The very thing we were hoping to avoid has happened--Mark has an infection! A couple of days ago, his bilirubin began creeping up, but that sometimes happens with IL-2. It was up more than expected yesterday, but there weren't any other concerning symptoms other than he just didn't feel good. A CT scan was done, but it was not conclusive. The stents looked like they were in place, and no tumors were pressing on the ducts, except a cluster on the left side of the liver that could be causing some blockage. Otherwise, none of the tumors have grown since the last scan, and some may be a bit smaller. There were no new ones, so either the targeted therapy or the T-cell transplant is working. That's the good news! But, an infection is definitely bad news! The chemo wiped out all of his white blood cells and took his immune system to zero, so his body can't fight infections.
The GI team came in yesterday afternoon to discuss having an ERCP to replace the stents and ensure the ducts are draining properly. That would be the natural next step, but not with such a low blood count. At that point, the decision was to wait to see how things played out. Hopefully, his bone marrow would start producing more white blood cells, which would boost his immune system.
Last night, his situation got worse with nauseous, chills, and a low-grade fever. By morning, the nausea was intense, his fever went up to 102+, and his blood pressure plummeted to around 75/40. And, this morning, his labs showed that his bilirubin count had doubled from yesterday. Now, we definitely had a problem! Not only that, his blood counts were still down. Some numbers indicated that they should rise soon. But, in the meantime, he is in sepsis with no immune system.
Dr. Taylor and Roxanne met with the GI team. They believe he has cholangitis again -- inflammation in the biliary tree. It was determined that the nurses would give him fluids and albumin to get his blood pressure up, as well as extra platelets. His BP needs to be above 100, and they'd like his platelets above 50,000. When the numbers are in a safe range, an ERCP will be done. If no blockage is found, another procedure may need to be done by a different team of doctors to drain fluids from the left side of his liver.
Earlier, the plan had been to take Mark to ICU first to get IV phenylephrine hydrochloride to increase his blood pressure. That can only be done in ICU except for the IL-2 protocol. Only one bed was available in ICU, and that needed to be left for an emergency. He didn't qualify at that point since his BP had risen above 100. I'm thankful we're staying here as I don't know if I could be with him in the ICU, and it certainly would not have been as comfortable. We have a fabulous room (with a view and a mini-fridge), and we know the nurses here. But, of course, my first priority is his health and safety.
At 4:00 pm, Mark was taken to short-stay for the ERCP. His blood pressure was in a safer range, but not his platelets. When last checked, they were only at 17 (far from 50) but, there is the urgency to stop the infection. He is there now. We're praying his body can handle the procedure, and the source of the infection can be found. While he is in a critical situation, we feel at peace. Your continued prayers are appreciated!
We are still praying. God is in control. I pray for his comfort and your peace of mind. Warmest hugs.
ReplyDeleteNothing better than the whispering and prodding of the Holy Spirit, so glad they found the problem, expecting big things today! Praying for peace and comfort.
ReplyDeleteA much better day!! By 6 am this morning Bilirubin counts were almost cut in half. The ERCP was needed as the stents were blocked. The replacement was a complete success! Fever is gone, I feel great. Thanks for great Docs. Thanks for the prayers!
ReplyDeleteMark