D+69: BiPAP Black Belt

WBC 3.7
ANC 3367

Love those counts! Ryan's respiratory picture is also looking up. He's still on the BiPAP at 40% oxygen, but the amount of time that he can maintain his oxygen saturation without the machine is steadily increasing. This is a good sign that his overall pulmonary function is improving. If we can get the oxygen setting down to the 20-30 range, we will probably move off of the BiPAP and back to the cannula. Never thought I would be excited about putting the cannula back on.

I read the manual for the BiPAP machine today. Pretty interesting stuff. I figured out how to refine some of the diagnostic settings and I inverted the display to a much cooler white-on-black setting. I'm sure it annoys the respiratory therapists to no end, and that really breaks my heart.

Ryan has had a fever in the early morning for the past two days. It's been pretty low (~38) and it goes away on its own in an hour or two. We're not sure what to make of these fevers. Seems like we move in and out of these periods of fever with no real explanation for why they occur. The most obvious cause would be infection, but we haven't seen anything stand out in his labs/cultures. It's also possible that it's a drug-induced fever. Ryan is on like 25-30 medications right now, so who knows what kind of interactions we will see. My pet theory is that one of the colony stimulating factors that Ryan is on, GMCSF, is the source of the fever. Another explanation is that transient weirdness in Ryan's brain is leading to temperature regulation issues. Cheryl did some poking around on the Internet and found that this is not unheard of in metabolic patients. The main reason why it's important to us is that every time Ryan has a fever, we see a new wave of antibiotics, antifungals, and antivirals. The docs have a lot of experience with this sort of thing and the don't want to let an infection get out of control. On the flip side, these drugs are super nasty. The disastrous consequences of prior drug effects/interactions have been well documented in this blog. That's the toughest part of this whole process. Every decision is a "damned if you do, damned if you don't" deal.