a technology grant for students with disabilities, my case being that I need a laptop in order to continue my schoolwork while I am inpatient since this looks to be a semi-regular occurance in my future. I had pretty much forgotten about it as it had been so long since I had applied and then it arrived! So this weekend I picked up a brand new MacBook Pro and I am absolutely in love with it!!! (And the high speed internet signal it can pick up from the hot spot downstairs!)

I think that's most of the big news... so much for short...

Thanks for checking!

K

Here's how the last few days have played out:

Wednesday:

1. Got my official training dates of Mon and Tues (20th and 21st) and noise was made of a Tues or Wed discharge (just in time for Christmas!).

2. Got moved to a new room that was in a better part of the ward, has a better view and was nice and quiet.

3. Found out I won a $2500 technology scholarship from school to purchase a laptop so I can continue my schoolwork while in hospital.

Overall Wednesday was awesome!

Thursday (aka - reality check):

1. Found out everyone who suggested I might go home next week did not know what they were talking about and the supplies and such needed for me to go home will not be delivered until *maybe* the 29th of Dec but with the holidays, most likely not until the 6th of January. Until then I sit in this hospital and wait.

2. My gut has launched into a seriously painful stage of 'who knows what's wrong now' and I spent most of the day hawking narcotics that still barely worked. Today we have to figure that out.

3. at 10pm I spiked a fever that earned me a full workup (blood cultures, labs, urine, etc etc. The fever kept up all night and I still feel like garbage this morning.

4. I developed what looks like a skin infection on my ankle last night that they are going to drain this AM and is hopefully the source of the fever (though that's doubtful).

Amazing how quickly things can go from 'awesome' to 'are you kidding me??'.

So for those of you that pray/hope/request from the big cahoona... anything would be appreciated at this point. Specifically this fever needs to go away so I can go home and see my family on a pass this week. And they need to figure out a way to get me out of here before Jan 6th as the whole 'nobody in our family has a job right now' thing is becoming problematic (while we have had terrific support from family and friends, it's still doesn't replace a full time income), and until I'm home nothing on that front can change. (and even once I'm home we still have a whole host of issues to sort out before my other half can actually go to work outside the home again.)

So yea - a teensy bit of stress/frustration/sadness here.

Trying to wrap our heads around me being in hospital for Christmas as that is apparently going to be the case (though I should get a pass for Christmas Eve and Day so I can spend them with my family at least).

Going to attempt to squeeze a whole seasons worth of traditions into a few day passes this weekend.


And on the bright side I think I will go computer shopping on Saturday after we drop the kids off at my parents house for the night! Nothing like a new toy to brighten up a crappy week.

Not much new - we are tinkering with my pain meds and nausea meds to try and find a decent balance that will allow me to go hom comfortably.

Im currently getting Dilauded (Hydromorph - a purified form of morphine) every 2 hours but since that isn't terribly great to keep up at home we decided that we will try a fentanol patch on Monday - the patch will give me continuous narcotics and I will take the hydromorph as a 'breakthrough' pain med when the pain is bad enough that the patch doesn't cover it.

Lots of drug juggling but we are getting to a point where we have a good balance.

Similar deal with the nausea meds - I am now on 3 different nausea medications (all IV) and was still getting nauseas so we played around with my oral meds and changed them to IV to see if that helps the nausea - it's really just a game of 'how can we keep me comfortable and functioning until I get to Mayo in January' - making sure my Christmas is as comfortable and pain free as possible.

Which sounds like a good deal to me.

I'm feeling a little overwhelmed wiht all the medicine, and hate to be on it all (especially since I was off everything in August... :( ) but at the same time i know I need it.

So life goes on.

The C. Diff treatment is going well and it appears Im recovering. I can have visitors without precautions on Monday it looks like. So that's fantstic!

It looks like I'll likely need another blood transfusion this week as my hemoglobin is dropping pretty quickly. This is (in a twisted way) good news as it means my immune suppressant is doing it's job - we just have to hope that it's killing off the bad cells along with the good ones. We will know in good time!

