I apologize for the delays in between updates – it has taken me 3 days to have the time to sit and write this post in between rounds, meetings, procedures, etc. Carol is so good to fill-in for me when things are chaotic, but this update is very detailed. Prepare yourself for lengthy medical talk.
Monday there were over 12 of Rebecca’s specialists gathered in person and Zoom to discuss her complex case: Colo-rectal surgery, GI, Infectious Disease, Interventional Radiology, Transplant, Hematology/Oncology, Hospitalists, OB/GYN, General Surgery, nursing staff and fellows as well.
This is where we stand with Rebecca’s infection:
Good News –
The multi-resistant Bacteroides bacteria is responding to the antibiotics and Rebecca is no longer septic. This is a HUGE praise! New abscesses have stopped forming, so we are only dealing with the recurrent abscesses that are not responding to treatment and drainage.
Bad News –
The bacteria is responding very slowly to treatment. Because Rebecca’s infection spread from her lungs down to her pelvic cavity, time is not our friend. During Rebecca’s infection state, her body leaked enormous amounts of fluid from her GI track either from colon leaks prompted from IVIG and/or protein loss enteropathy. This fluid formed in pockets around her lungs, liver, intestines, etc. The bacteria then mixed with the excess fluids and created abscesses (Bacteroides is known to create abscesses).
Strangely, although this was a GI issue, Rebecca’s biggest problem-spot is in her pelvic cavity. The bacteria settled down her abdominal cavity and multiplied fiercely. Rebecca’s ovary and fallopian tube areas are stretched to the brim with infection causing far more pain than the abdominal abscesses. Although abdominal abscesses are very painful, they have more space to grow.
There are two camps of thought in how we should treat our current status:
- Infectious disease and OB/GYN want to open up Rebecca’s entire abdominal cavity and clear out the infection surgically, wash out her system with antibiotics, and preform a full hysterectomy. Rebecca’s reproductive organs are too inflamed to remove individual parts right now, so a full hysterectomy would be necessary. Rebecca came to terms with not bearing children years ago and has big plans to adopt but removing her ovaries at this age will have long-term effects on her already damaged heart and bones.
- GI, transplant and colorectal surgery team feel another major abdominal operation at this time would be severely life-threatening on Rebecca’s compromised system and we need to attempt anything else possible in between. I agree.
So where does that leave us? We have tried the traditional draining technique 4 times and yet the pelvic cavity abscesses keep growing back. Tomorrow morning at 8:00 am, we will attempt an out-of-the-box solution and go in for another drainage but in addition, Interventional Radiology will inject the meropenem antibiotic directly into Rebecca’s abscessed area as a lavage (medical wash-out). We hope this directly applied technique will help more than the systemic IV antibiotics.
We ask for prayers for the procedure tomorrow, prayers for the infection to continually clear, and prayers for Rebecca’s pain.
I was told yesterday the doctors were overjoyed because they did not expect Rebecca to live through last week, and yet we still have our girl. I consider that an exquisite unexpected miracle.
Thank you Lord.
Love to each of you,