Sunday, November 25th - Day - 38

Jan’s chest pain was managed fairly well on Saturday, thanks to several doses of morphine. The results of her contrast Cat-scan confirmed that some infection activity is going on in her lungs. The pain today has been much improved, and has been controlled by oxycodone. According to the Internet, oxycodone is the most powerful pain medication that can be given by mouth. We hope that her pain will diminish as the new antibiotic (micafungin) does its work.

Today included a series of visits by infectious control doctors, as well as pulmonary physicians. They reviewed the Cat-scan results with us, and in fact one of the doctors actually took me aside to display the Cat-scan photos on a computer and went into some detail explaining the results, and comparing them to a similar Cat-scan which was done about three weeks ago. After that demonstration, I have a new respect for medical technology. After all the discussion, our options were reviewed with us. Option-1 would be to order a broncoscopy, which would allow them to insert a light with camera to an area near the infection. They would then flush and collect cells from the surrounding area and send them off for culture. If enough cells are collected, they can culture for bacteria as well as virus. The primary issue with this option is that the infection sites are on the extremities of the lung making it difficult to navigate the medical instruments to an area that is as close as they would like. However, they believe that they can get close enough. If enough cells can be collected to culture, then the specific organism can be identified, and the appropriate treatment confirmed. Option #2 would be to do a surgical biopsy of the affected area. The problem with this procedure is bleeding. Since Jan’s platelet count is low, bleeding of any kind can be problematic. Option #3 is to stay the course, and order no tests. The doctors are fairly confident that they know the organism that they are dealing with, and administering the proper antibiotics. However, in this business, “fairly confident” is not a term the doctors are comfortable with. The prefer words like “definitely and conclusively”. Most of us have white blood cells that would probably handle this infection without our even knowing it. But in Jan’s case, she has no white blood cells, and no defense mechanisms. At this point, we asked the lead pulmonary physician what he would select if it was him. He said he would opt for the first option, so tomorrow Jan is scheduled for the bronchoscopic procedure that will hopefully confirm that we are on the proper course of treatment, or will help identify what that course should be.