Debbi was really feeling weak today. I came home from work to find her listless and complaining of alternating hot flashes and chills. I grabbed the digital thermometer and found that she had a temperature of 101.1. We were under strict orders to call Sloan in case of a fever greater than 100.5 so we called. Before we were connected to the evening operator, Debbi took her temperature again and it had dropped to 98.9. I hung up the phone. After 15 minutes, the temperature was back up to 101.1 so I redialed the hospital. We were told to come to Urgent Care right away and that there was a distinct possibility that an overnight stay was in the cards.
We packed up some clothes, knitting, sudoku, the computer, earplugs, etc. and jumped in a black car outside our apartment building for the now very familiar ride to the East Side. Arriving at Urgent Care, we signed in and yes, Debbi had to provide her birthdate to the receptionist. Blood was drawn from her arm and then we had a bit of a wait for a bed in the bullpen. While we were waiting, a young child wearing the telltale beach cap came in to have her chemo-pump adjusted. Just tore at our heartstrings.
Soon we moved to bed 19 in the bullpen. The port was accessed for another blood sample. An IV drip was started at 8:30pm and Debbi was still pretty weak. At about 9:30, Dr. Mattai came in and explained that while Debbi’s counts were not low, per se, they were definitely on the lower edge of normal. Dr. Mattai then remarked that she had conferred with Dr. Bajorin and that they belived that the counts, especially ANEUT (Absolute Neutrophil Count) which had been 5.3 prior to the first chemo, 4.2 prior to the second chemo five days ago, and now stood at 1.2, could drop further over the next 24 hours.
ANEUT counts below 1.0 (0.7-1.0) imply a moderate risk of infection so the medical team wanted to be sure that adequate precautions were taken given their intuition that further reductions in ANEUT were possible if left untreated.
So, the decision was made to give Debbi this monster sized Potassium Chloride pill (her K was 3.4) as well as three different IV antibiotics, and a special drug named Filgrastim. Wikipedia says that Filgrastim is used to decrease the chance of infection in people who have certain types of cancer and are receiving chemotherapy medications that may decrease the number of neutrophils (the type of blood cell needed to fight infection). Immediately, Debbi thought of the difficulties of going back to work with all her young kids that she loves so much replete with colds, runny noses, etc! Oh, well… something to consider for another day. Right now we just have to worry about the counts.
The IV antibiotics have to be given in a definite order taking 3 hours to dispense. We have been assigned a bed in a regular room upstairs but until the antibiotics are finished, we have to remain in the urgent care bullpen. At the time of this writing, IV Antibiotic #1 (Amikacin) is complete, there is about 15 minutes left on IV Antibiotic #2 (Aztreonam), and the automatic dispensing pump was just programmed to deliver IV Antibiotic #3 (Vancomycin) over 90 minutes starting with the completion of the Aztreonam.
Readers of the blog know about Debbi’s naming proclivities. I can’t even imagine what she would call these antibiotics. Thankfully she is sleeping quietly now so she can name them tomorrow. I am told that this combination will probably be repeated once or twice more tomorrow in order to build her counts to safe levels.
Debbi’s vital signs were checked as the Aztreonam drip was started. Blood pressure and her temperature were normal and she looked a lot better. I am so glad that we decided to go directly to Urgent care. I estimate that somewhere around 2AM Wednesday, the Vancomycin will finish, we will go for a chest x-ray and then finally to our room. We can only imagine the plush mattress in room 511 as Debbi has been sleeping on the thin gurney mattress for over four hours now. So, we wait for now.
Hope to update everyone with good news in the morning.