First Infusion; Pneumonia Makes it Tricky

Wednesday - April 20, 2016

I had intended to post as I used to - with my pre-chemotherapy Rituxan infusions - from my infusion chair, as a productive diversion from the monotony of serving as a receptacle for the drip drip drip of the pump.  My body had other ideas.  Yesterday's pneumonia diagnosis did NOT disrupt today's first IVIG but it did make it a lot trickier and less comfortable.

The infusion room will be my monthly destination for perhaps the next 6 months.  At that point, my infusion rate may be sufficiently established to avoid side effects and my "trough level" (starting IgG rate) may be at the low end of normal (800 versus my current "atrocious and dangerous" sub-150) when I sit down in the chair.  Then I may be able to have an RN deliver the infusions at home.  The infusion room is a lovely, quiet space with treetop views and a sweep of Western Avenue in Friendship Heights.  Everyone was professional and attentive; the WiFi was robust and, best of all, the RNs and Dr. came in and out to change bottles, adjust rates, take vitals while I slept without noise and with a minimum of disturbance and disruption.  Hallelujah!  Great care!  No headaches, no light headedness, no flu-like symptoms, lots of sleep.

As for the low point of the day, my pneumonia caused a severe reaction as the immunoglobulin for this first ever  IVIG began to build in my system and to attack the lurking bacteria in my lungs.  The result was severe tremors, so rough that I almost fell out of the chair at one point and was blocked from falling by the attentive RN who was evaluating me.  The infusion was stopped immediately, saline was run, prednisone and ibuprofen were prescribed, and we waited 45 minutes for those very disconcerting body spasms to dissipate.  Then we started up again at the lowest infusion rate; we weren't even halfway through the first of my 4 bottles of immunoglobulin when the tremors / spasms caused the pause.  Ah, well.  "It's going to be a long but less-eventful day," my immunologist said.  And that's when I just settled down to nap ....

"Baxter" to the rescue :) - a good omen

Another interesting point is that the immunoglobulin mix I am receiving has been scrubbed of all IgA.  I only show a trace of IgA over repeated tests thus demonstrating that my immune system really does not produce enough IgA on its own for my body to recognize it.  While my skeletal ranks of IgG recognize the IgG reinforcements flowing in during my infusion, research shows that IgA might not be recognized in a depleted system such as mine resulting in the infused IgA triggering anaphylactic shock.  Best to be avoided.  I shall soldier on with only wisps of IgA and hope that my bolstered IgG will work overtime.

So today was 7 and a half hours in the infusion room.  How do I feel?  Well, I am pretty wiped out from the pneumonia itself as well as the IVIG which is also supposed to produce fatigue.  But from the point of view of my immune system, today is the best that I will feel until my next infusion on May 18.  The half-life of the immunoglobulin sets in immediately and my levels will decline steadily until we build them back up in a month.  Think "300" everyone!  That is my goal "trough level" for May 18!