Who Is The Enemy?
I wish I had better news to report. But I promised you the truth and nothing but the truth. That pesky fever that got Harvey back into the hospital is back, with a vengeance.
When Harvey was discharged for the second time we were given the guidance to manage any ‘low grade fevers’ with a couple of Tylenol. That worked for the first few days. Last night was definitely not a case of “managing the fever” and it was by no means low grade.
Harvey has been getting slightly elevated temperature late evening almost each and every day. So we did not worry too much when he started feeling a little feverish around 7:00pm. Tylenol to the rescue, same as before, right? Wrong!
Two hours later the fever had spiked to 101.2F. I made a phone call to the transplant ward at the hospital, got the ‘fellow’ on training. What else can one expect on a Sunday night? After a inconclusive conversation the advice was to take more Tylenol and sleep, show up for our 9:30 am appointment at the outpatient clinic.
Sounded reasonable, and an additional dose of Tylenol did reduce the fever a bit and let Harvey get to bed. Around 4:30 am I woke up to check on him. The guy was on fire! The temperature was was 103.6F, and Harvey was shivering up a storm. Another dose of Tylenol allowed us to wait it out until dawn broke.
We decided to get to the clinic a bit earlier, try for 8:30am instead. After waiting 50 minutes for the shuttle service that is usually a lot quicker than that, we finally got to the clinic just in time for our 9:30am appointment. Soon enough, as the experts were examining Harvey, he obligingly put on a spectacular display of chills, rigors and high fever. I have rarely seen him this miserable.
He is back on triple broad spectrum antibiotics (Vancomycin, Ceftazidime, Tobramycin), no one knows what else to do right now. The second viral titre for HHV-6 came back, it had nudged up from 700 to just a tad over 800. Not enough of a change in the viral counts to jump on it, the difference was well within the possible errors of the measurement itself. As I said in an earlier post, drugs such as gancyclovir and foscarnet are tough on the patient and only partially effective against the virus. Local guidelines call for hospitalizing the patient before these two drugs can be administered.
Harvey is going through another series of blood cultures, another chest X-ray, another chest CT scan – the whole works. The hope is that now the infection has gained strength it is more likely that they can catch it in the act, put a name to this enemy. Fighting the enemy is always easier when you know what you are fighting.
A new symptom that is scaring me: Harvey is complaining of significant level of pain on the right side of his chest, to the point where he says it hurts when he breathes. The docs cannot hear anything remotely suspicious when they listen to his lungs and heart. What gives?
We are back in our home away from home and this time the advice is to take Tylenol regularly every four hours to try and get ahead of the curve. We are back in the outpatient clinic first thing tomorrow for another round of Vancomycin, Ceftazidime, Tobramycin, then off to get the chest work-up. We should also get the early (24 hour) blood and urine cultures, see if anything started growing in the petri dishes. As I said above, I wish I had happier news to report. But it is what it is, and we are dealing with it as best as we can.