Monday, December 28, 2015

Obstructed bile duct - Monday, December 28, 2015

Monday, December 28, 2015...39 days in the hospital

Rough, overwhelming day. More adversity to add to his expanding list of challenges to overcome.

BJ spiked another fever late last night, and again this morning. All of the daily blood cultures remain negative since Christmas day. It seems that the fevers are now coming from something other than the infection in his central line. He is also still battling nausea, and even though several of his meds could cause that, it seems unlikely. This morning, he had an ultrasound on his abdomen, which showed that his gallbladder looks worse than it did on his Dec. 7th ultrasound. His common bile duct is obstructed, which is causing backup into his liver, raising his bilirubin levels. In just the past 2 days, his skin and eyes are obviously more jaundiced. If any normally healthy person's gallbladder looked like his does, it would be a no-brainer to remove it. However, BJ has no immune system, no neutrophils to help with healing and to help fight infection. Something has to be done sooner than later to prevent damage to his liver, so he will be having an ERCP under anesthesia tomorrow morning. Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure, done through an endoscope, that looks at the bile ducts. The GI doctor should be able to remove any stones and put in a stent to hold the duct open for other stones and sludge to pass through. The complication with doing this procedure is that BJ's platelet count remains low. He received a 2-unit transfusion of platelets today, and his platelet count went from 11k to 22k. It needs to be above 50k to have the procedure. He will have another transfusion around 5am tomorrow (Tuesday), so that they will have time to run more labs before the procedure. If it doesn't push his count up enough, he will have a platelet drip while having the ERCP.

To end on good news, BJ also had a CT scan on his chest today, to check the status of the pneumonia caused by the fungal infection he's had since August this year. This was done today to rule out a worsening fungal infection as the cause of the fevers. He has continued to take anti-fungal medication (voriconazole), and have regular medication level checks. Today's CT scan was not done with contrast, however, his lungs look better than the last CT scan with contrast. This report made us very happy, as that is a big wild card, and now something that we can rest easy. A worsened fungal infection would even prevent him from being able to have a bone marrow transplant.

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