It has been a rocky end to Dennis’ first week back to work. After not feeling too well a good part of the week he developed a fever Friday night and I sent him off to the Take Care clinic at Walgreens Saturday morning. A throat swab was positive for Strep and after discussion about the advisability of a trip to the ER he came home with a prescription for a strong antibiotic and went to bed while I hosted a baby shower for my niece and about 35 guests. I didn’t discover until Saturday night that he also had an apparent infection in his upper left thigh the area of which had grown since the morning and had become increasingly painful. While my immediate reaction was to take him immediately to the ER, his reluctance and a consultation with an on-call doc convinced me to monitor at home. After drawing a circle around the infected area so we could tell if it got larger, a really good suggestion by the on call doc, we both went to bed. As it turns out, my initial instincts were correct. By Sunday afternoon the redness on his leg had moved outside the circle and we were off to the ER. It was a long, nerve wracking and pretty scary experience. The ER staff were obviously pretty concerned about the leg and somewhat concerned about the generally bright red appearance of his face and red rash on much of the rest of his body. Was it “red man syndrome”, which I learned was a descriptive term for a drug reaction rash, or was it caused by the strep infection? Things got very interesting when the nurse taking vitals abruptly left the room and came back a few minutes later to announce Dennis was being moved “next door” for closer monitoring due to a low blood pressure reading. I knew from a previous ER trip with his mom that “next door” was critical care ER. A little concerning, but we also knew that due to adrenals that did not function well, Dennis often has trouble with hypotension when he is sick. Giving him some extra corticosteroids usually takes care of the low bp. When his monitor started beeping about 15 minutes later and his nurse told him rather urgently to take deep breaths I looked at the screen to see that his oxygen level had dropped to 78%. A lot more concerning. Within minutes he was on oxygen and his levels returned to normal. The question was what caused the drop? Dennis knew, but I didn’t, that the bp, low oxygen level, decreased kidney function which had already been reported and lack of fever could be signs of septic shock. He was visibly worried which scared me. Fortunately the staff were wonderful and were able to steady us and help us focus on what needed to be done. He was admitted to ICU on powerful IV antibiotics and close monitoring.
Now for the good news – the crisis has passed, the sepsis and cellulitis are resolving and this evening he was moved out of ICU. The consulting infectious disease doc, who wonderfully is the same ID doc who has been involved with Dennis’ treatment every time he was admitted to St. Francis BMT unit, believes that the infection in his leg is a strep infection and that he was close to having a major sepsis, but is out of danger. If things continue progressing well, he could be home Thursday.
Dennis asked me to post something about his current situation. I am sure he will be writing to update and give his perspective on these events in a few days.