The Plot Thickens, Too

Michelle's condition hasn't changed much in the last few days. She's still in the hospital and still on the same dosage of pain medicine. This is contributing to the mixed picture of her situation and has the doctors scratching their heads a bit.

To recap:

• Michelle had out of control pain and a fever at home on Saturday.
  
• We gave her Advil for the fever which brought her temperature down right away.
• We tried the oral pain meds we had on hand, but we couldn't get her pain under control and decided it was best to go to the ER.
  
• Initial blood tests revealed elevated white blood cells, which have been coming down steadily since then.
  
• The fever hasn't returned.
• Detailed review of the CT scans from Saturday show thickening of the tissue that enclosed the abdominal cavity and pelvis, the peritoneum, particularly around the part of her large intestine where it meets her small intestine, called the cecum.

All these facts point towards bacterial peritonitis, but several other factors don't fit with that diagnosis.

• The cultures of her blood and peritoneal fluid have not returned any results.
• She's not getting better. By this time, most patients with bacterial peritonitis are bouncing back and showing reduced pain and increased energy. Rapid improvement is the rule, but Michelle's pain hasn't abated at all, and she's still pretty wiped out.
• Her bowels aren't moving, although most patients receiving the high amounts of antibiotics she has typically have diarrhea.

After consultation with the infectious disease specialist, Michelle's oncologist Dr. Marschke believes a biopsy of the thickened peritoneum is the best course to pursue next, to see if there has been metastisis (spread) of cancer. All of the above symptoms seem to be pointing in that direction, although nothing is for certain. This test requires a needle biopsy which the interventional radiologists can accomplish with the aid of ultrasound. These are the same guys and similar tools that are used for the peracenteses that Michelle has endured 8 or 9 times already.

Speaking of which, the fluid has been building rapidly in her abdomen and it will be time for another peracentesis tomorrow or Friday. We suspect that they may do both procedures at the same time.

Michelle's spirits are about as good as can be expected. She's heavily medicated for the pain, which is making her fairly groggy and sleepy. The antibiotics are taking their toll as well, so she doesn't have a lot of energy. In spite of all that, she's not complaining and has been very patient with the nurses and the sometimes nonsensical hospital rules.

I've been able to get some work done in the mornings and here in Michelle's hospital room on my laptop, and the kids have been visiting when schedules permit. Chris left yesterday for his summer job, he's a medical officer at the Boy Scout camp in the mountains about an hour from home.