So, between my clean PET scan and making it to the halfway point, things have been going pretty well...except for another ER visit I had last week for a fever. It started the night before, when I had a mixture of night sweats and severe chills. However, since my temperature was fairly normal when I woke up, I shrugged it off as the changing seasons and too much cocooning under my warm covers and went to work.
Big mistake.
Almost immediately, the chills came back. Normally, I am always layered up at work, whether it be with sweaters, scarves, or both, but for whatever reason that day I had zero foresight and was only wearing a thin dress (the seasons were in whack, after all!). Needless to say, it was not one of my most "productive days", and I ended up clocking out about an hour early because I could tell I was getting worse.
The first thing I did when I got home was take my temperature. Unfortunately, I have the world's most finicky thermometer, which requires at least 3 different readings, all averaged, to get an accurate result. I normally run a little on the low end -- my temperature is usually around 97 degrees or so -- so I knew I was in for a treat when the first reading was around 99. Unfortunately, it kept on climbing to eventually get into the 101.5 range.
Being the good little chemotherapy patient I am, I knew this was cause for concern. My doctors had been very clear that if my temperature is above 100.5, I would need to head over to the ER because that is often a sign of an infection, or "neutropenic fever", as oncologists call it, and with a weak immune system, a small infection can quickly escalate. Up until this point I hadn't been too concerned with this since I am on Neulasta, which means I still have a decent immune system (though I still am anal enough that I check my temperature every night before bed. Like I said, I'm a good little chemotherapy patient!).
By this point, the sweats replaced the chills, which, in my opinion, are even worse. So, with a heavy heart I conceded that there maybe was something wrong and I might as well face the music. And with that, my mom, dad, and I headed out to ER 2.0. After all, there's nothing better than a weekly family bonding session in the ER!
By about 9 pm -- after an examination, chest x-ray, complete blood count, urinalysis, a bacterial culture on my blood, and EKG (I wasn't sure if my "chest pains" were an infection or anxiety -- turns out they were the Big A) -- we still didn't really know what was going on. Then, things got even more interesting when the ER doctor came in all flustered and informed us that my WBC was through the roof -- 21,000 to be exact (normal ranges are between 4,500 and 10,000) -- and that I either had some crazy infection looming beneath the surface or my counts were elevated as a side effect of Neulasta. Since he does not specialize in cancer treatment, he didn't feel comfortable making the call, which meant he had to connect with the oncologist on call at the U of MN for the final verdict.
Close to two hours later -- around 11 pm or so -- we finally got it: DISCHARGED. He still seemed a little skeptical about discharging me -- "You know, if you'd feel more comfortable we can totally admit you as a precaution." Part of the reason he said this is because the results of the bacterial cultures of my blood could take up to 48 hours, so if we wanted to be on the extra safe side I could start some IV antibiotics. What I also I think was going on, though, was that he was still trying to work his brain around the Neulasta. This is not to say that he was not an incredibly competent doctor, but it just goes to show that DOCTORS ARE PEOPLE TOO and each have their own area of specialization. By nature of working in an ER, this doctor generally sees patients with severe external injuries or other more routine conditions (pretty much anything is more routine than Hodgkins, in which the average person only has a 0.2 percent chance of developing in his or her lifetime). It seemed to go against all of his instincts to discharge me with such a funky blood count, but luckily he did, since it is one of my goals to NEVER spend a night in the hospital.
Go figure, by the time I got home I was feeling much better, and I even had a sweat-free night!
All of my tests came back normal -- even the bacterial blood culture -- so I guess we'll never know what caused this random spike in my temperature. As with the phantom blood clot that refuses to be detected, my body operates in mysterious ways. While I am always of the camp "it's better to be safe than sorry", I am getting very sick of ER visits, so I'm hoping things calm down a bit. I know I said that last time, but this time I really mean it!
A few other updates:
- I had my second pulmonary function test to make sure that the bleomycin (the 'B' in ABVD) + Nuleusta wasn't causing too much havoc on my lungs. If you remember, I really didn't like this test. I am happy to report that the second time went much smoother. The doctor I had was much clearer with the expectations of each test, so instead of doing 20 different tries to get an accurate result, it only took about 2-3 tries. Naturally, I thought this meant that my lungs were even better -- hey, I had been working out! -- however, that was not the case. While they're still within the normal range, they aren't as strong as they were before chemo. Whether or not this is permanent is still TBD, but at this point we will still be chugging along full speed, Bleomycin and all (some people drop the Bleomycin if they have more significant lung damage, which apparently doesn't really impact the efficacy of their treatment. Hmmm).
- I finally got the dreaded Nuleusta bone pain everyone talks about, which happened to coincide with my fever, making it extra pleasant. Many people get the most pain in their hips -- I had a little bit there -- but mine was mainly in my spine. SPINE PAIN! Weird, huh? I can't really explain it except that my spine REALLY hurt, especially with any movement. Luckily, this only lasted about a day. Apparently, taking a Claritin before administering the injection can help with this. Unfortunately I forgot about this little detail before yesterday's injection, so I'm hoping last time was just a fluke and that I'll make it through this cycle free of spine pain.
- Speaking of injections, have I mentioned that I really hate this twice a day Lovenox routine? Just as I felt like I was finally getting used to it (still not administering myself, but not totally freaking out when either my mom, dad, or Scott jabbed it into my stomach) I discovered a new surprise. LUMPS under the injection site. Once you're diagnosed with cancer ANY sort of lump will immediately spike your blood pressure, so I called my care team right away. They said this is nothing to worry about and that it can happen with injections. Apparently, these lumps (I have four so far), are just a collection of scar tissue that will go away in a few months. Needless to say I am rapidly running out of stomach space to inject these assholes. Still, I guess it's worth it not to get another blood clot. But just barely.
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