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Journal, Blood, - 10/09/2009

5:00 AM
Jaymun's fever has continued all through yesterday and last night.
It is cold in the room, and he has ice bags on him, but it remains 39.2
Heart rate: 127     Blood Pressure 94/50
His edema is worse, his face looks very swollen.
He is still sedated ...biggest reaction is coughing when suctioned.

They cultured him for flu, so we are in isolation and wearing masks.

His lungs sounded a bit crackly this morning ...more fluid.
He is less able to tolerate suctioning ...his stats dip.

6:30 AM
Just got back from a quick drive. Those egg muffin sandwiches from Starbucks sure hit the spot :)
Jaymun's stomach is still not moving. 60cc out this morning ...and I only put in about 35cc at midnight. We're still managing to hang on to his albumin though (4.0 this morning). Yesterday the attending doctor said he thinks the only explanation is that even though I may not be getting protein through to his intestines, I'm getting enough absorbed to help control Third Spacing. Things like: http://www.ncbi.nlm.nih.gov/pubmed/17196887
Effects of Astragalus membranaceus and its main components on the acute phase endothelial dysfunction...

And much as I like to brag about Green Tea for kidney and liver function, I found literature this morning that shows Green Tea is a "vasorelaxer": http://www.ncbi.nlm.nih.gov/pubmed/10216249
Involvement of endothelium/nitric oxide in vasorelaxation induced by purified green tea (-)epicatechin.
Probably not good to take Green Tea then, during a septic crisis (unless you properly compensate with Astragalus).
(which compensation I have been doing most of this week)

11:30 AM
Jaymun is hanging in there like the little trooper he is. I hate to see him unconscious and feverish, but he keeps fighting on. His little heart is beating fast today ...150 / 160 blood pressure 130, temperature 38.9

All his cultures are coming back negative so we are not sure what is the underlying cause. The ultrasound tech is just looking at his stomach for fluid, and checking his kidney perfusion.

04:00 PM
The ultrasound showed a large liver, kidney, spleen, and probably an inflamed pancreas. Pancreatitis? We are checking a few blood tests to know for sure.

4:25 PM
His pancreas numbers are fine.
His viral cultures are clear.
But his fever is high (39.1) and his heart rate way up (157).
Blood Pressure 100/48

Potential causes are bleeding in his brain, or his leukemia
or some sort of hidden infection (sinus?)

His renal saturations are low so we're going to give him blood.
Maybe that will also slow down his heart rate.

8:45 PM
Blood transfusion completed.
Rental saturation Improved.
Fever still 39.0 (102.2)
Heart rate still 148

10:30 PM
Jaymun is miserable and getting worse. His edema is increasing. His face is puffier, his feet are swelling, his eyelids look like he went a round with Mike Tyson.

His temperature has been raging for days. His heart is hammering at 164 beats per minute. His tummy is distended ...Xray's show constipation since the day we got here eleven days ago. I've been asking about enemas since then, but oncology has a rule against enemas for any of their patients and the ICU defers to oncology in that situation.

The only reasonable explanation the doctor can come up with for his fever is leukemia, head bleed, or endotoxins being released from his intestinal ileus.

But his peripheral blasts are the same as they were a month ago, and he had no fevers then. CT Scans show his bleed has been resolving since we walked in the door, and he had no fevers then. So I think he is clearly suffering from his stomach. I remember what a week or two of an ileus did to Jaymun last year.

In fact, if he had a fresh bleed his DIC picture would be getting much worse, but his DIC picture has been gradually improving as we are weaning dexamethasone (which irritates the gut and can trigger sepsis via endotoxin release). However, now I am afraid his gut is rumbling along under it's own steam.

And obviously they are not worried about bleed and head pressure, because since they took the head monitor out they've regularly allowed his CO2 levels to rise above 55, while his fever rages and his sodium levels are falling.
Which is it? Bleed or Gut? Because right now we are letting them both ride.

I'm sorry if I sound upset, but if I posted a picture of his poor little face here you would all be sobbing.

01:38 AM Sat morning
We gave him an enema. Not sure how good it will work, but at least we tried. I think it is good medicine
...it would have been good medicine 10 days ago ...if oncology doesn't like it they can complain tomorrow.
His heart rate is now hitting 170.
His face is so distended, that when I look in his mouth I can barely find his teeth. There is no sublingual space any more ...it's like his teeth are way back in the middle of his mouth.
We had to increase his respiratory rate to 40 times per minute to compensate for the lower tidal amount in his breaths due to the reduced space for breathing.
I don't think there is anything else I can do tonight.
...this is one of those times when for sure we need the One Who never slumbers or sleeps.