Edward completed his fourth cycle of chemo on June 7th. His post-chemo course was largely uneventful for the first 10 days. He had his typical nausea and depressed appetite, both of which are minimized by scheduled doses of ondansetron, an anti-emetic. His energy level was actually pretty good overall. Maybe we were starting to get the hang of all of this....
Then, last Saturday, Edward fell asleep in the middle of our living room, literally in the midst of playing with one of his toys. It was not even close to nap time. He had felt a little warm the night before and his temperature was a little elevated at 99.3, but overnight he defervesced and seemed to be himself when he woke up. I checked his temperature while he slept in my lap: 99.5 again. Thirty minutes later it was 100.1. Uh-oh.
We called the oncologist on-call to let him know that it seemed that Edward was developing a fever. He reviewed the protocol for fever with us as there is a certain temperature value over which we must be directly admitted. We checked Edward's temperature every thirty minutes and sure enough we crossed the threshold required for direct admission. We already had our bags packed as we knew a trip to the hospital was imminent. In the ER, poor Edward's temperature had skyrocketed to 103.9!! They drew blood work, urine and blood cultures, got a chest x-ray and started Edward on broad spectrum antibiotics.
His CBC revealed that his neutrophil count was dropping as expected due to his recent chemotherapy. He had a routine check 3 days prior and his neutrophils were ~450, but were now down to a little over 200. A level anywhere under 500 marks 'severe neutropenia' and puts him at risk of severe infections that his body would otherwise be able to ward off. His other lab work was fortunately relatively normal as were his other vital signs. Edward then developed some pretty impressive diarrhea and threw up on Katie a few times (never on me though!...he likes me better). After about 24 hours, his fever had actually resolved with the antibiotics and all his cultures remained negative. Unfortunately, his neutropenia persisted and you cannot stop the antibiotics until his neutrophils have recovered in case the antibiotics are suppressing an infection that has yet to be identified.
On Monday, hospital day #3, his neutrophils were zero....yep, zero. Katie, Edward and I were already getting a little cabin fever from having to isolate him to a 15'x15' hospital room 24 hours / day and now it looked like we were in for the long haul. Then on Tuesday, his neutrophils jumped to.....30. But on Wednesday they were 90 and on Thursday they had increased to just under 200. Finally, we were on the road of neutrophil recovery. Thus, they were comfortable taking the antibiotics off and discharging us as it seemed his immune system was making a comeback and all of his cultures remained completely negative. After nearly a week in the hospital, we were back home again!
Edward has now returned to his old tricks of getting into anything and everything - which, though tiring, is infinitely better than the lethargic, febrile, vomiting version of him just a few days prior. Despite all of the hurdles that life keeps throwing at him, Edward continues to grow and make developmental progress. He is able to walk quite well now (though still prefers to crawl from time to time) and is babbling more than ever. His favorite new food is anything chocolate!