I'm beginning to think of this disease and Marye's condition as a day-by-day, or even hour-by-hour thing. On Sunday, after the ERCP, she woke up feeling really good. She had color in her face, she was eating, and even joking around with the doctors. And with the steady stream of antibiotics, it looked as if her infection was really under control. But just a few hours later, her temperature was climbing, she had a lot nausea, and generally felt like crap. Well, as our recent experience with these symptoms indicated that she was suffering from infection again, I (once again) diagnosed her as having another infection. She felt so bad, that she actually asked for some morphine, which she never does.
So the morphine helped her sleep and the phenergan got the nausea under control, but I was all over the doctors when they came in on their morning rounds. Of course, by this time, her temp had gone back down and she was feeling ok. Dr. Vitale had previously told me that they knew that her infection was from a Gram-positive bug, but they were waiting for the final path report to find out exactly what kind of bug it is. And gram-positive bugs are not typically from the biliary tract or any internal organs, but most likely some sort of staph infection that can be introduced through a port or IV site.
Anyway, this morning, they came back with the final path report and it's enterococcus, which looks like staph, is Gram-positive, but can come from the colon, biliary tract, or digestive system. So, we still will probably never know exactly how she got it, but she's got it. The good news is, this is a strain of bacteria that is susceptible to Vancamiacin, which she's getting plenty of, so they should be able to control it. But just to be sure, Dr. Vitale contacted the infectious disease doctor at U of L and asked him to take a look to see if there is something else they should be doing. He did stop by, and we'll see him again tomorrow. Again, though, the Vancamiacin should take care of this.
As far as her discomfort goes, the doc says that until we really start treating the tumor itself, she's likely to have many ups and downs. There is, after all, a large mass in her liver that's putting pressure on the bile duct and other things. So until they can shrink that sucker, she's going to feel lousy. I'm grateful that she doesn't have pancreatitis after the last ERCP and that she was able to take some morphine without suffering her usual side-effects. So between that and the anti-emetics, she might get through this with a little less suffering.
Tomorrow (Tuesday), she's scheduled to get a core biopsy on the tumor itself, so by the end of the week we should have a definitive diagnosis as to what kind of cancer it is. Then the treatment can start. She'll probably stay in the hospital tomorrow night and come home Wednesday, but that will depend on how she does with the biopsy and what the ID doctor says about her infection. I'll keep you posted.
-Chris
