Help Vinay & Sameer

Dear Friends,

Sameer’s condition continues to remain serious but is stable. His status as of this morning is as follows:

1. He has not yet woken up. He is responding to us from time to time. When I was massaging his legs this morning, he opened his eyes for a very few seconds but closed them again. Later when Reena was holding his hand and talking to him sweetly, he opened his eyes again but very briefly. He is not able to squeeze our hands when asked. While we get very happy to see even a small response from him, we are not sure how much of it is conscious. We hope that he can hear us and the small flashes are consciously driven.
2. His temperature, blood pressure and heart rate are fine. This is encouraging since it (particularly the lack of any fever) implies that the antibiotics are working in keeping the infection in check. All his blood cultures have been negative (no bacteria growth) except for March 3, 7 and 9. They culture a blood sample for five days and generally see the bacteria growth, if any, by day 3 or 4. This means that there are no detectable bacteria in his blood at least since the 12th.
3. His white blood counts and neutrophils are a below the measurement thresh hold (they are practically zero). We need his immune system to start recovering but it might take some time (1-2 weeks) in spite of getting daily injections of GCSF (growth factor).
4. His medical team continues to weigh the risk-benefit of another lumbar puncture which will tell us if the bacteria are eliminated from the central nervous system (CNS). So far they have decided not to do a lumbar puncture due to a finite risk of bleeding and spinal injury.
5. The source of his infection was identified on March. 4 as a common bacterium called coagulase negative staph which all of us have on our skins. It does not cause problems for people with normal immune systems. Because he has no white blood cells right now, the antibiotics need to do all of the work to get him well. He was getting two antibiotics: linezolid and rifampin which have good penetration through the blood-brain barrier. They recently have replaced rifampin with a newer antibiotic called daptomycin since rifampin is known to affect the liver adversely.
6. We are concerned about his liver. His bilirubin level has increased to 17 or so. We understand that there is nothing that can be done to help the liver. We hope that as his organs recover, the liver will improve as well. In the meantime, we are feeding him some fresh coconut water through a stomach tube when possible.
7. He had been on a daily dialysis regimen of 8 hours but they have reduced it to 4 hours since 2 days ago, They are removing 2-3 KG of fluid with dialysis and his swelling (due to fluid retention) is much less. In particular, his face looks much more like him again. The kidney doctors are satisfied with his dialysis and will consider dialysis on alternate days to allow his kidneys a chance to recover.
8. They having been taking a chest x-ray every morning and his lungs are fine.
9. Sameer has a tube inserted to keep his airways clear (intubation) since the normal gag response is absent. He has some ventilator support at night (so that his lungs do not get tired) even though he is able to breathe on his own and maintain a good blood oxygen level. The doctors are pretty sure that they can remove the tube once he wakes up.
10. We have requested the doctors to review again all possible options even though they have tried already many unconventional therapies to treat Sameer. They have assured us that they will review his case again next week and see if there is anything more they can do. I have appreciated their putting up with my questions and patiently explaining the treatment options in detail. The whole medical staff has been very kind and compassionate.

We are essentially in a hold mode waiting for Sameer to wake up. As I wrote in my last update (March 9), his situation is risky due the danger of developing a lung infection which quickly proves to be fatal for most people.

We all enjoyed the Bombay family video Bimal sent to us. We played it for Sameer hoping he could hear it. It gives the impression that everyone likes to party with Sameer! We also shared the video with some of Sameer’s visiting friends as well as some of the nurses. Thank you for sending your love to Sameer and thanks to Bimal for putting it all together.

Reena and I have spent most of our time in the ICU and the hospital. Sunita has come to visit a few times to spend time with Sameer in spite of her own condition not being good. Reena’s mother has been visiting every day and helping Reena. Prashant is still recovering from a cold or flu. He has been talking to Reena and me on the phone to keep abreast, and also to Sameer once in a while. As a precaution, he is not meeting with any of us who are visiting Sameer for the fear of making us sick or carriers. He only meets people who are about to leave town after visiting Sameer. I think it is a wise precaution. He has to wait seven days after his last symptoms before he can visit Sameer.

Many of Sameer’s and Reena’s friends have taken long trips (from the east coast and California) to visit him. Melindah came on March 9 and left on Tuesday. Anamika left on Wednesday. Kruti and Anjali came on Thursday; Anjali leaves this afternoon and Kruti plans to leave tomorrow (Monday). Samir Jathwa came on Friday and is leaving today. Sonia visited for a day yesterday (Saturday). Also, Monica, Sharmila and Shana came yesterday and will leave today. I also met Jay (Bipin’s brother who lives in Seattle) waiting to see Sameer as I left the hospital this morning to go home for a shower. Several of my Seattle friends have visited also. Eli has been coming to visit regularly ever since Sameer has been in the hospital. Doug has been a constant source of support by keeping touch via phone and visits. Other friends who have come are Pran and Santosh, Ram Prasad and MP Singh. Many times we have so many people wanting to see Sameer and talk to him that they have had to take turns waiting outside. Many more friends have been following the web site and praying for Sameer’s recovery. The hospital staff and doctors have been very supportive and empathetic. I thank them all.

Please continue your prayers and keep sending positive thoughts Sameer’s way. I am sure that Sameer will recover. Take care.

Kumar Bhatia