Well I'm typing this with my eyes closed now - the IV gravol I just got has officially made 8:30pm bed time for this Saturday night!

Thanks for checking,

K

Yesterday afternoon I tested positive for Colostridium Difficile (C. Diff). It's a hospital aquired infection that people can get when they are on antibiotics, or are immune suppressed - I am both.

It's a nasty one.

It's also one that earns you isolation and means I cannot be around Brandon, or anyone who cares for him - so no visits home, and no family visiting me here.

It's treatable, they caught it early, and I am on the anitbiotics to treat it and they *seem* to be working so far (the docs say not to get too excited yet - because I'm immune suppressed it's still anybodies game for a few days yet). But I still have to keep my distance from family until next week.

So just another stroke of bad luck to throw onto the pile.

Thankfully (in a wierd twisted way) my roomate is presumed to have C. Diff as well as she is symptomatic - while unfortunate for her, it means they will not isolate me in a single room, and split us up. At this point the only thing keeping either of us sane is the fact that we have eachother - we get along fantastically, we spend our days visiting, joking, knitting and watching movies... splitting us up at this time would be a nightmare for both of us.

So at this point both of us are in 'lockdown' - any docs or nurses coming into our room have to wear gloves and gowns, and we are not allowed to leave our room without gowns and gloves.

It's a good arrangement and we are very thankful that we don't need to be split up. I would go nuts in a single room all alone. :(

Well thats today.

Well it's been eventful.

I will try to make this a 'quick' version of the past week.

We have a date for TPN training (this is where they train me to do the IV nutrition stuff own. I cannot be discharged until this is done.) - it should happen the week of the 20th of Dec. So if the stars line up I MAY be home on Christmas eve.

We are working on hopefully getting a home nurse lined up to do the TPN at home - if this works out I might be able to go home around the 15th and do the training as an outpatient. I have no idea if this will happen but time will tell.

Regardless I am mentally ready to be inpatient over Christmas.

I have been able to go home on day passes to visit my boys regularly so that helps everyone (except Dave who has to do all the driving - though he's been awesome and doesn't seem to mind too much). Last night we had Brandon's 8th birthday party and I was so happy to be able to be there!

It was a close call - my day pass yesterday was cancelled because I spiked a fever. I have been running fevers since Saturday afternoon and they have been playing the 'name that infection' game trying to figure out the souce (the worry with a central line is of course a line infection which can be VERY bad very fast). Thankfully today the source reared it's ugly head and I have a full blown gut infection - tests are pending to determine whether it is C.Difficile (which would suck - but would still be treatable) or just a garden variety virus, either way my gut is even less happy than it was before and I am in a world of hurt today. Loving the morphine.

On Wednesday (I think?) I had a blood transfusion because my hemoglobin was 74 (7.4 in US terms) and I was pretty symptomatic - turns out my iron levels were very low - they figure the anemia (low hemoglobin) is a combination of the low iron, and bone marrow suppression from my immunosuppressant medication.

Friday I had an infusion of Iron Dextran - IV iron - to beef up my iron stores.

The blood transfusion was amazing - night and day - my cheeks are pink and I feel fantastic!

I am currently looking very chipmunkish - and I have gained 10lbs in the past 2 weeks on account of fluid retention - my Albumin levels are low (it's a protien and levels drop when you're starving) and apparently this causes fluid retention in the tissues and leads to a puffy face (and puffy everything!). It makes me look healthier - but it's an illusion apparently.

To round things off it was decided last week that my autoimmune disease has indeed relapsed once again. I started the plasmapheresis treatments for the 3rd round today.

If this round of treatment does not result in a 'sustained remission' (meaning I dont relapse for at least a few months) the hemotologist wants to move onto a med called Rutuximab (not sure thats spelled right) which is a chemotherapy agent that works very well with conditions like mine apparently..

So we still have lots of options which is reassuring.

I beleive that is all -- as if it's not enough...
as I said - eventful!

Well off to sleep - hoping for a restful day tommorrow...

K