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Did the Extra Chemo Cycles Go Too Far?


Ed has medical emergency. Did the extra chemo cause it?

Two weeks following the last chemo cycle, Ed had blood drawn at the lab and went immediately to imaging for a follow up CT scan. They still snickered when once more Ed requested chocolate when they were getting his “barium smoothie” and they said that very berry was all they had. Just as with all the other times, nobody in the waiting room wanted any of Ed’s smoothie when he offered to share it with them. Ed had only 15 minutes to down the entire smoothie to stay on schedule for his CT scan, which would come 45 minutes later. Ed was eager to finish this test in preparation for his follow up visit with Dr. Asif early the next week.

Dr. Asif, the oncologist, greeted Ed as he entered the exam room and announced that Ed’s spleen was normal size as were the lymph nodes, including those putting pressure on the backside of Ed’s liver. However, the white cell count at 1,600 was way too low; the neutrophils were also very low at 1,800 and hemoglobin was also low at 10,700. Dr. Asif felt that Ed’s immune system was rebounding from the chemo and would continue to do so slowly but wanted to give it a chance. So, he was not going to order a Neulasta injection at this time and warned Ed to be cautious by wearing a surgical mask when he went out into the public. If someone in the household contracted something, even a minor cold/sniffles he should wear the mask at home, or the family member should wear a mask. Above all, if Ed’s body temperature were to rise above 99.9 degrees he was to call Dr. Asif immediately.

Dr. Asif wanted to wait for six weeks to take a bone marrow biopsy and would order another blood sample for evaluation between then.

Ed took precautions to protect himself and stayed at home most of the time. But six days later around 7 p.m., Sunday evening he began to feel slightly flushed. Ed took his own temperature and it was reading 99.8. Knowing that a couple of Advil should help lower his body temperature, he swallowed two capsules and took his temperature two hours later. It read 101.3. Recalling Dr. Asif’s warning, he decided to call immediately on Monday morning. He knew the cancer center would be thriving by 8 a.m. and went to bed. Ed awoke at 7 a.m. and took his temperature, which was now reading 104.1. Now, Ed was becoming alarmed and began calling the cancer center and finally was able to reach Elizabeth Wilson, the nurse practitioner associated with Dr. Asif. She listened as Ed related the past 12 hours of increasing body temperature. She promised to get right back as soon as she could consult with Dr. Asif.

Within 10 minutes, Dr. Asif called back and instructed Ed to report to the emergency room at Beebe Hospital and to “tell admitting that you are an active cancer patient and Dr. Asif had instructed you to go to the emergency room” and he would call ahead to order Ed’s admission.

Pattie drove Ed to the emergency room immediately, and as she parked her car, Ed went inside and sat in a wheel chair at the intake desk and repeated Dr. Asif’s instructions. The intake clerk said, “Yes we have the admitting order.” With that, just as Pattie joined him, a nurse came and whisked Ed down a long hall to a treatment room. All of Ed’s vitals were recorded and an IV of Antibiotics was started. It was to be the first of seven long days.

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