Though I spent much of the day yesterday trying to understand my attending oncology team’s (to me) counterintuitive attitude, the design behind the scattered pieces of the puzzle has become a bit clearer today. In essence, the attending onc team’s lead doctor, call her Dr. R, who is also the founder and grande dame of the stem cell transplant unit, has been equally uninterested in the positive and negative implications of the dermatology team’s certainty that my rashes are symptoms of Graft VS Host Disease.
The fact is that the rashes aren’t bothering me very much, I have some good creams for them, and they don’t seem to be connected to any more dangerous types of GVHD. Dr. R’s focus is on the bigger picture as regards the transplant itself, so she’s making sure that they are monitoring my liver enzyme levels—the liver would be a way worse battlefield for graft cells and host cells to be duking it out. But she is also (good for me to hear) very committed to dealing with the c-diff business, which can make my life truly godawful for 2-3 hours at a stretch. This means she’s discontinuing all the “covering” antibiotics, and stepping up the dose of the antibiotic we have been using to target c-diff.
The other implicit message here is calling “B.S.” on those who claimed I had double pneumonia (I remember a particularly annoying 1-step dance: a trumpeted announcement from the door frame that was never even followed up on). I had been tempted at the time to call in my favorite lung doctor from May (who was incredibly thoughtful and not so eager to jump to conclusions, let alone prescribe treatment, without a lot more reflection), but since that was the same day (consulting handy blog archive confirms it was Day +11) I also got the news about c-diff, I guess for once I chose to keep my skepticism quiet and let things play out.
One other newsworthy item to report: Dr. R said she feels that this coming Monday (February 1) is a realistic date to plan on going home. This isn’t too surprising, I guess, considering that my transplant per se was a massive success, by most immediate measures, and that c-diff is the only major visible fly in the ointment, as it were. It’s really not too much to suppose they’ll manage to get that under control within the next 5 days or so; I just learned that one of the Infectious Diseases doctors I met here last Fall has literally written the book on how to deal with c-diff!