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Rob is doing very well! During our appointment yesterday with Dr. Wakelee, we learned that Rob’s neutrophils were back up over 2000, and his temperature is normal. For reference, the measurement of neutropenia is the Absolute Neutrophil Count (ANC) and is graded as follows:
– Mild neutropenia (1000 <= ANC < 1500) — minimal risk of infection
– Moderate neutropenia (500 <= ANC < 1000) — moderate risk of infection
– Severe neutropenia (ANC < 500) — severe risk of infection — a fever can indicate a life-threatening emergency
Rob’s ANC was ~ 200 when he was first admitted to the hospital. There was no conclusion as to what caused the fever/infection, but when the neutrophil count is so low, the body’s own bacteria can grow unabated, so the real issue is to limit the extent of the neutropenia and thus reduce the risk of a life-threatening infection. According to the trial protocol, this episode mandates a reduction in dose of the docetaxel for his next treatment on Monday. Dr. Wakelee also wants Rob to receive an injection of Neulasta the day after chemo which will boost the production of white blood cells, thus reducing the risk of neutropenia.
Needless to say, we will also be more vigilant about infection avoidance, especially during the high-risk period between days 4 – 12 after treatment.
Neutropenic Fever - An abnormally high fever typically caused by a bacterial infection when a patient’s neutrophil count (the white blood cell component that fights infections) becomes very low due to chemotherapy. This is something we were warned about during our initial chemo education, and the reason we were so very careful about Rob’s exposure to possible contaminants during days 3 – 12 after chemo. However, after nearly a year of treatment, and no problems, it seems that we let our guard down. On Friday evening, after a nap and a healthy meal at our house with John and Jo Ann, Rob started to shiver uncontrollably. His temperature was 101 F. Fifteen minutes later it was 102.7 F. Remembering the earlier admonition by Rob’s cancer team to get to the ER immediately for a temp >102, all four of us jumped into the car and headed to the Kaiser ER in San Francisco. By the time we arrived, his temperature had spiked to 103 F. After more than three hours in the ER, where he received blood tests, a chest x-ray, and an examination by the ER doc, Rob was admitted to the hospital and put on IV antibiotics. His neutrophil counts were very low (~200) – severe neutopenia (Rob suggests that this will be the next Who album). Of course, Rob tried to convince the docs that they should just give him Tylenol and send him home. No such luck! Neutropenic fever is a serious condition. Happily, the results of Saturday’s blood tests showed his neutrophil count increasing and his fever slowly decreasing, but not enough to be discharged. By Sunday morning Rob’s counts were up and his fever was down sufficiently to be discharged after one last bag of antibiotics at 2 pm. We were out of there by 4 pm with a prescription for oral antibiotics.
It wasn’t exactly the fun weekend we had planned. About the only good part of the experience (which was Rob’s first time overnight in a hospital as an adult) was having a private room, as patients with crashed immune systems are kept isolated. Everyone complains about hospital food, but Rob’s meals were almost inedible. (Picture a shriveled hamburger patty on a white bun, and a package of mandarin orange slices packed in sugar water… Shouldn’t hospital food at least be nutritious??? ) People with needles and other medical devices apparently woke Rob up at all hours — why do they need to draw blood at 5:15 every morning? Contrary to common sense, hospitals are not very conducive to rest, and he finally had a good nights sleep in our own bed last night.
We’re off to Stanford this morning for a previously scheduled blood draw (he’s feeling like a pin cushion!), and appointment with Dr. Wakelee. It’s the standard 15-day check-up after chemo, and we certainly have lots to talk about!
