« Home for the Holidays (well, sort of...) | Home | New-monia »

The Eight Days of Christmas

Posted by Frederick Wasti
Jan 05 2013

[Yes, I know that the customary expression is "The Twelve Days of Christmas", which is the period beginning on Christmas Day, December 25th, and ending on Twelfth Night, January 5th, but, as everyone knows, "hospital days" are at least 50% longer than regular days, so that's my title and I'm stickin' with it - <grin>.]

I did spend a while in Brigham and Women's Hospital (BWH) over Christmas, starting on 12/23. That's both the good news and the bad news - it was not an ideal time to be in the hospital (is there ever really an ideal time to be in the hospital?), but, when I left there on 12/30, I was well on the way to recovery, so I guess it was a week-plus well spent (?) after all.

On Sunday morning, 12/23, after talking over the phone to Dr. David Fisher, my D-F hematologist-oncologist, Diane and I headed to the Emergency Room at BWH. Although we could have gone to, say, Jordan Hospital in Plymouth, the connection between D-F and BWH (physically connected to each other but also associated with each other) made it seem logical to go to Boston for checking into my condition. (As it turned out, it was a wise move.)

For a couple of days before heading to BWH I had a feeling something was wrong, and this became more obvious by Saturday evening, when it not only hurt to breathe deeply - a sharp pain in my upper left chest rib cage - but it also almost seemed as if my chest muscles were affected, as if I had perhaps strained a muscle - and my upper left chest even became sensitive to the touch. I had also developed a bit of a fever.

At the Emergency Department I was examined and blood samples (of course) were drawn, and I was sent out briefly to Radiology for a chest X-ray. The results all seemed to point to pneumonia in my left lung. As the ER doctor explained, if I were a "normal" pneumonia patient, I would probably have been sent home with prescriptions for antibiotics. However, as an immunocomromised CLL patient, it would be better to admit me to BWH, and a room was prepared for me to stay for "a while".

[An interesting poster, from the Federal Art Project of the Works Project Administration (WPA), from 1936 or 1937]

The odd thing to me was that I didn't feel as if I had "pneumonia symptoms". I did have a small fever, and I did have a bit of a cough (but it was a "dry cough", and not the "productive cough" that I assumed was typical of pneumonia). I did have some pain, but it felt as if it was centered in the rib muscles of the upper left rib cage, and not deeper in the chest. I did ~not~ already have a cold, as is often the case (and as suggested in the poster above), but I am taking antiviral (as well as antibacterial and antifungal) prophylactic medications daily, and I have not had any cold at all since starting treatment last March.

Pneumonia. Well, that's something I've never had before. "Well, there's always a first time." (Well, thankfully there's not ~always~ a first time, as there are ~many~ things that we would all just as soon avoid having for the first time, right? - <grin>)

"Pneumonia is an inflammatory infection in the lung, affecting primarily the microscopic air sacs known as alveoli. The infection can be only in one lung, or it can be in both. There are several causes of pneumonia but the most common are bacteria, viruses, and fungi. Left untreated, pneumonia can be deadly. In the days before antibiotics, it’s estimated that about one-third of those who developed bacterial pneumonia died."

But, that was in the "good" (bad) old days - nowadays, ~prompt~ treatment with the ~right~ antibiotic(s) generally results in a cure (although not always - Jim Henson, creator of the Muppets, died of pneumonia in 1990 at the age of 54 years). People still die of pneumonia, but, with proper medical treatment (which, unfortunately, is not the rule in many parts of the world, or, in fact, for ~many~ people here in the US), deaths due to pneumonia are not common.

In order to help determine the extent of pneumonia and also perhaps which type(s) of pneumonia I had, a CT scan was taken of my chest. (A CT scan is like a super-duper 3-D X-ray, providing more info than a regular X-ray can show.) It seems as if I had three areas of infection in my left lung. Two of these, lower down in the lung, appeared to be "just regular, garden-variety, run-of-the-mill bacterial pneumonia". However, the third of these, the one higher up in the left lung (at about where I had been feeling pain) seemed to be denser and was termed "atypical" by my BWH and D-F doctors.

I was subjected to a number of additional blood and other body fluid tests, as well as nasal swabs (of two types, one of which involves a Q-tip being inserted and twirled around in the outer nasal passages, which merely tickles, and the other of which involves a Q-tip being rammed way back in the nasal passages, and which hurts a whole lot more than it tickles - <groan>), but nothing initially showed (yet) what was specifically going on (but it does take time to culture the various fluid samples - there is no such thing as an immediate culture test result), so I started receiving broad-spectrum antibiotics by infusion and by mouth, usually two different ones at a time. I believe that these were all various antibacterial antibiotics (following the suspicion - and the hope - that my pneumonia lesions were all bacterial), but I do admit to maybe losing track of the names of some of them (<g>) - a few at least were Azithromycin (Zithromax), Ceftriaxone (Rocephin), and Vancomycin (Vancocin).

It does seem as if the main indicator for judging the effectiveness of the treatments was my body temperature (and, although I was given Acetaminophen at first to bring down my fever, this was soon stopped, since doing so was masking measurement of my true body temperature). Of course, other clinical symptoms and parameters (such as the level of chest pain) were also considered as well.

Eventually, my treatment regime settled on two antibiotics, Cefepime (Maxipime), which was given by infusion, and Levofloxacin (Levaquin), which was administered orally. I finished the Cefepime regimen while I was still at BWH, but I was given a prescription for the oral Levofloxacin to continue taking at home, and I was discharged on Sunday afternoon, 12/30.

Please stay tuned for some more details of my BWH "Christmas vacation" in my next post...

Categories: Leukemia