10-29-10 Friday Day  +2

Status: 8.75/10. Feeling better but still with abdominal cramping. Figured out what it was by serendipity. I had suggested a stool culture several days ago for C. difficile, the diarrhea-causing bacteria  because if I developed diarrhea I wanted to be able to request Imodium, but they won’t give it to you until lab reports for C. difficile come back several days later. Thought I’d get a jump on things. Murphy’s law is still in effect. Results came back positive!  The powerful antibiotic vancomycin is ideal, but I was already on it IV.  So they switched it to orally to get better antibiotic levels in the GI tract where they count.  I learned yesterday after being VRE negative (vancomycin resistant entetococci) that I had turned positive.  So I am on contact precautions (gloves and gowns) and strict hand washing for visitors and staff (alcohol-based gels aren’t particularly effective against C. dif).

Events: Today was the first of two days of IV Cytoxan to reduce graft vs. host disease. Cytoxan does not injure stem cells so it can be given right after transplant, but it does have a powerful effect on a type of white blood cells responsible for rejection, the T-lymphocytes. Getting rid of these right after transplant has been shown to decrease the incidence of GVHD. Timing is critical with the first dose given within 60-72 hours after the first drop of transplant marrow.

  Following the Cytoxan they run in 2 liters of fluid to keep the urine dilute. Cytoxan is metabolized to chemical called acrolein, which is irritating to the bladder.  It causes hemorrhagic cystitis (literally, bloody bladder inflammation).  In addition to the dilution, they are giving me Mesna, a drug that binds the inflammatory metabolite.

Comments: I was asked this morning by my attending physician how things were going in comparison to my expectations.  I said they were better.  Of course the tougher times are coming as my counts drop, but each day without a major difficulty is one day closer to leaving.

Love,

-Bruce

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6 Responses to “”

  1. wendy Says:

    it has been said that the dan’s defy the odds..So keep that myth going…

  2. Henry Miller Says:

    So far, so good. Keep it up!

  3. joel steinberg Says:

    Just keep clicking off the days. This is something to endure; and you will. Joel S.

  4. Michael S Says:

    Bruce

    You obviously contracted c difficule in the hospital. It is possible to 100 percent eliminate this and other HAIs with new diagnostic tests combined with pre-admittance screening as is done in parts of Europe. And the newish test, from Cepheid and standard at the VA, takes as little as two hours for results. When you get your strength back you should ask your insurer if they are going to pay for the C difficule treatment, Medicare no longer does so, stir up a fuss. This is unacceptable laziness on the part of the hospital. The Cepheid system is called GenXpert and also works on other HAIs including MRSA. Be well my friend and hope to see you soon.

  5. Gail Lehmann Says:

    Bruce, I am harassing everyone to vote, but thought I would give you a pass this year! I am very proud that you took the time and felt well enough to even think of voting. We are following your blog everyday and can’t believe the level of detail you write. Keep up the good fight and keep us all posted of progress!
    Gail & Mark

  6. Donna Hill Howes Says:

    Sending you Birthday wishes….and love and good cheer. So happy that the transplant has now been completed and we all pray for excellent success….
    XOXO
    Donna

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