I am Sick - Or Maybe Not

For the first time in years, I have come down with something.

Or maybe not.

Here's the story.

Yesterday I got the relatively new conjugated more antigenic protein based pneumonia vaccine, PREVNAR 13.

My last pneumococcal vaccine, the weaker but broader spectrum Pneumovax, and the older PREVNAR 7 were administered more than seven years ago when I was first diagnosed in the hopes that early in the disease, my immune system had not crumbled too much and I could still mount a protective response.

The new improved PREVNAR 13 made my arm sore, which I took as a good sign, suggesting some immune response. In contrast, the flu jab a few weeks early was a non event.

That night I felt pretty awful- achy, lightheaded, nauseated, chilled, agitated. I slept little.

The next day, today, I went for my every 8 weeks IVIG. This by the way, may also dampen my immune response to the vaccine, but I wanted to get the immunization as far out as possible from the last boost to my passive immunity with the infusion of IVIG.

It was not that long ago that I was getting IVIG every 2 weeks! My veins are much happier.

I still felt terrible this morning.

Although the news was good with my hemoglobin and platelets (both within normal ranges), despite my stretching out the time between the protective dosing with other peoples' antibodies to prevent me from killing my own platelets as I have done so often in the past with my ITP, I got a surprise with the white blood cells.

My lymphocytes were zero, nada, missing in action, on the automated differential although I did have a normal 0.4 count of atypical lymphs.

My lymphs are my cancer cells. I am happy they aren't around.

But they are also my T cells and presumably some healthy non-clonal B cells. Where are they? I need you guys to fight infections and search and destroy any early secondary cancers. Come back!

Strange, but it gets stranger.

My absolute neutrophil count was a very high 16.7, most consistent with a bacterial infection. These are levels one sees in pneumonia or appendicitis or a kidney infection. Serious stuff.

Occasionally however, very early in the course of a viral infection, the neuts will rise. In the past when I was sick, my lymphs shot way up, not the neuts.

And although I had no fever, my blood pressure was as low as 81/45. It was still low, but better by the time I left the cancer center.

Despite the fact my wife was very sick all last week with multiple specific signs and symptoms, I have had no focal problems, just this general overwhelming malaise.

So is it the prodome of a coming illness? The oncologist who saw me at the infusion center wisely wrote a script for a broad spectrum antibiotic just in case, but said to hold it until it is clear I am actually sick with something infectious. Good counsel.

Or was it all just a weird rection to the PREVNAR?

I slept much of the day, and am starting to feel better, so I am betting on the latter. Us CLL patients have pretty weird immune systems.

More bad news.

On a sadder note, another CLL warrior died this week. Ellen Rhudy was a fighter, very actively battling her disease for years in her own unique way with mostly alternative, non allopathic medications. Over the years, we exchange many emails and a few phone calls as she tried to leverage her comprensive knowledge of different nontraditional therapies with the changing and less toxic CLL treatment landscape. We often disagreed, but we were friends because we shared a common enemy.

CLL plays for keeps. I hate it.

I will miss our exchanges, Ellen. Rest in peace.

Really sad.

Old Vaccine for a New Population: Prevnar 13

Good news. I pasted this article from a link sent by Therapeutic Daily about approval of "kid's" vaccine for adults over 50. This news is about the conjugated form of the pneumococcal vaccine that kids have been getting for years. Protein conjugated vaccines such as Prevnar are better at eliciting an immune response than the wimpy antigenic stimulation of a polysaccharide vaccine such as Pneumovax that until recently was the only FDA choice for adults. Moreover, protection against 13 subtypes of this potentially lethal bacteria in those with compromised immunity is better than the old Prevnar 7 but still not up to the high water mark of Pneumovax 23. More quantity, less quality. So if we are early in your CLL, and haven't had recent rituximab or chemo, we should ask our doctor about it. The longer we wait, and the more immune damaging drugs that have hit our veins, the less likely of any meaningful response. Still, the risks are low, though the timing of boosters can be tricky and the small but real chance of untoward reactions are issues best discussed with our local providers.

More importantly, suggest that appropriate family members and friends do the same. See my recent post about the importance of herd immunity. Remember that the leading cause of death in CLL is infections. The leading infection is pneumonia. The leading bacteria that causes pneumonia is what old school doctors like me called pneumococcus, but now more commonly answers to streptococcus pneumoniae. This invader can also cause a host of other infections including meningitis and sepsis. This vaccine offers an extra modicum of protection and for that I am grateful. I have been suggested the off label use of this vaccine for years in adults, Now the FDA has caught up so it should be less of a stretch for a primary care provider to OK the shot. Here's the pasted text:

FDA Approves Pneumococcal 13 Vaccine From the PharmaLive.com News Archive - Dec. 31, 2011 From UPI Health News (Business) (December 31, 2011) Prevnar 13, a pneumococcal 13 vaccine, was approved by the U.S. Food and Drug Administration for people age 50 and older to prevent pneumonia, officials said. Dr. Karen Midthun, director of U.S. Food and Drug Administration's Center for Biologics Evaluation and Research, said pneumococcal pneumonia, caused when the bacterium Streptococcus pneumoniae infects the lungs, is the most common disease caused by this bacterium in adults. When the bacterium invades parts of the body that are normally free from germs, such as the blood or spinal fluid, the disease is considered "invasive," Midthun said. "According to recent information for the United States, it is estimated that approximately 300,000 adults age 50 and older are hospitalized yearly because of pneumococcal pneumonia," Midthun said in a statement. "Pneumococcal disease is a substantial cause of illness and death. Today's approval provides an additional vaccine for preventing pneumococcal pneumonia and invasive disease in this age group." The new use for Prevnar 13 was approved under the agency's accelerated approval pathway, which allows for earlier approval of treatments for serious and life-threatening illnesses, Midthun said. The pathway allows for the demonstration of effectiveness of a vaccine using an immune marker that is reasonably likely to predict clinical benefit.