unmanageable infection

[ppmguy]

  my wife has been dealing with chronic infections for 8 months.  she has radiation enteritis and can not eat anything. so she is being fed by TPN. it is a IV catheter, with a picc line that goes directly to the heart.  her line became infected in february, with positive cultures for yeast and bacteria(i cant remember the bacterial strain). it was dxed as early sepsis and she cleared in 9 days of iv antibiotics. she was moved to a skilled nurse facility to finnish her iv tx, and pt.after 2 weeks there she developed a UTI. she cleared the infection, but 1 week later her wbc was starting to rise. she got flagyl and a 2nd antibiotic, and wbc rose to 24. she went into septic shock in april and had a positive staph culture.  for the next 2 months she is living in the hospital and nursing facilities.  she responds to most antibiotics, but her wbc starts climbing when they are stopped. lately her urinalysis are chronically positive for yeast, bacteria, and blood. she has become ressistant to vancomycin, and is now using meropenem.  we have become frustrated with drs.  being in the hospital, her dr is changed every week.  we get conflicting info about the seriousness of her issue.  any input would be great,  

[mkh9]

I'm so very sorry. It is such a bad situation. Is she in remission now?  Have they changed out the picc line after the last infection? What if she eats a fluid diet? Such as blending foods in a food processor or blender, and/or using ensure etc. Maybe that would keep her from getting the  bowel obstruction and if you didn't have to use the TPN line perhaps she wouldn't get the infection. Do you think she can drink liquid foods?

My mother had grade 4 cervical cancer and she had about the same amount of radiation treatments (Cobalt) and internal radiation (radium implant) as well. Her radiation enteritis eventually got better but didn't go away entirely. It took about a year for the worst of it. Then she was able to do more. But she didn't have the bowel resection. She lived 20 years after that.
So I'm hoping that if you can give her liquid foods and avoid the TPN line that maybe that would keep the infection down and obstruction? Does the doctor give any advice? Do you have any help taking care of her? I'm sure you are very tired.
mkh9

[ppmguy]

     she had cancer of the uterus. the drs did the hysterectomy, and had to do a bowel resection, because scar tissue from prior surgery had fused her small bowel to her female parts and bladder.  they took 10 inches of small bowel to free the parts being removed.

    6 months after surgery her cancer recurred. she did 25 external radiation treatments, and 3 internal.she finished tx 7-15-2013.  she lost 40 pounds from july to november.  her oncologist said her radiation enteritis was chronic after 4 months.  he also said she needed to be on TPN for the rest of her life, and would not be able to eat solid food again.  the tpn requires special training to avoid infections.

     all of 2014, she has had 4 bowel obstructions, and numerous infections, two times with septic shock.

    it has become a nightmare. if she eats food, her bowels obstruct.  with tpn , the line infects within a couple weeks.  
barry

[mkh9]

I'm so sorry about your wife's condition. How long ago did she have radiation? Was it for cancer? My mother also had radiation enteritis. There must be some better anti-nausea or other drugs to help her eat better. I would ask about this. They have some strong anti-diarrhea medicines as well. These don't work well for the first months, but it gets a lot better with time.

The worry is when she gets yeast in the blood or bacteria. Yeast is more serious. Sometimes catheters can get contaminated with bacteria and cause an infection such as Staph. But picc lines are very good for preventing this. However, it is still possible as you saw. They may need to remove and start a new picc line. Usually if it is the picc line they suspect they will do a blood culture on it (but they would have to take a snip of part of the catheter or remove it in order to do this) and replace it with a new one. Since it did get infected that might be an option.

The urine infection isn't as serious (even though it is uncomfortable) as the sepsis. Except that it can get into the kidneys and cause infection there, which isn't good either. I would try to talk to them about possibly replacing the picc line or asking them if that is an option. Perhaps, trying to get a single doctor or group on her case. Also ask about better meds to get her eating. So far those are my thoughts.
mkh9