Waiting it out. . .

I called this one. 

 Just before midnight Brendan's tests came back positive for C. diff.  (I think this makes 5 times Brendan has had this?  Or is it just 4?  Anyway, it feels like way too many times of having this come back.  C. diff is what brought Brendan by Life Flight three weeks ago -- or has it been 4 weeks now?  It's all a blur.)

Each time Brendan has had C. diff the same thing has happened.  He starts fevering, the fever climbs rapidly-- often to 104 degrees, his heart rate climbs, then his blood pressure starts falling.  Usually this all happens within about 2 to 3 hours.  Often Brendan starts complaining of cramping -- diarrhea starts about 12-24 hours later.  

Here is an overview of C. diff from WebMD:

"Clostridium difficile (also called C. difficile or C. diff) are bacteria that can cause swelling and irritation of the large intestine or colon.  This inflammation, known as colitis, can cause diarrhea, fever, and abdominal cramps.  You may get C. difficile colitis if you take antibiotics.  C. difficile also can be passed from person to person.  But the infection is most common in people who are taking antibiotics or have taken them recently.

The large intestine normally contains many good bacteria that keep it healthy and do not cause disease.  If you take antibiotics to kill bacteria that do cause disease, your medicine may also kill the good bacteria.  This may allow C. difficile bacteria to grow in your large intestine and release harmful substances called toxins.  Experts also think that, in some cases, antibiotics may cause these toxins to be released."

More info from wikipedia:

"C. difficile is transmitted from person to person by the fecal-oral route. The organism forms heat-resistant spores that are not killed by alcohol-based hand cleansers or routine surface cleaning. Thus, these spores survive in clinical environments for long periods. Because of this, the bacteria may be cultured from almost any surface. Once spores are ingested, their acid-resistance allows them to pass through the stomach unscathed. Upon exposure to bile acids, they germinate and multiply into vegetative cells in the colon."

We have been giving Brendan keifer (probiotics) with his feeds (which also contain probiotics) to try to combat the bad bacteria, but it hasn't stopped these infections after all of the strong antibiotics he's been on.  We've been cautioned not to use the probiotic capsules as they may contain too many strains that could actually cause more problems in his intestines.  Chemo can actually cause the intestines to become "thin" or perforated, and it is easy for bacteria to get from the intestines into the blood stream and cause sepsis.

Anyway, I'm sure that's more information than you ever wanted to know about C. diff.

The C. diff spores are why the doctors and nurses and cleaning help and volunteers always "gown up" and wear gloves when coming in to Brendan's room.   

Here is the sign on the doors where "contact precautions" have to be followed: 

Speaking of "gowning up" -- I've been interested in watching all the different ways it's done here.  When we first got here, the gowns were all made of material and put in the laundry baskets when they left the rooms.

More recently, the hospital has gone to these disposable paper gowns.  Bags or them are put outside the doors of rooms marked with contact precautions and every medical worker has to put them on before coming into the room.  Then they take them off and throw them away when they leave the rooms.

The latest style of gown has elastic on the back to hold them on. . .

. . .Because this usually happens with the gowns.

 The latest fashion also has a sash to tie around the waist.  The ladies usually tie them up . . .

. . .the guys usually don't.

I'm thinking they are going to re-think the sash idea because I've seen them get caught up in their feet, closed in doors, and just generally in the way when working with patients.

When Brendan is on contact precautions it gets much quieter in the room.  When nurses and doctors and techs have to gown and glove up each time they come in, they calculate their duties and get them done all at once to keep from having to take things on and off.  If they forget to bring something into the room, they have to take off gloves and gowns when they step out the door, throw them away, and get new gowns and gloves when they come back into he room.  Usually, the garbage is overflowing with yellow gowns every day.

Colors mean things here at the hospital.  The yellow gowns are used for contact precautions while the blue gowns and purple gloves are used when handling chemo.

Wow.  I really got off on a tangent tonight.  I'm sure what you really wanted to know is. . . how's Brendan?  

Brendan is much better today.  We stayed out of PICU last night -- (Yipee!) because Brendan kept his blood pressure up after that emergency fluid bolus.  His fever also came down and he slept pretty good most of the night.  (His blood pressure had to be taken every two hours.)  Oral vancomycin was started again to fight the C.diff.

This morning Brendan had a low fever, then he fevered again at 3 p.m.  Each time he fevers we re-start the 24 hour clock as to when he could possibly be discharged.

Brendan's tummy didn't feel good today, but has gotten better with each dose of oral vanco.  He spent the early part of the day watching "Mirror, Mirror" and "Tale of Despereaux," and the afternoon listening to me read, "The Giver" to him. 

 Hunter and his family saved us from complete boredom this afternoon and we enjoyed their visit very much.  (We all had to wear masks while Brendan's clave was changed and more blood cultures were taken.)

Brendan and I both took a nap in the sunshine at about 6 p.m.  (Well, I had a nap -- Brendan went out for the night.  He's still sleeping.)

In order to go home Brendan has to do three things:
1.  No fever for 24 hours,
2.  Have ANC blood count above 1000,
3.  Have negative blood cultures-- (where no bacterial infections grow in the blood samples taken).

I guess there might be one more thing--  when we can get the insurance to approve the oral vancomycin prescription to take home.  (That's one thing that has held us up in the past.)

Mostly from here it's just a waiting game.