A slight blip on the radar screen as John was admitted to the hospital last night. Serves me right after I proclaimed yesterday that we were a little short on news. When a transplant patient is neutropenic and his temperature reaches a certain level (100.9), he is instructed to call the team nurse. Eager to be a good patient, he informed me yesterday afternoon that his temp was 101.2, and I dutifully reported in. They called us over to the clinic and started the lab procedures of blood draw, vitals, etc. By then his temp had dropped, all other signs were normal, and we were on the verge of being sent home. One more check of the temp, and uh-oh, back up to 101.6. So . . . protocol dictates that he must go into the hospital.
The University of Washington Medical Center (i.e. hospital) is part of the Seattle Cancer Care Alliance team, and when transplant patients need hospitalization, their care transfers seamlessly. We checked in at 7 pm, by which time John was feeling a fair amount of pain in his lower back as well as a growing headache. He had taken no oxycodone all day and was seriously regretting that decision. After numerous check-in and paperwork procedures, a nurse finally brought the pain pill around 8 pm (fortunately the quick release variety), and just a few minutes later he felt much better. He is now staying ahead of the pain game by taking 10 mg of oxycodone every 4 hours, as the neupogen continues to fire up a storm of stem cells in his body.
So far the lab tests have shown no sign of infection anywhere in his body, which is the primary concern with neutropenia. He is on IV antibiotics to kill off anything that might be thinking about growing in there. It now looks like the apheresis and stem cell collection will take place in the hospital, perhaps tomorrow or Sunday. This is fine with us as long as it doesn’t interfere with watching the last 2 rounds of the British Open.
In sum, this whole hospitalization routine appears to be “much ado about nothing”, but it is not worth taking any risks when someone is as immune-suppressed as John is. He actually feels more comfortable there than he did at the apartment, partly due to the drugs and partly due to the hospital bed that offers him more options to relieve his lower back pain. He is walking a tightrope with these various drug regimens and their multiple side effects. While he temporarily lost his balance, the SCCA safety net was there to catch him.
11:40 pm
So . . . much ado about nothing turned out to be much ado about something, as John has pneumonia. Again, this is a fairly common occurrence in patients who are neutropenic, as they simply have no defense mechanisms. John had a chest x-ray last night as soon as he checked in to the hospital, then noticed a sharp pain in his ribs during the night. Sure enough, the x-ray results showed pneumonia and he is now receiving two IV antibiotics, one targeted specifically at the pneumo.
While this feels like a setback, we are assured that it should not interfere with the stem cell collection. We are also told that they don’t want to collect when John has a fever, and when I left the hospital tonight he was still running one. So we are left to wonder what will happen when the two worlds collide: 1. CD-34 spike and optimal time for harvest vs. 2. Fever from pneumonia.
Right now the hospital staff is focused on killing the pneumonia bug and hence the fever. They do not seem alarmed at what is occurring, so I guess we shouldn’t be either. John actually feels pretty good, though he gets tired after walking the halls. He was alert most of the day, more so than the last few days at the apartment. Hopefully he is on the mend, and tomorrow will bring good news in terms of his blood counts and temperature. I’ll keep you posted.
Marilyn
Good Blood, Bad Blood 