Wednesday, October 18, 2006

Spontaneous Bacterial Peritonitis (SBP)

SBP is the diagnosis for what happened to shut Jim's system down on Saturday.

In the human system, bacteria naturally transmigrate out of the bowels and into the belly cavity. Most of us have no fluid in that cavity and we have a strong enough immune system to fight the relatively minor amount of bacteria.

Not Jim. He has ascites, an accumulation of fluid in his peritoneum because of his damaged liver. We try to keep it down with diruetics, but that's a fine balance (because diuretics lower blood pressure). Jim also has a weakened immune system. The transmigrating bacteria stayed in his belly fluid and cooked up a nearly fatal stew. The infection spread to his kidneys, his bladder, his blood (sepsis), and probably other places the DRs haven't cared to share with us.

Yesterday's conversation with the internal medicine specialist--

To DR: Is this a condition that is likely to recur?
From DR: Yes. Once it occurs, it likely is going to be a chronic condition.

To DR: So what does one do?
From DR: Lifetime antibiotics.

To DR: What is the standard of care?
From DR: Two weeks of antibiotics.

To DR: Two weeks in the hospital on IV antibiotics?
From DR: Not necessarily. Depending on his response, he may be moved to oral ABs.

To DR: How long in the hospital?
From DR: Let's take that one day at a time.

To DR: What are the markers for saying he's ready to leave the hospital?
From DR: Blood values and mental status.

Today's conversation with the GI specialist indicated that Jim's liver may be so damaged that it is completely dysfunctional. The DR started mentioning liver transplant. I know that's going to be a long shot given Jim's age (66 next week) and drinking status (only 2 months without alcohol). The DR did say he thought Jim was only a few days from release from the hospital. He also said he would write an order for hospital based PT/OT. Jim and I did his arm exercises today.

The infectious disease specialist ordered a CT scan for Jim. I didn't see him so I have no idea of the site of the scan or the purpose of the test. Jim may have been told, but he doesn't remember.

Jim is mentally confused. This afternoon as I was getting ready to leave, he told me he was at the airport. That is a real hoot because Jim is terrified of flying, and won't even go to airports to pick people up or drop them off.

What is so scary is that Jim's total crash happened within 2 hours. What if I had been out and about at a DRs appointment of my own or shopping? There have been times I have left him alone for 4 hours at a stretch.

I'm not a praying person, but I am about ready to get down on my knees and plead with whatever power out there watches over children and fools that s/he watch over Jim and me and help us get through our diseases and back to health. Jim promised me that I would see parts of Europe with him. I want him to be able to keep that promise.

Update on radiation: Nothing until next week at the soonest. They have to replace the door on the treatment room so that it will lock. I am "expendable" because I haven't started treatment. Others, I am guessing, are being temporarily transferred to the cancer center facility.

1 comment:

Alice said...

Sorry things are sounding sucky. I also hope you and Jim get to see part of Europe. Sending my love your way.