WBC 14.7 K/uL (!!!)
RBC 4.10 M/uL
HGB 12.9 G/dL
PLT 496 K/uL
ANC 12.4 K/uL (!!!)
(I'll skip explaining the Fish Sandwich reference. If you are interested check out the search box at the top of the page.)
So everything looked great yesterday - The levaquin was doing its job and Ann's fever was gone. We expected that her WBC would drop back down to normal levels as the immune response her body was having to whatever she was fighting started to pass. Nice and simple in theory...at least until last night.
Just before going to bed, Ann had a small coughing fit, so I asked her to take her temperature. A few moments later, her digital thermometer started sounding the "Trouble" alert indicating a temperature over 100F. Specifically 100.3F, which was close enough to the 101 F limit that MDA told us would trigger a trip to the ER. Ann looked crushed, but we dressed and headed off to the ER in Baton Rouge anyway.
When we got there it was pretty much the same drill as last time except for the large number of armed Louisiana State Troopers standing guard on two of the examination rooms. The ER nurses talked about the ER being in "lock-down", so I presume that the Troopers had brought someone(s) in custody that needed treatment. The Troopers didn't look friendly or happy so we didn't ask.
Just like last time Ann got sent to the front of the line. We were put in a private room and waited for our doctors and nurses to come in. I always feel a little sorry for new medical professionals who get to deal with us for the first time. They get overloaded as Ann and I rattle off her history, time lines, diagnosis, complications, current perscriptions, drug interactions, and recent CBC differential numbers. That's about 1 million times more thorough than they expect from most patients they see, I guess. The doctor we saw last night actually asked me where I studied medicine and what my specialty was...Crikey! I corrected him fast and I could see his astonishment when I told him I was a Mechanical Engineer.
So Ann had to endure the same battery of tests as last time. Chest x-ray, looking for pneumonia; result negative. Nasal swab, looking for influenza A or B; results negative. Urine cultures, looking for UTI; result pending. Blood cultures, looking for sepsis; result pending. CBC and smear results were the same as the day before-- lots of mature neutrophils, and no pre-cursor or blast cells in sight. So the conclusion seems to be the same: A bacterial infection of some sort.
Ann's baby stem cells are reacting to the invading bugs by "dog piling" them. Billions and billions of nuetrophils are being cranked out by her new marrow every couple of hours, and they are literally throwing themselves at the enemy looking for anyway they can to kill the germs off. Eventually one of the neutrophils will "figure it out" and pass it on to the rest of it's cohort.
After leaving the ER this morning we discovered that Ann has passed a milestone, too. Because she still had a fever this morning of 100.7F, we called to check with MDA and our local doctor on what to do. We were pretty surprised by the answer...nothing. As in "do nothing, unless it gets really bad".
Well OK, not nothing: MDA the bastion of cancer research and treatment, the place that has the most qualified professionals in the nation, the people I would trust implicitly with Ann's life has suggested...(Pause for Dramatic Effect)...Tylenol. Until they have evidence of something more serious in Ann's blood they are just gonna let this one ride and see how the baby stem cells cope.
Looks like the training wheels are off and the baby stem cells are cycling on their own now.