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I received a call in the afternoon from one of the haematology registrars
telling me to come to hospital on Saturday to pick up some anti
fungals - Voriconazloe. They'd also cultured a fungal infection
from the spewtum samples I'd been giving on a regular basis at hospital
called; Aspergillus. Another nasty infection to add to the GVHD
The TB drugs have interactions with certain drugs. That is to say
that they increase the metabolism of certain drugs in the liver,
hence a dose of some medicine may only be 50% effective. This means
that twice the dose needs to be given in order to get the intended
amount. I already knew that we had to increase the dose of my current
anti-fungal (Fluconazloe), so I asked the doctor to check with the
pharmacy about the interaction of the TB drugs for the new anti-fungal:
Voriconazole. Sure enough, the TB interacts. Infact so much so that
the voriconazole is rendered totally ineffective.
Voriconazole is the only tablet anti-fungal that can be used to
combat the the Aspergillus. The other drugs are IV only. Since the
course of anti-fungals is a minimum of four weeks, I had to come
back to hospital and have a hickman line inserted.
To remind you, the hickman line, is a tube with 1,2 or 3 lumen (channels),
which is inserted in to your jugular vein (the thick vein on either
side of your neck. This vein leads to the heart. It means that blood
can be taken from the line and IV drugs administered without having
to use needles in various veins around the body.
The procedure itself isn't too painful as your neck and chest are
anaesthetised. If you're not too squeamish and want too know more
click here. After the procedure. the area is quite tender for a
few days so you don't really use your arm on the same side. After
a week, the line becomes unnoticeable, and your silent companion.
You have to have the dressing changed every day to prevent the line
from getting infected. If this was to happen the line would need
to be pulled out.