10.23.2009

Hospital: Day #3

10.23 7am from Matt:

Dr. S just came by. Mollie's WBC are the same as yesterday (0.5), and her other measurements (HgB, Hct and platelets) are roughly the same as well. No ANC yet (I hate it when they come in here without it). She had tylenol at 9p last night and had slept well since then. Cefepime at midnight, then normal temps at 1A and 4am, vancomycin around 5am. He also mentioned that her IgG levels were low, but not so low that they would need to transfuse her. I was happy to hear that, Mollie had an infusion to bolster her IgG level during her December stay and had a reaction to it - one of the scariest moments we have had during her treatment.
So, at this point we are at 10 hours and counting with no fever. Need to get to at least 24 before we go anywhere.

Update (1:30 pm) and FAQs:

We missed the doctors rounds this morning because Matt and I were doing the "Lucy exchange" downstairs. Mollie reported that Dr. B told her to keep blowing her nose. I'm sure if there was a change in "the plan", Dr. B will come back and let us know.

Mollie's temp was 37.8 @ noon; now she feels warm to me so I wouldn't be surprised if it is higher.. She just had a session with the school teacher, Ms. Pam. They did a lot of the make up work that her teacher sent last week and she enjoyed being out of the room and getting attention from someone else! Mollie didn't eat any of her lunch (don't blame her- it looked unappetizing) and doesn't want the bagel I got her (they didn't have plain, ugh) so she's grouchy and hungry. She only wants french bread and cheese or a bagel from Einsteins or vanilla yogurt. I'm going to try to get her to eat some cereal.

A few people have asked about blood counts and ANC. Every time they draw "labs" the blood is sent for a CBC (complete blood count). This measures the number of red blood cells (RBC), white blood cells (WBC) and platelets in the blood sample. Neutrophils are a type of white blood cell that is the body's main infection fighter, but only a percentage of white blood cells are neutrophils. The ANC (absolute neutrophil count) gives the total number of neutrophils and is a measure of infection-fighting ability. To get the ANC, they have to do a differential count, where they look at all the white blood cells and then calculate the percentage that are neutrophils, lymphocytes, monocytes, etc. They multiply the total white cell count by the % neutrophils to get the ANC. An ANC below 500 is considered neutropenic and requires special precautions to reduce the chance of infections.

Another question is why the temperatures are reported in Celsius. I think most hospitals now use the metric system exclusively. Pediatric medications are usually dosed in mg/kg body weight, so for consistency, I think they measure everything using the metric system.

Julie, we don't have a printer here, but Matt and I are switching shifts at least 2x per day so we can print things from home and bring them here.

Update @ 4:30 pm: The fever continues (38.4 @3:15). She got some tylenol about an hour ago, so hopefully that will bring the temp back down. Dr. B says keep waiting- she may have a virus that won't respond to antibiotics and just has to run its course.

Mollie is in a good mood though- she's been using the nurse-call button as a microphone!

20 comments:

  1. Keeping my fingers crossed.

    Michelle

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  2. Love you all so much. Please let me know if there is anything I can do short of being there. (That can be arranged too!)

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  3. 9:45am

    Mollie's ANC is 55. I dont want to speculate on the implication of this without talking to the docs, who havent rounded yet. Meantime, she is getting another vancomycin drip and watching TV. The schoolteacher, Ms. Pam, just came by and will do some work with Mollie in a little bit - will be nice for the break and to give Mollie something to focus on.

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  4. Hello! Please let Mollie know that Mrs. Partridge is thinking about her. We all miss seeing her smiling face in class and hope she feels better soon. May God be with you all! Mollie is an AWESOME kid!!

    Stephanie Partridge

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  5. Argh! ANCs are supposed to go up, not down. Well, chalk it up to the lab issues in correctly identifying at low numbers. Do you have access to a printer at the hospital?

    Hang in there, we're all pulling for a fast resolution to any bugs and getting that ANC back up. Hospital stays always stink and during maintenance - even more so!

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  6. Matt-
    Do the doctors know why her fever keeps coming and going?
    I am sure thinking about all of you!!!
    Thanks for all of the updates. We are checking in throughout the day.

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  7. Hi Sylvia, the fever would probably have been there the whole time were it not for the tylenol. It suppresses it for a while, then it comes back. We keep hoping it wont of course. And Liv to your question - not sure about that either, other than all measurements of everything are using the metric system, which I think is the standard. Its funny though, the nurses all carry around little cheat sheets to translate C into F, and kg into lbs.

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  8. Thanks for answering that, Matt!
    What about the ANC number? What does that measure exactly? I have googled it, but I don't know if what I am reading really makes sense to me!

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  9. ANC is the absolute neutrophil count, basically a measurement of how many of her white blood cells are neutrophils. A "normal" ANC is around 1,500 and above. Mollie is neutropenic, and therefore susceptible to infection, when her ANC is below 700 or so. This is why she is kept in isolation at the hospital when it is so low - also cant have flowers, fruit with peels etc in the room. When she was diagnosed, her ANC was Zero. We need to get this measurement moving Up, in order to be confident that her immune system can attack whatever she may come into contact with, either here in the hospital or in the outside world when she is discharged.
    (Sorry for the long winded answer, just had my second large coffee of the morning :)

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  10. OK, that's what I thought. Thank you for the long winded answer. :-) I like long winded answers!

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  11. Thinking about you, Mollie!

    Otis says Hi!

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  12. I am thinking about Mollie and miss her here. I hope she can get the emails sent through MCG. Let her know we miss her! Mrs. Swenson

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  13. Big hugs guys and get better soon Mollie! Thanks so much for all the explanations, I so hope all these antibiotics kick in soon and kick down her temp!

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  14. thanks for the (repeat) explanations. we've been thinking of you all a lot the last few days. hoping some positive thinking (and the drugs) get her ANC back up.
    sarah, don't worry about lucy snot. a box of maternity clothes is packed and will be headed your way ASAP.
    love, nicola

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  15. Sophia Donohoe & her big brother Justin really hope that Mollie is better soon. Sophia told us during dinner tonight about Mollie & the pretty pictures she gets to make in the hospital. Sophia hopes to see Mollie back in class, Love, Sophia.

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  16. 10:15pm

    Keep your fingers crossed...but we might finally be getting somewhere. We ate dinner together out in the lobby around 7pm and Mollie really felt warm - Sarah and I were sure the fever was back. About an hour later, back in the room, the nurse took her temp, and surprise, no fever (she still felt a little warm). Just now, they took her temp again, and again, no fever - 37.1 C.

    Not celebrating yet but finally some positive signs.

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  17. Thanks for being such good troopers-- Mollie wouldn't be anywhere near where she has progressed to if it weren't for parents like the two of you!

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  18. 10-24 745am

    Fever back again, 38.4 C. Maybe the silver lining is that she held it off longer this time around. Anyway, will wait and see what her counts are this morning.

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  19. I'll be back at 2:00 P.M today. I can take Lu after that. Bella wants to spend some time with her.

    Michelle

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  20. Hopefully the ANC count is up this morning! We're thinking of you all here in D.C.!

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Comments are always welcome!