At My Wits End

Julie,
Sorry to hear Dick is having all these concerns. It would have been nice to have lunch or a day out with your mom. Julie, I used a caregiver service in Tucson for my dad. Well actually it was more for Thelma his wife. We wanted to eleviate her having to get run down herself, so I hired them for 3 months to come when she wanted them. They have all levels, 4 hours is minimum time they come out. It sounds kind of cold but if you find one you like it can work. Unfortuneately Thelma didn't like any of them, my sister and I interviewed them before we flew home. We thought it was a good thing..and it can be if your open to it, I will look up there name, my dad actually sold them marketing materials, they knew him well. Not so so expensive.
I really pray he gets some relief, as God knows you both have been in this mode for a while, er, er, er,...and I worry about you as well. It isn't an easy road for any caregiver..Ginger Beane

Patricia, thank you for this summary this certainly fits with what has happened to Dick. Could you send me a link to this article as I want to have his Urologist and Infectious Disease specialist read the article. Perhaps they are well aware of it but I don't know that. He is being treated with the antituberculous drugs. The infectious disease specialist told us the BCG was not the problem but the MRSA is. I'm not so sure. His abscess is in the retroperitoneal area.

Mornings are the worst times and he perks up in the late afternoon and evening. He seemed delirious this afternoon but was not running a fever. His liver panels are good so there has been no sign of hepatitis. He dowa have some renal insufficiency so he cannot take ibuprofen, aspirin or Aleve as they send his creatinine level up.

I think you're right Julie...he needs different treatment..the BCG is now systemic..see follow article....
Gonzalez OY, Musher DM, Brar I, Furgeson S, Boktour MR, Septimus EJ, Hamill RJ, Graviss EA.
Department of Medicine, Infectious Disease Section, Baylor College of Medicine, Houston, TX 77030-3498, USA.

Intravesical instillation of bacille Calmette-Guérin (BCG) effectively treats transitional cell carcinoma of the bladder. Occasionally, BCG infection complicates such treatment. In some patients, infection appears early (within 3 months after instillation) and is characterized by generalized symptoms, with pneumonitis and hepatitis. Late-presentation disease occurs >1 year after the first BCG treatment and usually involves focal infection of the genitourinary tract (the site at which bacteria were introduced) and/or other sites that are typical for reactivation of mycobacterial disease, such as the vertebral spine or the retroperitoneal tissues. Noncaseating granulomas are found in the majority of cases, whether early or late. Most patients respond to treatment with antituberculous drugs; in early-presentation disease, when features of hypersensitivity predominate, glucocorticosteroids are sometimes added. Late localized infection often requires surgical resection.

PMID: 12522745 [PubMed - indexed for MEDLINE]

My husband is home after a week in the hospital where he was started on IV Vancomycin. The abscess material was cultured and they found something like TB. The infectious disease specialist and the Urologist are convinced it is BCG as the abscess is next to the path of the nephrostomy tube and where the BCG was instilled once in late June. He now been home two weeks and he is still having fevers and chills. Last Sunday I took him to the ER and they found a UTI and started him on CIPRO. He had two days with out a fever and started running them again.

The Urologist said on Friday that there was no sign of a UTI so to stop the CIPRO on Monday. The Vancomycin was finished on Thursday.
Yesterday he had a high fever in the morning and again this morning. When he runs a fever he gets delirious and is difficult. He gets dehydrated and resists taking medication. This upsets me because the fever won't come down unless he takes the Tylenol. The Dr. doesn't know what is causing the fevers and said it could even be the drain they put in the abscess.

I have not been able to do anything other than look after him or take him to the Dr. My Mother and Sister are here for two days and I could not even take my Mother out to see something of Tucson as Dick was running a temp of 101.5 this morning and I could not leave him. I will not have him spend another 9 hours in the ER and then be sent home again. If he needs to be in the hospital they can admit him directly as he does not need another endurance contest in the vile gurneys they use for beds in the ER. I don't need to have constant sciatic pain from sitting in their uncomfortable chairs for hours on end. I don't even want him in the hospital as they totally mess up his diabetes control.

I believe now that his treatment led directly to this miserable situation.