Things Look Much Better in the Morning?

In general it's true that things look a bit better in the morning.  For us, I'm not quite certain.  When he woke up things were looking good.  His heart rate was down.  His breathing was improved.  His fevers were better.  Then we started to get results.


His nasal swab came back essentially negative.  However, he had blood cultures drawn, and they are already positive (less than 12 hours to being positive is on the faster side).  Right now it looks like gram negative rods (if you are reading and interested, but I'm not going to discuss microbiology on this post).  His blood counts have all dropped further since Monday.  This is not surprising.  His white blood cells are now below the detectable limit.  His red blood cells are low, but not to the point where he needs a blood transfusion.  His platelets have dropped.  Bleeding could be a problem, but again, he's not low enough to where they would give him a blood transfusion.  His blood pressure is on the low side.  He still has enough uncomfortable spots that he can't sleep well, and with the anemia he always feels tired.

Right now the treatment is antibiotics.  Generally the first antibiotics selected can treat almost everything "broad spectrum", but we want to hold them in reserve so that we don't get bacteria that are not treated by the big guns.  As we learn what bacteria we are treating, we also can learn what that bacteria is susceptible to and we'll get a simpler antibiotic that we know is effective for the infection, so we narrow the coverage and then treat with that for 14 days.  He also gets IV fluids.  One of the dangers of infections, especially when it gets into the blood, is that you can go into shock, and you can't maintain adequate blood pressure.  Giving IV fluids is one of the main things to help with that, as well as a "stress dose" of steroids, sometimes.  Fortunately, his blood pressure is rising nicely with fluids.  If we can't get his blood pressure to increase with fluids, then we have to talk about escalating care and going to an intensive care unit.  For now, we are good where we are.  Hopefully I'll never have to write about the adventures in an intensive care unit.