Top Line: Susan's pain has returned in spades, but it may be a sign that the engraftment is taking hold.
Susan had a pretty good night, but mid-morning, shortly after she and Bob got to Dana Farber for the ususal, the pain of the other day returned and was quickly even more severe than before. She's been put on heavy duty pain medications and it's an open question at this point as to whether she'll need to be admitted and kept in the hospital until the pain has clearly receded to levels manageable with home care (i.e., pills vs. infusions).
That was the bad news. The good news is that this kind of pain may be associated with the engraftment making rapid progress. The pain is across her pelvic region and is probably coming from the bones, which is where the donor stem cells are engrafting in the marrow.
Corroborating evidence is the fact that her white counts, which were 1.2 on Tuesday, have rocketed to 17. This is considered a very rapid advance, but certainly not unheard of. Of course, the daily injections of Neupogen have been stimulating the production of white cells, so we can't be sure how much of a role engraftment is playing at this point. They'll know more as they continue to get results from bloodwork and other tests over the next several days.
The urinary tract/kidney infection, which was revealed in the CAT scan, continues to be treated but is apparently resolving. Today was probably the last day for the Vancomyicin and, now that the white count is up so dramatically, the Neupogen. At this point it appears that Susan will NOT need an infusion of platelets or whole blood, which is good.
Speaking of infusions, though, and just to give you an idea of the tribulations in Susan's ongoing saga of the connections, when they went to infuse her today, the PIC line was clogged, so they decided to re-insert a heplock. The heplock turned out not to be useable (remember, Susan's had trouble with heplocks), so they then removed the heplock , returned to the PIC line and applied some kind of anti-coagulant (think Liquid Plumber, but non-toxic), which did the trick, and they were finally able to start infusions. Thank God, because in addition to the Vancomyicin, she's needed two bags of morphine for the pain.
I'll let you know later this evening whether Susan needs to be admitted and if there are any other developments.