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5-13-10

Status: 7.5/10.  A busy and tiring day.  After feeling a little punky last night, the team decided to send me for a CT scan today to look for possible infection. 

Events:  But not before I had to have platelet transfusions in preparation for another lumbar puncture with chemotherapy infusion.  But the platelet level didn’t get high enough for their criteria (don’t want possible bleeding during the LP).  So I had more platelets. 

This time I had an experienced physician’s assistant do the LP, but she had a difficult time performing it.  It took her two or three times to get it.  Fairly traumatic.  During the procedure she asked me, “Are you comfortable?”  I had to laugh and said, “No, are you kidding?” 

She finally got it done but I was wiped out.

Lisa was here all day and made it bearable.  She brought some knit caps from her brother Michael and his wife Greta, who live in Montana and know something about keeping warm at night. After the LP I had to lie on my back for two hours, and then they sent me down for a CT scan of my lungs and sinuses.  I came back to my room to find my nurse with gown and gloves on.  I asked her, “What gives?” and she says, “You’re on contact precautions.  You have VRE.” 

Comments:  I’ve been on multiple antibiotics including vancomycin for some time now.  That virtually assures that any bacteria left in my body are resistant to vancomycin (simple Darwinian selection pressure).  As I have told my children many times there are no slow cheetahs, the slow ones died out many thousands of years ago.   

So one of the common bacteria in my GI tract has become resistant to vancomycin, called vancomyin resistant enterococci (VRE).  It’s a modern problem in hospitals since if it spreads from me to another patient they may get an infection which would be difficult to treat.  So they have me on contact precautions, which mean that all persons who come into my room must wear gown and gloves.  It is for their protection, not mine.   It’s likely it will stay that way until I leave the hospital (hopefully in a few weeks). 

So I can only hope to get some sleep tonight and start again tomorrow.

One day at a time, just one day at a time.  Your comments and cards help me do that, thanks. 

Love,

-Bruce

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20 Responses to “Next Post”

  1. Bill Israel Says:

    Dear Bruce:

    Always eager for your updates, even when you’ve had a rough go.

    The infection precautions recall my mother’s two bouts with pneumonia last winter, the last of which I was pretty sure had her down for the count. On that round, she contracted MRSA, which meant hospital gowns, gloves, and masks for the rest of us. As she came out of the worst of the pneumonia, a surgeon said: “Now that we’ve tapped your lungs, we need to open you up and clear out the rest of the infection — or you’ll die.” At that point, Mom, tired, looked up at me and said, “What about hospice?”

    That was January. She’s been on hospice ever since, at the residential community in which she’s been living in NW Ohio. And she improved! Age 89, working on 90. Not only missed the surgery, but cheated death again. No guarantees — but she enjoyed a good bowl of ice cream today.

    I think you’ve got many such years to go, Bruce — and I look forward to spending hunks of them with you!

    Best wishes, from Eileen and me–

    Bill

  2. MOM & DAD Says:

    JUST ONE DAY AT A TIME! DO IT! BRUCIE DAN!
    WE LOVE YOU SO VERY MUCH, AND PRAY FOR NO ADDED PAIN TOMOPRROW. SLEEP WELL.

  3. Ed Baker Says:

    Hang in there Bruce! We’re thinking of you

    Ed

  4. darya Says:

    Dear Bruce,
    You are so brave in the midst of all this pain. Hang in there! As you said “one day at a time”. The better days are around the corner…
    And I hope you got rid of the noisy morning nurse so you can rest.
    Much love-
    The Nasr’s

  5. joel steinberg Says:

    It is often easier to do an LP at L3-4 or even L2-3 than at L4-5. Why? Because the spondylotic changes are most pronounced at L4-5 and make sticking the needle in at L4-5 more difficult. And yes, you are of an age when lumbar spondylosis is almost universally present. Also, repeated LPs at a single site make subsequent tries at that level progressively more difficult (I don’t know why for sure–just personal experience). Your comments about the bacteria and cheetahs are right on. We are your devoted friends and fans. Joel and Margaret S.

  6. Sheryl Stolberg Says:

    Bruce:
    I am reminded of the book I used to read my girls, Lily’s Purple Plastic Purse. Rachel probably read it too. It ends with Lily getting a note from her teacher: “Today was a difficult day. Tomorrow will be better.”
    And so it will, I know it will.
    Love,
    Sheryl

  7. Robin Says:

    Hi Darling Bruce,

    Tonight I spent a long time catching up on your blog. I had already read a lot of it, but I wanted to read it very closely — it took me a while as I wanted to read all of it in a very focused way, when nobody was around to interrupt me — a challenge as you know!

