Taking a Breath

It’s been about a week since our last blog. A lot has happened since then. We had gone from thinking that Logan would be discharged within the week to seeing no discharge in the near futureand then back to being discharged soon. Logan was doing great. He had been weaned off the nicardipine (a blood pressure reducer in drip form), which was a big step toward discharge. His solumedrol (a steroid) had been cut down to less than half of his peak dosage. Things were looking up. Then he spiked a fever of 102.2 and was having trouble keeping his 0₂ saturation above 90%. The doctors ordered an x-ray of Logan’s lungs and the results were somewhat inconclusive. The doctors said that the x-ray showed either an infection in his right lungor adelectisis (collapsing of portions of the lung). It was at this point that Logan started getting albuterol, mucomist, and DNase treatments. The albuterol was to expand the passages in his lungs. The mucomist and DNase were used to break apart any of the mucous in his lungs. After each treatment, Logan had to wear a vest that inflated and deflated rapidly to shake him to loosen up the remaining mucous so he could cough it up. Soon after starting the treatments, a CT scan was ordered to get a better look at his lungs. It had only been a couple of days but the CT showed no improvement and actually showed that whatever was in his right lung had spread to his left. The breathing treatments were then increased to every four hours. The doctors decided to order a bronchoscopy to obtain a sample from his lungs (to determine what kind of infection may have been present) as well as to flush his lungs to try and clear up some of the passages. The procedure went well and was fairly short. The doctor explained that she had found barely any mucous and flushed his lungs. The sample obtained from his lungs would be cultured to find out what bacteria may have been present. After the bronchoscopy you would expect him to start getting better, but he seemed to get worse. For two days following the bronchoscopy, Logan needed blow-by oxygen to keep his O₂ saturation above 90%. During those two days it seemed that we would get conflicting reports about how his lungs sounded. One nurse would say that his lungs sounded clearer, another would say they sounded junky, a doctor would say that the airflow was more diminished than previous observations. The doctors began to suspect that the paraflu Logan had contracted had moved down to his lungs. Dr. Szabolcs suggested that if Logan did not improve in a few days that we should try the Ribavirin Tent again. It was also during this time that Logan began to have elevated blood pressures again. The doctors could not explain why this was, but went ahead and put him back on the nicardipine drip to maintain blood pressure control. Noelle had noticed that every time Logan would get an albuterol treatment, his blood pressure would get quite high and then slowly drift back down to the normal range and then jump back up when he got the next treatment. We mentioned this to the doctors and, at first, they didn’t think much of it. It wasn’t until they saw the trend, even with the nicardipine drip, that they replaced the albuterol with xopanex. Albuterol tends to raise the heart rate which could lead to hypertension, whereas xopanex does not. Once on the xopanex, Logan’s blood pressures stabilized and the doctors took him off the nicardipine drip once again.

Now that he was back off the nicardipine drip, we had to go about getting rid of the respiratory problems. Three days post-bronchoscopy, Logan actually started to get better. He wasn’t needing blow-by oxygen when he was awake, which was a good step forward. Over the next few days, he needed blow-by less and less overnight and only when he was in a deep sleep. The doctors, seeing that he was improving, ordered another chest x-ray. It came back showing that his left lung was almost completely clear and his right lung was greatly improved. The doctors said that it was a remarkable difference. During all this, the cultures from the bronchoscopy came back negative except for the paraflu. Seeing this, the doctors discontinued Logan’s cellcept (a GVHD med) because cellcept attacks lymphocytes. It is these lymphocytes that are essential in fighting the paraflu. With the discontinuation of the cellcept, Logan developed a mild GVHD rash on his head, back, and legs. Dr. Szabolcs prescribed basiliximab to counter the GVHD rash and to avoid having to increase his steroids. Within a day, the rash had all but disappeared.

Last night Logan didn’t need any blow-by oxygen and is staying above 95% while awake. The doctors think since he doesn’t need supplemental oxygen, he’s off the nicardipine, and his lungs have greatly improved, that he may be discharged to outpatient as early as late next week. This is where we are sitting right now, so things are looking good.So that was all the medical happenings that have gone on. Aside from that, there have been a few other things going on.

Last week one of the nurses told us that a professional wrestler would be visiting the floor. My family and I used to watch wrestling religiously and Noelle watched it for awhile when we first got together. We figured that it would be some local wrestler, no one of any significance. When he got here, one of the nurses poked their head in the door and asked if Logan would be interested in meeting him. We said sure, not really thinking anything of it. He came to our room first and in walked Goldberg. Logan may not have been very interested, but I thought it was pretty cool. We talked for a little bit, he autographed some portraits and we took a picture together. Goldberg got one of Logan’s first goodbye’s that he’s said in a long time. He visited the rest of the floor afterward. We thought it was awesome that he would take time out of his busy schedule to come visit like that.

A little after Logan came down with his respiratory problems the doctors decided that he needed to get moving around to help get rid of the junk in his lungs. Logan wouldn't do anything in his room because he had been couped up in there for over a month and a half. They said he could go out in the hall, as long as he wasn't symptomatic for paraflu. Problem is, physical exertion caused him to cough, which is what the doctors want, but they didn't want him around the other immunosuppressed children. They then said that Logan could go out into the rest of the hospital, as long as he wore a mask. This was great. We went over to the Children Health Center after it was closed and let Logan ride the glass elevators there. He absolutely loved it. To get him to walk/run around, we would let him go up and then down the elevator and then carry him down the hall, just out of site of the elevator. He would then run down the hall to the elevator. We would repeat this ad infinitum. This seems to have helped a lot with his respiratory problems.On one of the walks we decided to go to the top floor to look at the helicopter. Logan got to see it but wasn't all too interested. While we were up there, one of the flight nurses saw us and invited us to go up close and see it. This was Logan's first time outside in almost two months and he got to see a helicopter up close. It was pretty cool. We were only out there a few minutes when the sun decided to come out. Logan is really sensitive to the sun right now, so we had to go back in, but it was fun nonetheless.

Also of great significance is the news that Logan’s chimerism test came back. This is a test that takes Logan’s blood and determines the ratio of new donor cells to Logan’s old cells. Logan is already >98% donor cells, which is basically 100% due to the accuracy of the test being ±2%. This means that the transplant was successful and he is growing all new blood cells.