The bacterium that attacked me is most probably a "gram negative rod". These live quite harmlessly in our guts, but not when one is neutropenic! They gave me a right good going-over! At the first attack they treated it with two broad spectrum antibiotics (they don't get to know what they are dealing with until blood cultures are done, which takes hours). That first Saturday night was just a survival regime. As well as the rigor, the most serious effect is the lowered BP - no blood, no life! So they pump you full of fluids, and expanding jello, and goodness knows what, to try and keep a vestige of BP. The bad news is that as the bacteria multiply, they release gasses and other waste substances that both dilate and weaken the blood vessel walls, making it into a real race. The fluids pumped in wind up festering in any open spaces they can find; belly legs, abdomen, lungs. When BP strengthens, and the infection is under control, these fluids are eventually flushed by the body in the normal way, which is why a catheter is essential.
The hospital ITU team were heavily involved. They have an outreach team to both help treat and identify potential patients, so they can manage their resources. I was impressed with them (as indeed I am with the whole staff). As I mentioned in the preview, my left leg was really sore on the Saturday, and during the course of Sunday I started my campaign to make sure that all doctors treating me were aware of the history. It was a combination of the ITU night doctor (who took most notice) and the weekend overnight on-call haematology doctor who booked a CT scan at 4am on Sunday! I mention here in passing that I knew I was in trouble as at one stage all 3 doctors who might have had an interest in me were around my bed! Although the CT scan was inconclusive, we also added a third antibiotic to my drug regime, that is good at penetrating tissue, in the hope that it will help my left leg; the trip to the CT scanner was hair raising. Interestingly, UCH overnight radiology consultants are in Australia! (makes perfect sense) For the medically minded, after identifying the bug, I get two antibiotics; Meropenem and Clindamycin. One of the original broad-spectrum antibiotics was not considered necessary. One of the more interesting procedures they did is take blood from an artery. It is a whole other ballgame to venal blood. The arteries are buried from view for example, not sitting proudly under the skin! It hurt quite a lot!
Having survived the initial onslaught (I may be overstating that), Sunday was devoted to stabilisation (aka the fluid race). My BP steadily climbed, to reach 90/50 by about 8pm. However, as the night shift progressed, it dropped back to around 75/45, and I felt we had reached a stalemate. Ultimately, the extra weapon we have is the antibiotics of course ... Which was adjusted on identification of the bacterium. During the course of Monday, my BP recovered, and Stabilised to 100/60. I was a little nervous that it would not hold like last time, but it has, so I think the infection is well on the way to being beaten. I am still pretty bloated with fluids (8 litres or about 18 pounds weight), especially in both legs, ams still have great pain in the left leg. These will become the focus for today I hope. There is one other small problem, my blood is not carrying enough oxygen, so I was hooked up to an oxygen mask all night (still wearing it). I need more oxygen than those little nose based onces can give. This is because there is a lot of fluid I'm my lungs, impeding breathing. It makes receiving visitors very difficult!
And of course we must remember the whole thing is just a side show! It is likely that it will delay the leukaemia treatment schedule by a few days.
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