Drug and Kidney Issues

With Annie being on the IV Vancomycin, they have been doing blood draws daily to check the amount of drug in her system.  She should have a Vancomycin level of 15-20, and she was hanging out right around 15 earlier in the week, however, yesterday it spiked to 33, so they cut back on the medication.  But despite that decrease in her dose, today her level is at 42! 

Similarly, related to her Vancomycin level is her creatinine or kidney function lab.  Annie's normal creatinine is 0.2, but it had increased last night to 0.48, and now this morning was 0.91, meaning that her kidneys just can't tolerate the Vancomycin anymore so they are stopping it.  They also started Annie on IV maintenance fluids to try to flush the lingering Vancomycin out of her system.  She will remain on the oral Vancomycin that's she been on because oral Vancomycin doesn't get absorbed into the blood stream, but stays locally in the gut to help prevent c-diff from all her other antibiotics. 

Tomorrow they will start the Daptomycin for gram positive coverage in place of the Vancomycin.  Then she will remain on that Daptomycin for a year.  Unfortunately, it can cause changes in muscle enzymes causing sore muscles or muscle weakness, so as long as she's on the Daptomycin, she'll have labs drawn weekly to check for any problems--yes, every week for the next year.  :(

For now they are keeping Annie on her Zosyn for gram negative coverage, until after her surgery on Friday, and then after that they will switch to the Ertapenem to be on for a year.  We are not thrilled to have her on these heavy-duty IV antibiotics for a year, to say the least.  There are other complications that can arise from such long-term use, but hopefully they will successfully treat the lingering infection in her back.  On the plus side, Annie won't be having any UTIs over the next year!

There have been some concerns today about Annie developing some pressure sores from her hospital bed, so they delivered a new specialty bed for her.  The specialty bed she had after her spinal fusion surgery was an air mattress that sent waves of air up and down it to help re-distribute pressure regularly.  I thought we'd be getting that same kind of bed, but instead, they got her an air bed that also has little beads in it, so as the air blows around in the mattress, the little beads float around as well and supposedly help.  It is definitely extremely soft and squishy--kinda feels like a waterbed--but it is also extremely loud!  The motor on it is not nearly as quiet as her previous air bed.  It is difficult to talk to doctors when they come in the room unless I stand right next to them.  I'm hoping that at night it will become like white noise and not keep us awake all night long!  On the plus side, it came with a bead-holder for Annie!!! ;)

Annie's new extra soft and extra loud air-bead bed.  They even included a "toy bar" for her beads! ;) The peach wall around the mattress is air-filled with continual blowing air, and the center white area is filled with beads that blow around with the continual air flow.