Orthopedic and Infectious Disease Follow-ups

Annie saw her orthopedist on Thursday last week.  It was a fairly uneventful appointment, although she did get all the stitches in her back taken out--it took the nurse about 30 minutes to remove them all and put steri-strips down the length of her incision. 

They also took another set of x-rays and everything looked good. They were some of the clearest x-rays I've seen--they showed her hardware much better than ones in the past--but I didn't think to snap pictures of them quick enough.  It's always impressive to see a profile view and see really how long the screws are that go through her pelvis.  They are about 4 inches long! Dr. Hasley said she looks great, although he then quickly admitted that her x-rays and incision always looked good since her fusion, even when there was an undetected infection raging below her skin and muscles! We'll return back to her orthopedist in another 6-8 weeks.

After we finished up with the ortho, we headed over to see the infectious disease doctor, Dr. Delair.  Today was the first time that we were told that they might be able to transition Annie to oral antibiotics at some point over the next year, instead of keeping her on the IV antibiotics for a full year.  They said there's really no protocol to follow for Annie's case because unlike most patients they treat for this, Annie's culture from her back never grew anything.  So since they don't know exactly what kind of bacteria is causing her infection, they have to be more aggressive and use much more broad-spectrum antibiotics, potentially for much longer. 

Annie will stay on the IV antibiotics for at least three months minimum.  She will continue to have weekly blood work done and we will meet with her infectious disease doctor every 2-3 weeks.  I'm not quite sure how they would decide when she could transition to oral antibiotics for the rest of the year, but when they do, it will be done by trial and error.  I think they might keep her on the IV antibiotics as long as she is tolerating them well, but if issues with them arise, they would consider trying the switch to orals.  When they think she's ready for orals, they will leave her central IV line in place while they see how she responds to an oral regimen.  That way, if her white blood count or CRP or other lab values start increasing, they can put her back on the IV antibiotics for longer.

Right now Annie's labs look really great...

White blood count is about 9,000 (was as high as about 40,000 in the hospital, and was even 16,000 the week and day of her original spinal fusion.)

CRP which measures inflammation is at 0.7 (it was over 27 at it's highest).

Creatinine which measures kidney function is 0.2 (it was 0.94 at it's highest).

Hemoglobin is 10.8 (up from being around 7 at the lowest and requiring a couple blood transfusions during and after her two surgeries last month).

And the lab value that measures the muscle enzymes that can be effected by the medications she's on is still staying normal and stable, so that's good too.

So, overall, Annie is doing really well right now.  We still have a lot of uncertainty over this next year, and even beyond that, as these infections tend to recur, but we are grateful for relative health now and the fact that spring is just around the corner, hopefully! :)