    So, now I know stories I never knew — great, fun-loving, clever stories that show me a different side to you — how lovely to get to know you better. The circumstances suck, no doubt, but a pleasure to read your eloquent writing.

    I think about you everyday Bruce. I pray for you — but more than that, I just hope you’re not in pain. Futile, but just wishing it makes me feel better, and telling you I’m in a state of hope and faith re: your health, will hopefully make you feel stronger.

    Amazing to see the love you have for Lisa. We all know how much you love her. But reading it definitely makes me hug my loved ones a bit tighter than usual.

    I’m learning a lot about the medical community as well as infusions, platelets, etc. Quite an education and you are the perfect doctor to explain it to us — I feel like I’m reading one of those “Idiot’s Guide to Understanding Cancer” books…but it so helps to get the details. Helps me understand the analytical part of the disease, which is a good combination with the overwhelming emotion I feel — I stay balanced, which keeps me completely focused on you…vs. my reaction. As it should be.

    Well, my reaction is that I love you. Your family loves you. And I have a feeling those nurses are craaaaazy about you — all that Southern charm — mixed with your obvious medical knowledge (sorry Lisa, but he really is so sexy when he chats away with all the medical vernacular!).

    I hope this will become a memory very soon. I know it’s just day to day right now…but the more you get through each day, the closer you come to the memory vs. the reality. So a smooth transition to this time becoming your past is what I look forward to…and I also hope you know you are on my mind…every day.

    I love you and look forward to giving you a hug…and a big, wet, sloppy kiss next time I see you.

    xo,
    Robin

  8. Donna Hill Howes Says:

    I send you love.
    I send you peace, in the night and all day long.
    I send you BIG smiles for a better day.
    You and your incredible bride make a mighty pair….you both inspire!
    Hang tough, dear friend….a bright day is in store….
    XO
    Donna

  9. Ashby Says:

    Bruce,

    PBS ran a program this past Wednesday on The Doors. I bet you would like it. Same ending, but new and previsouly unseen footage of a fantastic group and Morrison’s self-destruction. As usual, great music, too. Amazing to think back to the year 1969 and imagine Morrison getting a felony conviction for being a prima donna! Your earlier reference to the Stones made me think that Morrision ranks higher in the pantheon of front men than Jagger. But what do I know?

    As the said back then, keep the faith!
    Peace and love,
    Ashby

  10. Cindy DiBiasi Says:

    Hi Dan,

    Incredible “sharing” of what you’re going through. Thank you for keeping us up to date. You’re even more incredible than I thought (and that’s a high bar!)

    Are you up to visitors? I’ll be in Baltimore on Sunday and would love to see you and bring some cheer. (I will also bring whatever “treats” you’d like – so ask away!) If you’re not up for company – I’m happy to SEND whatever you’d like.

    XOXO,
    Cindy

  11. Nancy Douglas Says:

    Bruce,

    We are rooting for you every step of the way. You thought that today would be bad – you were right. Tomorrow, I hope, will be better.

    Saw Rachel in Guys and Dolls yesterday – it was the abbreviated version that they do for the students. She was absolutely dynamite as General Cartwright. Brought the house down.

    I gave her a ride after school yesterday. “Did you enjoy that?” I asked. “YES!” was the reply. I’m afraid that you and Lisa having a budding starlet on your hands…

    Nancy

  12. Mary Pat Alcus Says:

    Bruce,
    I took some pictures at yesterday’s preview of Guys & Dolls. I sent you a link to these on your Aol address. I hope that looking at these will brighten your day. Rachel was great.
    Our thoughts and prayers are with you.
    Mary Pat

  13. Roxanne K. Young Says:

    Bruce! Just a note to let you know that the JAMA folks in Chicago and beyond are thinking of you. I of course am following your “story” with great interest as both friend and editor. Greetings from Drummond, Cheryl, Terry, Jeanette, Tom, Helene, Richard, David, and Annette (we just had our editorial board meeting). Keep on truckin’, brave one. You the man.

    Fondly,
    Roxanne

  14. Warren Says:

    I feel so bad for you Bruce. Grinning and bearing torture. I wish I could take some of your pain and discomfort. I can only send you my love and best wishes.
    Warren

  15. Aileen Says:

    Rest your head
    You worry too much
    It’s going to be alright
    When times get rough
    You can fall back on us

    Lady GaGa

    (ok, it’s only a cover, but everyone’s forgotten Peter Gabriel and you need to quote someone Rachel has heard of).

