Fever of Unknown Origin

John was discharged last night from St. Francis Hospital.   The official diagnosis: 'fever of unknown origin'. Typically this diagnosis results in another diagnosis of the more serious underlying disease that has not yet manifested.

Nephrologists, cardiologists, infectious disease specialists, and gastroenterologists spent the last week running tests to rule out some possibilities.  Although they can't tell us for certain what is causing the fever, they did tell us what it IS NOT:

• UTI
• Hepatobiliary infection (or cancer)
• Endocarditis 
• Bronchitis / pneumonia 
• A long list of things ideas from the infections disease doc--most of which I did not understand, and decided not to research unless necessary. Some of those blood tests were based on the fact that he has spent time in Wisconsin!  

A couple of those would be deal-breakers for a kidney transplant, so these past days have been full of concern.  John's rock-star nephrologist was worried, too.  Still not understanding exactly what is going on, but some scary possibilities are ruled out, and he has a couple of theories.

It could be the end-stage of function for the donor kidney that has been working for 22 years.  Or the body's rejection of that kidney now that some of the anti-rejection meds have stopped.  Treatment will include vancomycin (an IV antibiotic) during his dialysis treatments.  

The current goal is to get John healthy enough to receive a kidney transplant.  At this point, there are three steps within that goal:

1. Get home hemodialysis up and running, and John's numbers stable on that treatment
2. Resolve the symptoms and fever associated with this last hospitalization
3. 6-12 weeks course of treatment for the liver disease Hepatitis C

Then we can focus on the next step:  finding a viable kidney donor!

In other words, getting a transplant right NOW is not an option, and would not fix the current issues.  We need to go through the steps in order to have the best chance of a successful transplant. 

We continue to be impressed with John's nephrologist.  He and all involved in John's care at St. Francis were conscientious and professional.  And human.  John amazed much of the staff with his story and the fact that he does his own dialysis.  Many of them had never heard of that concept.  He also pissed off some nurses by insisting on things being done his way.  

Each time the doc says "FUO" (fever of unknown origin), for some reason I think of the RoUS in the Princess Bride.