9:30 AM: Sophie's attending physician just came in to talk to us. He said that her ANC is still at .2 (no improvement from yesterday). Her lymphocytes and monocytes are both on the rise, so that's a good sign that her ANC will start to go up before too long. Meanwhile, they got the sensitivites back from the lab, and her bacteria only appears to respond to vancomycin (which she's already on) and oxacillin (which has to be administered by IV every 6 hours and isn't practical to administer at home). Since it responds so well to the vanc, they'll concentrate on finding a practical dosage of that. The nurse told us yesterday that they were changing the frequency to every 4 hours because the levels in her blood were too low, even after increasing the dosage level. The doctor said this morning that he had actually ordered it every 6 hours, but he talked to the pharmacologist about finding a dosage that will work every 8 hours. If they can't get it to 8 hours, he said it would really be too hard for us to manage at home, so that's one goal for getting us out of here. The other good news on that front is that the culture they took on Wednesday (after she had been on the vanc for 24 hours) has not grown staph after 24 hours. If nothing grows after 48 hours, they will be confident that the infection is under control.
The other issue keeping her here is her low ANC. When a patient has her type of leukemia with low ANC, the standard treatment is to administer cefepime (a different antibiotic that prevents a certain type of secondary infection). He said that even though her cultures are showing no sign of this other infection, he really won't feel comfortable stopping the cefepime. Once again, he doesn't want to send us home having to administer multiple or frequent IV antibiotics, so we have to stay until her ANC is high enough to justify cutting out the cefepime. How high, we asked? He said if he just sees it improve, that will be fine with him. That's good, because as I mentioned above, her monocyptes and lymphocytes are on the rise, so the ANC is sure to follow.
As for an estimate of when the stars will be aligned properly so we can get out of here? He said he would be happy if we got out of here this weekend, but early next week is a distinct possibility. And if we can't get the vanc frequency up to 8 hours, we're here until she's had it for 14 days, which would send us into early the following week. Meanwhile, he said she'll be the healthiest kid on the floor. I distinctly remember those very same words coming out of his mouth during an earlier hospitalization.
We'll keep you posted!