We’re now on day 27 of round 4 (Intensification 2). There’s been some concerning fevers, but Noah’s doing okay.
He’d been feeling okay most of the round post-chemo other than some early stomach pains. Mid-day on Friday he started getting tired and hit the 100.4 “fever” threshold. At that point he had to get a blood draw from his arm. He did better with the “poke” this time, but still about his least favorite thing here. This draw and another from the central line — called blood cultures — are monitored over the next few days for bacteria growth. Getting the draw from the arm ensures that it’s detected if the source of an infection is actually from the central line itself.
Around midnight on Friday night, his temperature was all the way up to 103. Tylenol got the temperature down, but it appears something more than a “count recovery” fever was at work. He also had a bit of a headache and cough, but no other obvious signs pointing to the source of the problem. Given the lack of a functioning immune system, the strategy is to bring in some heavy hitter broad-spectrum antibiotics (vancomycin and cefepime) that hopefully cover whatever is going on. Blood cultures get monitored, but you just can’t wait for those results. If something were to come back from those, a more targeted approach is taken.
Additionally, he got a swab for RSV/Covid/Flu that came back negative. A chest x-ray was also taken and was clean. Nothing has been flagged in cultures so far. He hasn’t had a fever since last night when Tylenol brought it down so hopefully the antibiotics knocked it out quickly. The vancomycin requires close monitoring for kidney side effects and “red man syndrome” (it’s exactly what it sounds like); that will get dropped as soon as possible. As with any antibiotics, the less you have to use, the better, but this is clearly the time when required. Throughout all the rounds he’s been getting the anti-fungal micafungin and antibiotic levofloxacin, but those are both maintenance doses.
He’s got a touch of a sore throat today, but has looked and felt good. Let’s hope this is all just a bump in the road, but we’ll be relieved when his immune system comes back and can fight these things on its own. He’s still effectively at an ANC of zero. From time to time morning labs report a neutrophil or monocyte, but then nothing the next day. I don’t read into the labs for the white blood cell composition too much until the percentages of neutrophils get more sizable and consistent for a few days.
Hemoglobin had been holding pretty okay throughout the round, but he got his first red blood cell transfusion on Wednesday. This morning’s hemoglobin is down a full point since yesterday, so either it’s dropping more quickly or the lab is a bit off (would be my guess). Platelets have been consistently dropping this round. He’s already gotten three platelet transfusions and likely another tonight. There was talk of doing another swab for other viruses, but that couldn’t be done today because of the low platelets and risk of scratching the nostrils.
Not much to report other than that. We’ve been watching a whole lot of Olympics. It’s like a terribly designed UN in this room with 100s of flag decorations for the Olympics. There’s at least a little bit of extra rivalry juice in this family as Mayumi is a Japanese citizen and the kids are both dual citizens. The Olympics have always been one of my favorite things and they hit at just the right time for this long round in the hospital. A lot of negativity in the world, so nice to have some positive vibes and hard-fought competition.
Okay, that’s it; we love you all and over and out.
