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New-monia

Posted by Frederick Wasti
Jan 08 2013

[Well, "new-monia" is new to ~me~ - <grin>.]

As I reported in my previous blog post ("The Eight Days of Christmas", from 1/5), I recently spent a week-plus at Brigham and Women's Hospital (BWH) due to pneumonia in my left lung. The good news is that I seem to be doing OK now, and I've been home for over a week.

Yesterday at Dana-Farber (D-F), I resumed my CLL clinical trial treatment, receiving a "regular" injection of Alemtuzumab (Campath). However, I also found out more about the myriad of tests performed on me and on my bodily fluids during my stay at BWH. Interestingly, almost all of them (fortunately) came back as negative - it is nearly always better to have "simple" bacterial pneumonia than to have either viral or fungal pneumonia (which several of the tests were looking for), and it does appear as if I had "only" bacterial pneumonia(s) (whether I had a couple of different bacterial pneumonias or "just" one is not clear).

I never developed much in the way of overt pneumonia symptoms. Coughing was minimal, and breathing never became difficult (although deep breathing did become painful toward the front of my upper left lung by the time I was admitted to BWH). Nonetheless, there were three areas in my left lung that showed as pneumonia-involved, resulting from the alveoli being filled with fluid and blood cells instead of air.

It turns out that many bacterial pneumonias are treated successfully without ever finding the exact organism(s) involved, and that would seem to be true in my case. Interestingly, one test did indicate the possibility of Legionnaires Disease, caused by one of the several species of bacteria belonging to the genus Legionella ("The Fred's Foreign Legionella" - <grin>) - both the type of pneumonia and the type of bacteria involved are named for the first known mass infection that occurred among many unfortunate members of the American Legion that had attended a convention at one hotel in Philadelphia in 1976.

[Headlines from 1976 about the newly discovered Legionnaires Disease]

There have been a number of outbreaks of Legionnaires Disease worldwide since 1976, but the number of people dying from these incidents has generally decreased over time, due to both increased awareness of this type of pneumonia and the availability of better antibiotics for treating it (and other pneumonias, too). In my case, whether my pneumonia(s) had any Legionella involvement or not, the principal antibiotics I ended up taking happen to be very effective in treating Legionella (and most other bacterial pneumonia organisms, too), so I "was covered" whether I had Legionnnaires Disease or not.

I do have to say that my treatment at BWH seemed to be top-notch. Each day I was visited by a number of doctors (from both BWH and D-F), and I started to get the feeling that there had to be a pool being run among the staff where every doc had a chance to bet on which particular pneumonia(s) I had (I don't know who won the pool, because I don't think there could have been be a clear winner in the end). It was sort of like an antiques auction, where every potential bidder wanted a chance to see the "merchandise" before bidding...

I did have one serious test worth mentioning. On the day after Christmas I had a "CT-guided lung biopsy". In this interesting procedure, I got to slide in and out of a CT scan machine several times, while the biopsy doc and a pathologist examined both my CT scans and the biopsies obtained by poking a needle through my chest wall and into the upper part of my left lung (using the CT scan imagery to "aim") - I ended up with four biopsies being taken before the pathologist was satisfied with the results. And, I did ~not~ develop either a pneumothorax (i.e., loose outside air inside the lung cavity) or a collapsed lung, which are the two principal potential bad outcomes from the procedure (<Whew!>).

The room I was in at BWH was also interesting. It basically was "just" a private room, but the ventilation and entrance/egress doors were unusual. Filtered air under pressure was constantly pumped into the room, so that outside air from the nursing area outside the room could not enter the room, bringing germs with it. There was a double door to/from the room - there was an outer door to the nursing area and an inner door to my room, with a short "air lock" corridor in-between, where people entering and leaving the room could wash their hands and put on or take off breathing masks as necessary. Not surprisingly, the outside window was sealed - it could not be opened to the outside air.

Therefore, the room is designed to be as germ-free as possible, and is especially useful for patients who are very immunosuppressed. There was a sign on the wall stating that "This bed is licensed by DFCI", meaning that this is one of several rooms within BWH that are for the use of Dana-Farber Cancer Institute patients, particularly for those undergoing a stem cell transplant (which is still something I am trying to avoid). Quite high-tech, all in all.

BWH and D-F are physically connected to each other, and they are also members of the Partners Healthcare group of hospitals (which also includes Massachusetts General Hospital, for example). All of these hospitals are also teaching affiliates of Harvard Medical School, as well - as an example, my principal D-F hematologist-oncologist, David C. Fisher, is also an Assistant Professor of Medicine at Harvard Medical School. There is a significant amount of cooperation between the member hospitals, certainly so in the case of D-F and BWH - since D-F functions as an out-patient treatment hospital only, any D-F patient requiring an overnight hospital stay can do so at BWH. In my case, although I did have to spend Christmas at BWH, all of my doctors (both BWH and D-F) had easy access to all of my records at D-F (so that, for example, the BWH docs could see, by looking at my last CT scan from November at D-F, that my pneumonia was indeed a "new-monia", in that there had been no signs of pneumonia in either lung a month and a half previous).

Well, I am hoping that this will be my last mention of any pneumonia in this blog. The good news is that I did spend almost eight days at BWH being diagnosed and apparently successfully treated for pneumonia. The less comforting news is that no one could tell me how I picked up my pneumonia, or, other than in general terms, how I can prevent contracting pneumonia once again. It was somewhat reassuring when Michele Walsh, my D-F nurse practitioner, yesterday told me that I have actually been pretty lucky so far - patients there on Alemtuzumab for as long as I have been on it usually had found themselves hospitalized with one infection or another long before I did. (I don't know if this is literally 100% true or not, but it did make me feel a little less discouraged - <grin>.)

So we press onward...

Categories: Leukemia