    A better tomorrow my friend–
    All our best wishes,
    Aileen

  16. Penelope Douglas Says:

    Hey Bruce,
    Sorry to hear about your day… I sure hope tomorrow is better. You have good thoughts, prayers and best wishes from all of the ITV gang.
    We also have a bunch of us who are willing to “donate” to the blood bank…so just let us know when we can do that.

  17. Harold Says:

    I’ve been following your blog for quite a while and really appreciate your portrayal of the UNVARNISHED TRUTH of a typical hospital stay. In some ways it brings me back to my own years in hospitals.
    There aren’t many among us who would chronicle such a personal event.

    Thanks

  18. Bill Schaffner Says:

    Hi Bruce:

    Hang in there, good buddy!

    All the physical stress and the interrupted sleep must make you feel punk and lethargic, but I’m pleased to see that you are staying mentally agile. That is so hard – you have to make yourself think.

    So, you’ve become a VRE celebrity; just remember that colonization is better than infection! Speaking of healthcare-associated infections, I’ve just returned from a collaborative research meeting at the CDC with that as the main topic. You would have been fascinated. I used to think of healthcare-associated infections as those delineated by the four walls of an institution. Sure, hospital pathogens could leak out into the community, but mostly it was institutional. Today, the CDC is thinking regionally – the continuum of care among different facilities. They hope to get the healthcare facilities within a region to collaborate on defining and then reducing healthcare-associated infections.

    I find this fascinating epidemiologically, but worry about two operational issues. First, the CDC hopes that local and state health departments will take the lead in orchestrating such collaborations. Unfortunately, health departments are not held in very high regard by the hospital infection control professionals because the H.D. don’t have expertise in this area.

    Another problem is that the facilities (especially hospitals) are competitive. Indeed, the recent moves to make public some hospital infection data have made hospitals especially antsy on this topic. It will take some doing to persuade them to take a regional point of view.

    I anticipate that the infection control nurses (oops, that’s not P.C. Today they’re called Infection Preventionists) will accept the regional concept readily-they already have regional APIC chapters. On the other hand, the hospital epidemiologists are likely to hold on to their traditional institution – specific view a bit longer.

    In any event, I found it provocative and stimulating. Imagine – a real public health vision of healthcare-associated infections. Who would of thunk it?

    Which means, of course, that will have to keep our eyes on you when you leave the hospital with your VRE fellow-traveler…

    Remember: wash your hands after you wipe!

    Cheer,

    Bill

  19. Gail Lehmann Says:

    Bruce, hopefully the accupressure bands on your wrists are working. I use them every time I get on a plane or boat and know how well they work for me. Looking forward to hearing if GINGER (ale, candies, jellies) work as they have for my Mother-in-law who recently had a double mastectomy (at 88) and swears they helped her through chemo and radiation. I read your blog everyday and send you our best regards that you will soon be HOME.
    Love,
    Gail

  20. Victoria Cushey Says:

    Hi Darling Bruce,

    Tonight I spent a long time catching up on your blog. I had already read a lot of it, but I wanted to read it very closely — it took me a while as I wanted to read all of it in a very focused way, when nobody was around to interrupt me — a challenge as you know!

    So, now I know stories I never knew — great, fun-loving, clever stories that show me a different side to you — how lovely to get to know you better. The circumstances suck, no doubt, but a pleasure to read your eloquent writing.

    I think about you everyday Bruce. I pray for you — but more than that, I just hope you’re not in pain. Futile, but just wishing it makes me feel better, and telling you I’m in a state of hope and faith re: your health, will hopefully make you feel stronger.

    Amazing to see the love you have for Lisa. We all know how much you love her. But reading it definitely makes me hug my loved ones a bit tighter than usual.

    I’m learning a lot about the medical community as well as infusions, platelets, etc. Quite an education and you are the perfect doctor to explain it to us — I feel like I’m reading one of those “Idiot’s Guide to Understanding Cancer” books…but it so helps to get the details. Helps me understand the analytical part of the disease, which is a good combination with the overwhelming emotion I feel — I stay balanced, which keeps me completely focused on you…vs. my reaction. As it should be.

    Well, my reaction is that I love you. Your family loves you. And I have a feeling those nurses are craaaaazy about you — all that Southern charm — mixed with your obvious medical knowledge (sorry Lisa, but he really is so sexy when he chats away with all the medical vernacular!).

    I hope this will become a memory very soon. I know it’s just day to day right now…but the more you get through each day, the closer you come to the memory vs. the reality. So a smooth transition to this time becoming your past is what I look forward to…and I also hope you know you are on my mind…every day.

    I love you and look forward to giving you a hug…and a big, wet, sloppy kiss next time I see you.

    xo,
    Robin Victoria, Ron, Kayla & Kendall

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