Friday, October 15 - Day +2

Around 12:30 Thursday morning, Collin woke up a little fussy, and then I heard him fill his diaper. As I was changing him, he continued to have diarrhea; I'd get him cleaned up, and he'd go again right away. Then as I continued to get him cleaned up, he vomited quite a large volume. I ended up having to bathe him and change all of his bedding. Then we had to change the dressing over his Broviac because it was smelly. I hated having to change the dressing so soon after it had been put back on Monday after the Thiotepa baths were done, because the skin on Collin's chest was so red and raw. It took three of us to accomplish the dressing change; one nurse to do the dressing, another to hold Collin's hands so he didn't reach up and touch the sterile field, and me holding a disposable chuck pad under his chin so he didn't vomit all over his chest. He did vomit again during the dressing change, and we were afraid he aspirated some of it into his lungs because of how he was laying (on his back) and because it took him a minute to get his breath. After we finally got the dressing changed and everything cleaned up for the last time, Collin was given more antiemetics to help with the vomiting, and his tube feeds were stopped. Two residents came up to assess him, and based on how his lungs sounded, they didn't feel he had aspirated any emesis.

Collin spent most of Thursday morning sleeping. Then a little before lunch time, he perked up, and when the lunch tray came, he wanted to eat. He ended up eating a whole bowl of chicken noodle soup and six saltines. After he ate, he went back to sleep, and later was sitting up in bed playing. Then out of the blue, he vomited again, pretty much everything he ate for lunch. His oncologist felt the vomiting and diarrhea may have been caused by the stem cell preservative, not necessarily mucositis yet. In the end it doesn't matter what the cause was, it just stinks to see Collin sick like that.

Over Thursday night into this morning, Collin continued with the diarrhea, so last night wasn't restful either. Today the diarrhea had some blood in it. He had received platelet transfusions Wednesday and Thursday morning, as well as this morning, and because of the blood in his diaper this afternoon, he received another platelet transfusion this afternoon. The frequent need for platelets is expected after transplant, so at least I'm not surprised by all the transfusions.

Collin has now developed mouth sores (which he's never had before), and is unable to eat even though he may be feeling hungry. Tonight he was started on TPN, the IV nutrition he was on in the first round of chemo back in May. He had a dose of Morphine this afternoon, and will probably need to be on a continuous Morphine drip very soon (mucositis has been described as a mouth full of canker sores, and a sunburned GI tract). He is drooling a lot because of the mouth sores, and is sounding more congested. I have been told that the mucositis is usually at it's worst around days four and five after transplant, so I expect this weekend will be rough. Collin also developed a fever tonight, so the usual blood cultures, etc. will be done, and he is being started on antibiotics.