Thursday, February 25, 2010

The ongoing saga of this chest-cold...

Tuesday night, when I returned from dinner, I felt pretty lousy. I realized I was running a fever. It was getting worse. I hadn't had a fever since I left treatment in Arkansas, and while it's probably nothing, people get very concerned about it when it gets up there and won't break. Fever is a common side effect of Velcade, although I've never had one from its administration and I'm six months into therapy with that stuff. Dex, as an anti-inflammatory, also reduces fever, so that is probably one of the reasons they use the two in tandem.

At any rate, my fever climbed from 99 degrees to 101.3. My poor little girl was so sad, because she knows I got the cold from her. I explained that everybody gets it, and I was glad I got it from her and not from somebody else, and that I would rather be around her and get sick than not be around her and not be sick. That made her feel a little better. I love her so much!

Anyhow, at 101 we call the 24-hour call number for Arkansas. It's around 10PM by now, but a doc from Arkansas calls back in a few minutes. He's 99% sure it's just a virus, but he wants me to take some tylenol to see if the fever will come down, and double up on my TamiFlu (which I had been doing), and take Augmentin (which I had been doing) and then get some blood cultures done as well as a respiratory viral culture.

The fever broke a couple of hours later, so I managed to avoid the hospital, but still felt awful. I felt a little better Wednesday morning and managed to get into the office of my primary care physician -- the wonderful man who found my disease early enough to put me in a good position to battle it -- yesterday afternoon. I met with his colleague since he was not around. She, like he, is an infectious disease specialist -- turns out she was incredibly helpful to speak with because she knows all about immunosuppressant treatment and the impact of that therapy, and what can be done to ameliorate it.

The first thing she said is that being on Dex once a week is the same thing as being on it constantly. My T cells are being killed by it. It actually, she thinks, has nothing to do with suppressing the IgG whatsoever -- it simply makes the system less able to fight the medicine that is used to suppress the IgG, and because of its anti-inflammatory properties is counteracts a lot of the side effects of Velcade. For example, fevers. She thought that if I were to discontinue dex, I would be much more likely to get fevers from the Velcade. She wondered if perhaps the recent increase in Velcade and the recent decrease in Dex could have resulted in the fever -- I told her that was an interesting theory but Occam's Razor* dictates that I got the fever from my daughter who had the same symptoms four days earlier.

She looked in my throat and told me I had thrush. Yuck. I remember thrush was one of the concerns in Arkansas during primary treatment -- they gave me Fluconazole to combat potential thrush. Some people, like my friend DP who maintains a blog elsewhere, were unlucky and got it -- it sounds awful. So I really didn't want any! I asked if I should go back on the Fluconazole and she recommended against that because that's hard on the liver (I remember this having an impact during therapy, though nothing serious) she recommended a mouthwash whose name escapes me. We'll try that for a couple of weeks and it should clear up, she thinks, and if not we'll go to the Fluconazole. She said that it was not yet severe, and that I will likely just need to do this quarterly while I am on the dex to keep it away.

She pointed out that TamiFlu is not effective against H1N1 if people have taken it prophylactically. So that answers that question. I'm not gonna take it any longer until I have a cold or flu that is flaring up. That will save money and be one less pill I have to take. She said that H1N1 will be back as it is making the rounds outside the US right now. She said that it's not seasonal, unlike the regular flu (regular flu season being over). I found this interesting and a little alarming, but I'm not a big "oh noes [sic] the end of the world is near!" H1N1 phobe.

She told me I should get the blood cultures done. I wanted to push for Tuesday, but she insisted they be done today, so I'm off to the infusion again this afternoon.

She also suggested that I go on prophylactic antibiotics. One she mentioned that was popular could decrease white count -- I told her that wouldn't work because the Revlimid is depressing my whites too much as it is, and she acknowledged that Myeloma docs generally don't like that particular drug. One cycle wasted on that conversation! :) She said there is another drug, however, that does not have that side-effect. She is going to call Arkansas, speak with either BB or Dr. EA, who is responsible for all supportive care, and make sure it's okay.

Meanwhile, I'm off to have blood cultures drawn this afternoon. The fever is gone, but the hacking cough remains. Ugh.

As for the IVIG, no point in getting that until I get over this. First, it won't make a difference at this point, and second, they want to be able to track my response to the IVIG, and some of that could be masked by flu-like symptoms so I want to make sure we know what's causing what.

And that, my friends, is all the news that's fit to print for the day. I still have those WBC charts to put up soon!!

*Occam's Razor. One of my favorite little ironies.

This is a critical element of logical thinking and an historical moment for reasoning in man's history. William of Occam came up with the simple maxim that the most obvious answer is the most likely one. For example, if there is smoke coming out of your house, the most likely answer is that it is on fire.

The irony, which I find hilarious but nobody else seems to laugh at, is that when this maxim was popularized, the most obvious answer to ANYTHING was "invisible gremlins did it."

"My horse just fell over dead." "Aha! Invisible gremlins did it." "However did you deduce that?" "Occam's Razor, my dear boy."

"My wife was drinking polluted water and now has the Plague." "Aha! Invisible gremlins did it!"

You see what I mean.

I can hear the peals of laughter coming in from all around cyberspace...