Wednesday, March 7, 2007

Day +14: Buttons and Counts

Brianna had a very rough night last night. The pain in her right side began to become unbearable. She was coughing and later had a difficult time moving. It all stems from the infection in her right lung. There is no way to tell whether it is viral, bacterial or fungal. They've taken every kind of swab and blood test they can, but we won't see results for several days. So at this point, she's on a very strong antibiotic for any bacteria and was put on an antiviral medication. This evening, they'll start the antifungal medicine. They are very careful to cover everything - and we thank God for that. But it may get worse before it gets better, for a good reason.

Yesterday, her blood counts showed that her white cells were 0.2. White cells are the first line to start being produced by the new marrow. Since her pre-conditioning regimen, Brianna's white count has been at 0.1 - which basically means no white cells. Today at day +14, these white cells could actually start coming in - and in fact we think they are. For the past two days it's measured 0.2. Now we're not jumping up and down yet. It may linger at that rate for the next week. But these new white cells could actually be contributing to her pain in her lung.

Because white cells fight infections, these new cells may all be going to her lung to fight whatever she has. When your body wages a war, the white cells will cause inflammation of that area. So this could be why she feels worse, but in fact she may be getting better. Crazy huh?

Also, today we learned that the count the lab is getting may not be truly accurate. Yes, there is a margin of error, but that's not the intriguing thing here. What could actually be happening is that most of her new white cells are all going to her lung and not floating around in her peripheral blood. Well they measure her white count based on what's in her peripheral blood. If they're all camping out in another part of the body, you're not going to see how many are really there.

Another reason they suspect her counts are coming in is she's had a mysterious rash appearing every now and again throughout the day on her ankles and calves. We've seen some pinkish spots appear on her shoulder, her arm and thigh. But it never remains long. This could be a first indication of graft-versus-host disease (GVHD). Typically, transplant patients get it in the liver, on the skin or in the gut. Getting a little of it is thought of as a good thing, because it means the new marrow is aggressive. Brianna has been on lots of meds for the past two weeks and will continue to be on new ones to minimize the degree of GVHD she gets.

For now, we're just trying to make her comfortable by easing the pain. I've never had pneumonia, so I don't know what it's like. But from her winces and yelps of pain, I can tell this is really hurts. The hard part for me is I just can't do anything to take it away. I am able to help her when she needs to go to the bathroom, but the stabbing pain she gets comes and goes and nothing I do makes it better.

The doctors and nurses have told her it's okay to push the button on her patient controlled analgesic machine. She has finally gotten used to using it today whenever she feels an inkling of pain and when she needs to get up. The only other thing we can do is say some prayers that whatever she has is cleared up soon so we can see her bright smile again and she can get back to those days of sheer boredom in the hospital.

No comments: