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11-08-10 Monday Day +12

Status: 8.0/10.

Events: A long night. Started with several platelet and blood transfusions. Awoke with increasing mucositis. Couldn’t swallow foods or liquids, even my own saliva, so they changed almost all my oral meds to IVs. Also started patient controlled analgesia, started with morphine but switched to fentanyl. Then down to radiology services to place a new Hickman catheter. Although some oral pain, most of the discomfort is in the throat. I use saline rinses and suctioning just to keep up.

Comments: This minor side-effect often results in major morbidities. An in convenience no doubt, buy one that will be short-lived until white cells come back.

I’ll try to get some sleep tonight. You, too.


vomiting about 11 pm, which continued. Then shaking chills, and a temp. Stayed up all night taking blood and urine cultures, and taking vital signs. My blood pressure was low so they started rapid saline solutions. Felt exhausted come morn.

Events: Blood culture bottles have already grown out gram-negative rods (these are typically gut organisms that probably entered my blood stream through my now permeable GI tract. Today they added another antibiotic, Amikacin, which is particularly good at gram-negatives.
And in order to play it safe, they pulled my Hickman catheter (second occasion to do this). Quick but brutal.
My difficulty swallowing has resulted in all meds being given as liquids, lots of syringes laying around.

Comments: Similar scenario to the last time my count went to zero – shows you how important those white cells are. When I was an ID fellow we worked on a new antibiotic called BBK8′ now called Amikacin. It was so new that no bugs had developed resistance to it yet. The Infectious Diseases Dept held it jealously, and it couldn’t be given without our permission. The same holds true here at Hopkins all these many years later.
We’ve overused so many useful and common antibiotics that very few have any efficacy anymore. Although doctors and nurses are prime offenders in overprescribing unnecessary antibiotics, the major cause is the antibiotics used in animal feed lots. Cattle evolved to eat grass, but to fatten them up right before slaughter they are fed corn.
But cows aren’t meant to eat corn, and they develop a bacterial overgrowth in their stomachs that eventually kills them. This is definitely not a good long-term strategy for feed lots, so they pump antibiotics into the feed. The result is that trillions and trillions of bacteria are exposed to antibiotics and become resistant. The same ones we get infected by, and then we have limited choices in what to use.

As soon as my cultures come back with antibiotic sensitivities they switch from Amikacin, and save it another rainy day.

Hope your day is full of sunshine.



10 Responses to “Previous Post”

  1. Nancy Douglas Says:

    Dear Bruce,

    We’re rooting for you every day. Hope that you’re feeling 100% soon.

    Walter left for Pakistan yesterday. He’ll be there a year, but can still follow your blog from there! Isn’t life amazing these days?

    Even though I don’t comment much, I’m hanging on your every word in this blog. All the best to your whole family.

    Nancy Douglas

  2. Blaine Charak Says:

    Hi Bruce,

    I Just want to echo Nancy’s sentiments that I’m hanging on every word and rooting for your full recovery. I pray everyday that you feel better and are pain free!

  3. Blake and Amy Golding Says:

    Dear Bruce,

    Wow. Amy and me have been following your travails through out this amazing journey. Your latest entry reminds us of a man in a sailboat up against torrential storms and winds that come out of nowhere and yet, in the midst of such storms, is able to visualize that land is soon ahead. We remain steely confident that you will prevail against this personal storm and very much appreciate your humor and dictates about life during this chapter of your life.

    Very inspiring.


    Amy and Blake

  4. wendy Says:

    now you’ve ruined it for me..I may never be able to eat meat again. And what is wrong with our food industry that they think this is ok… We are what we eat apparently you have confirmed that… really -going to think about that..perhaps you could too and everyone else who reads this blog..

  5. Judie Davidson Says:

    I bought a share in a local organic farm so Rick and I get locally grown vegetables for the next 35 weeks. Your bit about cows being pumped full of antibiotics could convince me to be vegetarian. Imagine Rick going vegetarian…now that’s a good laugh. Take care. Hope Lisa, Rachel, and Ethan can visit soon. Judie

  6. Wally Schlech Says:

    Hang in there buddy..there’s light at the end of the tunnel!

  7. Lewis Lefkowitz Says:

    At least these bacteria are of community, rather than hospital, origin — at least from this round. One more advantage of those glorious weeks at home.

  8. Henry Miller Says:

    Re antibiotic-resistant bacteria, see this in today’s NY Times:

  9. Donna Hill Howes Says:

    Hi Bruce….our hero!
    It’s tough enough for you to have to go through this amazing process, but to do so without your fearless partner by your side makes it even more challenging….prayers for Lisa’s recovery right along with yours. And through it all, you manage the energy and caring to educate the rest of us on the journey through a transplant.
    I send you my love, and then some….
    Hang tough, dear friend….you are a gift.

  10. joel steinberg Says:

    You have been down such a long and painful road. That you find time to comment on cows and corn and antibiotics amazes us. We just hope those stem cells are multiplying and taking root and that the good white soldiers will soon begin to fight off the evil bacteria. Joel and Margaret S.

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