sudden onset of pneumonia

[Cabisbee]

We have had a pretty crazy weekend. My husband was finally able to get round 9 of Folfox after several delays. It went pretty much as usual, discontinued the pump on Saturday after chemo was done and saline bolus was finished. He puked once Sunday morning, swears he didn't aspirate, and then noticed his breathing sounded weird. I'm a nurse, so I grabbed my stethoscope and his lungs sounded awful with crackles. I took him to the ER on Sunday, not sure if he was developing pulmonary edema or infection. They decided his xray showed pneumonia in his right lung. He stayed in the hospital overnight getting 2 antibiotics and fluids and his lungs sounded much better today so they sent him home on oral antibiotics. He was not neutropenic, so I don't know why he didn't have much of an immune response. His WBC was only 7 and he never ran any fever. He really had not even had a cough. He said he had a little clear drainage the 2 days before that if he felt like he needed to clear his throat he was able to cough a little out, but no real cough until the day the crackles developed. He said it sounded like coke fizz to him. They were concerned about his blood pressure, it was a little low but he had not really drank anything the day before and that one liter of saline just didn't go far enough. It just all happened so fast it was weird. To top things off, our oncologist partner who was on call said for them to admit him under our PCP since it was pneumonia and he was out of town. He rarely ever takes off, but it's spring break here. We ended up under the hospitalist group and we did NOT like the doctor. Glad he is back home now, but praying for no more of that. We've managed to make it since August with him on chemo without him catching any funk from any of our kids so I guess we have done good overall.

[Val*pal]

I'm so sorry your husband came down with pneumonia. If it isn't one thing, it's another, right?

I guess it's no surprise that so many of our spouses who have colon cancer suddenly develop "extra" health issues. I know my husband's white cell counts have been pretty bad lately, but he's managed to escape some of the viruses going around, thank goodness. But he did get extremely dehydrated (and very quickly) when he developed diarrhea in January. That put him in the hospital for a week. He must get tired of me asking him how he is, but I'm always afraid he'll get a cold or other virus. A year ago he had a mild head cold that kicked his butt big time, so I appreciate how difficult it is when our loved ones get sick.

[dianne052506]

Cabisbee,
By any chance is your DH on Avastin with the FOLFOX?
Over the years, I've had lots of Avastin - first with FOLFOX, then with XELIRI (irinotecan + Xeloda), and since August 2012, with a study drug as part of a phase I clinical trial. Over the last 4 years, I've had a number of episodes of proteinuria from the Avastin. Apparently once you have proteinuria, you are more susceptible to dehydration. I only found out recently when the research onc told the nephrologist who was treating me for acute kidney failure.
I've had 3 episodes of dehydration since Christmas. Once after a reaction to IV contrast for a CT, once with 105 fever and pneumonia (caused by one of the lung tumors) and this most recent time probably because the first two times were not handled well. Every time I was at the research clinic after Christmas, I commented on my unusually low blood pressure and got the "what are you complaining about" look. Now I know that low BP is also a sign of dehydration.
Your DH is lucky to have you watching out for him. When I was feeling lousy these last few months, all I wanted to do was sleep, and my family didn't know any better so they let me. Now we know that I should have been pushing fluids. The nephrologist wants me to have 1.5 liters/day, but with my low appetite and frequent nausea, that's impossible, so I'm going in for IV fluids 3 times a week. Quite a pain, but if it keeps me out of the hospital, it's worth it.
Sorry about the pneumonia. Hope that gets resolved soon as well. Just wanted you to be aware of the higher dehydration risk if he is on Avastin.
Best wishes to you both,
Dianne

[Cabisbee]

Nope, no Avastin. He's just on Folfox with Leucovorin. On the day his pump comes off, he's always the sickest. That's the day he gets a saline bolus from me before I unhook him. We have found the right combination of meds ( Sancuso patch, Scopolamine patch, oral Ativan and Compazine) so that he's not puking all day, but he still tends to get a little dry because he can't make himself drink that day. Sometimes he does get sick one last time on the morning of day 4, but not always. He's really done pretty well overall. They took a break after round 8 due to fingertip neuropathy and did his radiation. Unfortunately, radiation caused some pretty significant colitis, so now that's contributing to losing fluids when it kicks in. He was delayed another 3 weeks from restarting with round 9 due to foot neuropathy kicking in. We think it was triggered because the colitis flushed out his b12. He's done better with b12 shots now. All in all, we have felt blessed that his side effects have not been any worse, but this whole pneumonia episode threw us for a loop.