5-30-2022 C.diff is back, as we feared (and expected)

(Tricia)

Once Linda finished her two-week round of vancomycin two weeks ago, which was treating the C.diff that sent her to the hospital last month, we kept our fingers crossed. Even though history was not on our side, we truly hoped that somehow, with enough yogurt (to add "good bacteria" to the gut) and hopeful thoughts, we could keep C.diff at bay. And, in fact, we had a good ten days or so where everything had seemed to stabilize, and Linda seemed a little bit stronger and in better spirits. And, of course, she and Hopscotch have continued to bond in the cutest way. Here is another one of their moments :-) :

With Linda, things have always been relatively OK until the very moment they're not. And, on Saturday afternoon, things suddenly weren't OK anymore. The C.diff returned as it always has with Linda--suddenly and definitively.

To make matters worse, this was preceded on Friday by another problem with her catheter, where we had to call the hospice nurse to come out and replace it for a third time. This time, unfortunately, it turned out to be a more painful process than usual. Afterward, Linda was still in pain, so the nurse recommended we give her morphine.

If you recall, the last time she received morphine was the day before the C.diff returned the last time, sending her to the hospital. I gave her morphine on a Wednesday evening--on Thursday morning, she was still unresponsive (even though the morphine should have long since left her system), and by late Thursday morning, the C.diff symptoms had returned. Fast forward one month: After the catheter was changed out on Friday evening, the hospice nurse advised us to give her morphine for pain; on Saturday morning, she was still unresponsive, and by late Saturday morning, the C.diff had returned.  It was the same sequence of events, practically to the hour.

Everyone (the hospice nurse, the caregiver, Ed) tells me this was just a coincidence. They assure me that the morphine had nothing to do with "waking up" the C.diff infection. Obviously, I don't want to go for a third round to test the theory out any further! But all I can think (to myself, of course) is that morphine does not affect Linda in the same way it typically affects most other patients.

Luckily, Pathways, the hospice agency we're now using, was more prepared to help than the Visiting Nurses Association was last time. Its doctor prescribed Flagyl, another antibiotic used to treat C.diff, as well as an antidiarrheal medication; Pathways had the meds delivered Sunday morning. Linda has been on them for just over a day, and her symptoms are improving, although they are not yet resolved. But even if the symptoms do resolve (and we hope they do), the underlying problem remains. Once she goes off the antibiotics again, we are likely to see the C.diff return. She is one of those unlucky 20% to 30% of C.diff patients who simply cannot fight it off--it just comes back again and again.

Each time it returns, Linda has a little less buffer to work with. And as a result of this recurrence, Linda doesn't want to eat; she's becoming dehydrated and losing more weight. So, we realize that we are fighting a losing battle. We have never been sure what will be the "final blow" will be for Linda, because she is coping with so many issues at once. But, in the end, the major contributing factors are likely to be her refusal throughout to participate in physical therapy (a direct result of the brain injury) and the ongoing bouts of C.diff.

But Linda is still with us now, so we're trying to focus on what time we have. She is sleeping, and the caregiver for this evening is in the front room, keeping an eye on Linda via the monitor. I'm going to try to set the worry aside as much as possible and read to take my mind off things for a while. The house is especially quiet because Ed is in Cleveland for work until tomorrow evening, so I look forward to when he comes back home.