Infection? PAP? or Both?

Well just as I was about to head downstairs to post the last entry, our Lung Specialist stopped by. We have not seen her since the last lavage. As an inpatient you are followed by the "Team", who consults with your doctor if necessary. Today she stopped by to discuss a few things, mostly when we should restart his GM-CSF treatment as he has now been off of it for over a week. They have decided to wait until Monday as we just started new antibiotics and don't want to throw too much into the equation.

She did not have a huge update on the work the scientist is doing, but what she did bring was not the most encouraging. So far, they have determined that the macrophages (which are cells) in James' lung show to either not work or not work to capacity. (Check here for how macrophages work. If you can, watch the video that's near the bottom. Amazing!)So, some do work, but not as good as they should. This in itself is nothing new and just confirms and supports the PAP diagnosis. The problem is that you need macrophages to fight infection. Which brings us full circle to todays problem. Is this problem indeed more a PAP issue then an infection issue? Are we unable to get rid of the infection because his macrophages are not doing their job? Is the PAP progressivley out of control because of this? This theory is supported by the increasing amount of foamy phelgm we are getting from his stomach, something which the doctors are no longer ignoring, but have come around to see it as a factor in the equation.

How do we get the macrophages to work? Sometimes a WLL is enough to get them up and going again ... so far we have been shown no reason to believe that this has been the case for James. The only other known way is to provide GM-CSF to the macrophages, but it is such a challenge to do this. We have been using the inhaled treatment. The other method is done by injection into the blood stream, which then works through the bone marrow, back to the blood stream, and delivered to the lungs. But this also causes more white cells to be produced, which in turns causes more problems in the lungs. So this way usually carries too many negative side effects for PAP. The question still remains whether the inhalation method will do anything, since it did not help before. But at the same time we can't give up on it just yet as we hope by removing the worst of the buildup we will create an environment where the GM-CSF can stay on top of whatever new build-up develops. Therefore we will restart GM-CSF on Monday, hoping it will indeed work better this time around.

A quick summary:

1. GM-CSF treatment is needed to to get the macrophages to function properly.
2. Macrophages are needed to fight infection
3. Infection of some sort is present.
4. Will GM-CSF treatment work?

The scary question is: If the GM-SCF treatment is unsuccesfull.... are we fighting a losing battle? There is no answer to this question right now. But we do know that if we remain focused, with our blinders on, regarding the achievements and limitations of man and his science, the question can be haunting. But we can lift up our hearts where Christ is seated at the right hand and majesty of God. It is here that we find rest, and hope.