According to my doctor one medical rule of thumb is:  In your 50’s you have a heart attack; in your 60’s you have cancer; in your 70’s you have stroke; and in your 80’s you fall, break a leg, and die in the hospital of pneumonia.  Somehow I had managed to skip the heart attack and had a stroke in my 50’s instead.  I’ve been collecting cancers since my 30’s and managed to lick them.  But that luck came to end in my 60’s.  I have acquired lymphoma as a result of my service in the Marines.  I’ve been living with it for about five years now, but it’s now time to begin treatment.

Last Tuesday I received my first rituximab infusion.  After receiving my prep cocktail of meds, my nurse went to get the rituximab and came back carrying it at arm’s length in front of him.  He was wearing a full-body onesie with headgear that was seriously sci-fi looking.  The bag he was carrying had a big biohazard symbol on it.

¿What the heck?  Was this serious or maybe just part of the hazing process?  None of the other people here were wearing any protective gear.  If he dropped the bag and it burst did mean everyone there except him would become zombized or die an agonizing antibody death as all their CD20 protein bearing cells were whoop-assed upon?  The short explanation is that all monoclonal antibody drugs can be reproductive toxic, so if any gets into your bloodstream (like mine) you could have children with three eyes or maybe even—common sense!  Since I’ve been neutered that wasn’t happening here.  If I hadn’t I would need to refrain from baby making for a year after taking the drug.

Everything was going fine until the beginning of the second hour (it’s a six hour infusion) when they bumped the rate up to 150 ml/hr.  Almost immediately I began shaking so much I couldn’t talk and they couldn’t get my vitals.  So I got a push of steroids and another of dilaudid.  Until then I didn’t know that an injection into your IV is called a push—I’ve received a lot of those.

After about 20 minutes I returned to “normal” and they restarted treatment about another 40 minutes later.  I completed the treatment without any further reactions.  That evening I felt great.  But that was short lived.  On Wednesday I started feeling dizzy, lightheaded, and breathless.  Those are “see your doctor” side effects of the drug.  So off I went to the ER and was admitted.

It wasn’t clear whether it was side effects of the drug or something else.  My liver enzymes were extremely high (ALT was 149, normal is 0-55; AST was 243, normal is 5-34), plus my platelets were 14 (normal is 140-400).  Beside that I was flipping in and out of afib.  None of that was good, though a short term drop in platelets is a common side effect of the rituximab, elevated liver enzymes is rare but possible.  On the other hand my white blood cell count had dropped down into the “sweet zone” as my doctor called it.

It’s interesting watching the interaction between the specialists and the hospitalist who was in charge of my case.  The hospitalist’s first priority was to determine whether I had had a stroke; not whether this a symptom of my treatment.  I was given NIH Stroke Test (see below…what’s happening in picture 1, what are the objects in picture 2, and read aloud the sentences and words in picture 3) every four hours as part when my vitals were collected.  After a while I had all the cards memorized.  I had every kind of scan of my brain and neck, and as the joke goes they found nothing.  I had sonograms of my liver, an echocardiogram, multiple EKGs, along with the usual chest x-rays, etc.  It’s interesting that even though I was on a heart monitor the whole time, they had to attach different leads for the EKGs.  As furry as I am, I now look like I have the mange.

And another thing, my bed was alarmed!  I was stuck on this 7’×4’ rectangle of memory foam.  Even if I sat on the edge of the bed with my feet on the floor an alarm would go off.  That meant someone had to come and unalarm the bed every time I had to use the bathroom.  Eventually they got tired of that and gave me one of those disposal urinals.  It takes real skill to use one of those keeping all your body parts on the bed without causing a mess.  Try it sometime.

I was eventually released Friday when it was determined I hadn’t had a stroke and that probably my problems were a result of my infusion.  At discharge, my ALT was down to 93, my AST 97, and my platelets had roared up to 17—a high for the week!  My next treatment, which was to be this Tuesday, has been cancelled.  I’m not sure why after all, “rituximab administration can result in serious, including fatal infusion reactions. Deaths within 24 hours of rituximab infusion have occurred. Approximately 80% of fatal infusion reactions occurred in association with the first infusion.”  That seems to mean the odds are with me, right?