Still in hospital

The urologists stopped late this afternoon to say the report had come in regarding the abscess and they found AFB (acid fast bacillus) and MRSA and they have asked an infectious disease specialist to see Dick. Later the Infectious Disease Fellow stopped by and interviewed us and reviewed he chart and said he thought the AFB was related to the BCG treatment and the MRSA is what is still causing the fevers.

The abscess was surrounding the area where the nephrostomy tube had been installed which was used to instill BCG into the renal pelvis and ureters. It would seem that the tube was not place the way it should have been and some of the BCG may have entered Dick's system instead of being confined in the urinary tract. We do know as of May he tested negative on a TB test.

Thanks for the tip Zach, we wrote down a bunch of questions yesterday so he was able to ask them this morning when I was not there and they responded to them again this evening when I was there. Now we have a new series of questions because he is back on Bactrim and off the IV vancomycin.



As soon as the morning does of Tylenol wore off Dick had another fever episode and next his blood glucose was over 250 so he was sleepy. I spoke with the resident about diabetes management this evening and she will write the orders so he can use his own fast acting insulin and titrate it himself based on both his blood glucose levels and the amount of carbs he is eating. She had been concerned about his going low and we are concerned about his eyes and diabetic retinopathy. Believe me Dick does not want to go low, he had a very severe episode a year ago which scared us both.

This afternoon our response to the news was "Oh TB must be the BCG." Except I don't know what might happen if the BCG gets into the blood stream. So far the blood cultures have been negative but that was before the drain was inserted. They took more blood cultures this afternoon as well as a chest x-ray and another CT scan. Pretty soon he will be emitting radiation from all the radiology procedures. (joke)

Hello Julie,

Dick's hospital experience unfortunately reminds us how many other factors besides just the cancer can complicate our recovery.

I also wanted to emphasize how important it is to keep a notepad nearby to write questions down as they come up. That way Dick won't have to remember anything.

Sometimes a doctor visit is such a whirlwind of information and emotions and distractions that it's easy to forget to ask important questions. Plus, it's very tension-relieving to not have to try and remember crucial concerns--as soon as it's written down you can release it from your mind. A couple of weeks ago I was cooking dinner for my wife and went to the store *three times* because I didn't have a list the first time. I kept it in my head.

I hope Dick comes home very soon.

Zach

I just phoned Dick to find out if there was anything he wanted from home. He said the urologists had been by already and told him they are keeping him another day as they don't know what the infection is and the source. The cultures have not come back yet. So they don't know what bacteria was harbored in the abscess near his kidney plus he ran a fever again last night. I hope Dick remembered to ask them to change the orders regarding his insulin so he can get better control of his diabetes while he is in the hospital.

This means I have to call another Doctor to reschedule an appointment as he was supposed to see his retina specialist tomorrow. I hope he is out in time to see his oncologist on Monday.