Day +46

Well its been an interesting week. With the last note I wrote, I was feeling great but my neutrophil counts were extremely low. After being neutropenic for several days, I eventually got a fever Wednesday evening. My temperature had been rising and falling all that day, but rose to 101.8 just before 7:00. The hospital wants you to call if a fever goes above 101.6. Since my temperature was elevated and I was neutropenic, I was told to come in and be admitted to the inpatient wing I have previously been on.

That night they gave me antibiotics and took blood cultures to see if they could find the source of the infection. The cultures were inconclusive and the doctors never truly figured out what caused my fever. Most doctors seemed to blame the Bactrim, although I received one dissenting opinion from a doctor whose judgment I trust. He pointed out that my platelets held steady and it was just my neutrophils that dropped. Usually when Bactrim is the cause of a loss in neutrophils, the platelets are also effected. This occurs because the neutrophils and platelets grow in the same area of the bone marrow. This doctor thought it was likely a delayed reaction to the Rituxan I took with the EPOCH-CR back in the fall. Rituxan can cause delayed neutropenia several months after it is taken. I remember my chemotherapy doctors mentioning this a year ago when I finished EPOCH-R the first time. This explanation seems to make sense to me, although I guess it can't be proven as the cause either. Overall, I'm not concerned with the cause, but am just happy to be feeling better now.

I did have a large cold sore on the inside of my lip that swoll up pretty good. It was extremely uncomfortable for a couple of days, but has subsided for a few days. The doctors said the cold sore could have been a result of the neutropenia, or it could have helped cause the infection that led to the fever. Its hard for them to pinpoint what caused me to get a fever, but the good news is that it went away quickly after starting antibiotics.

So by Thursday morning my temperature was normal but I didn't get discharged until Sunday. I was receiving neupogen shots to stimulate neutrophil growth, but my counts didn't start to rise until Friday. By Sunday morning the number was high enough that the doctors felt good to take me off of the antibiotics. Their plan was to keep me another 24 hours for observation, but I wasn't ready to spend another day in the hospital when I hadn't had a temperature in days. I pointed out that I would be back to the hospital for an outpatient visit today, and they agreed to discharge me on Sunday rather than Monday.

So I was able to get home and watch the Super Bowl at Kate's cousin's apartment. That was a lot more enjoyable watching the game with others than sitting on my hospital bed by myself.
The outpatient visit today was pretty routine. My blood results were good, and I didn't need any infusions. It feels like I'm back to where I was before my neutrophil counts dropped more than a week ago. My energy is good and everything else at home is going well.