Wednesday, October 1, 2014

Diary of a Crohn's Flare: The Fever

During my August hospitalization I had been placed back on Prednisone.  My doctors had me taper down from 40 mg and by the time I got to 10 mg / day, my Crohn's doctor asked me to maintain my Prednisone dosage at 10 mg / day until I could start my biological treatments (Remicade) scheduled to begin 9/15.  I was not taking Imuran during this period and in fact the Surgeon forbade me from resuming it until 9/15.

During my hospitalization that started on 9/8, my immune system was still suppressed from these medications.  When they discovered the Cryptococcus lung infection, the doctors forbade me from taking any immuno-suppressant drugs (steroid, sulfasalazine, Imuran, or Remicade) until I cleared the lung infection and they started me on the antifungal medicine Diflucan (fluconazole).

The doctors theorized that the reason I was showing no signs of lung infection was that the other drugs suppressed my immune response enough that it wasn't reacting the infection at all.

Fortunately (or unfortunately), once I returned home from the hospital on 9/11, my body began to recognized that I had pneumonia and along with the Diflucan began to vigorously fight it.  What this meant for me was - feeling terrible.  I maintained a fever 24 hours a day for about 13 days.  My temperature ranged from 99.2F up to 102.2 F.  I suffered from feeling achy and tired and just felt miserable for most of this time.  I also suffered severe night sweats up to 3 times per night which required toweling off each time.

When I talked with the infectious diseases doctor he said I should expect the fevers to continue from 2-4 weeks after starting treatment.  Last week I started having days in which I had a normal temperature for about half the day and a mild fever for the other half of the day.  Over last weekend I began having days in which I had no fever at all.  This week I mostly haven't taken my temperature but on the days I have taken my temperature I've found that I suffer from a low grade fever for a few hours each day but am mostly maintaining a normal temperature.  Even better, most of the aching has stopped and I'm not nearly as tired as I had been.

Although I find this terribly frustrating, I've taken some consolation in the fact that I am recovering from pneumonia, that pneumonia is a serious ailment, and that it is life threatening.  The fact that I am able to function at 75% or so is actually a very good sign.

On a side note, a friend of my family is a clinical and laboratory pharmacologist.  He reviewed my medications and pointed out that several of my medications could have potentially serious / life-threatening drug interactions.  I thought I would mention those for other people who might be in my situation.

Diflucan (fluconazole) has a potential drug interaction with ZofranPhenergan (anti-nausea medications) and Prilosec (the proton pump inhibitor [PPI] that I take for GERD).  He recommended that for anti-nausea medication that I switch to Meclizine (an OTC motion sickness medication).  For the GERD he recommended several options but the one I selected was OTC Prevacid (lensoprazole).  The drug interaction was that using Diflucan with these drugs could result in heart timing issues / arrhythmia (I don't know the technical jargon) but here's what I've found on Drugs.com about it:





Drug interaction between Diflucan and Zofran:
Using fluconazole together with ondansetron can increase the risk of an irregular heart rhythm that may be serious.

The other drugs had similar warnings.

My family friend also recommended that I being a 81 mg aspirin regime to reduce the chances of blood clots (I have a history of them and my latest CBC showed elevated platlet counts).

Instead of simply making these changes on my own, I consulted with my GP, GI, and ID (Infectious Diseases) doctors about wanting to make them.  All doctors agreed to the changes.

No comments:

Post a Comment