Neupogen
Neupogen is a drug used to stimulate white blood cell growth. People having chemotherapy often have a lowered immune system because chemo targets rapidly-growing cells in the body, including white blood cells. If you have an organ transplant, doctors suppress your immune system on purpose so that your body doesn’t attack the new organ, and reject it. Too much suppression, however, and you need to be very careful about who you’re around and what you do. Stay away from crowds and wear a mask if you’re near other people. Any cut can lead to an infection, and it’s really hard to stop. Mold spores in the dirt and on plants can get in your lungs and cause an infection.
I’ve had Neupogen shots at least twice before. After my liver transplant my white and red blood cell counts were a mess. The surgery left my spleen enlarged—one doctor explained to me that an enlarged spleen sucks in and holds on to a lot of cells when it’s inflamed. At the time my body was recovering from being at the brink, and my doctors seemed happy just to see me steady, if not gentile, improvement. At times they gave me a boost with different drugs when my body wasn’t able to do things on its own. Epogen and iron supplements when I was severely anemic, and Neupogen when my immune system was too compromised.
Neupogen has worked for me both times it’s been given to me before, and my WBC count improved. Last week it was very low, and I was given the drug again. This time it was a series of three shots instead of one. Also, the previous injections were in my arm, like a flu shot. These were not into muscle, and we found a spot in my stomach that worked. I guess the back of the arm works as well.
I felt terrible in general when I was on dialysis, so it’s hard to say how bad the shots felt the last times I’ve had them. I remember them making me feel achy, and that my bones hurt, but it was just a slight bump up on my pain scale for the day. Before the shots last week I was actually feeling okay, going on walks, and not as achy generally. I had shots Friday, Saturday, and Sunday. The back pain hit me the first night, and I had pulsating pain in my tailbone and lower back—nothing helped, and the pain followed me when I was sitting, standing, and laying down. Saturday it was still painful, but I was able to walk around a little better. By Sunday the pain was much better, and since then I’ve felt tired and a little off, but generally better. My back still hurts, but not as bad.
When I got the shots I was told to take Tylenol and Claritin to counteract some of the side effects. It’s hard to tell if it helps, but I’m still in some pain walking around after taking both medications.
My blood test from this week showed an improvement in my WBC count, so the drug seems to have done its job. Hopefully they will be able to keep it at a safe level.
When I discussed my labs with my doctor this week she noted that she will probably bring a new immunosuppressant into the mix so that she can lower some of the others that she has me on. My creatinine inched up again this week, to the top of the normal level, 1.17 mg/dl, and some other indicators point to more inflammation and possible rejection again. I really don’t want to go back to the hospital again for Thymoglobulin or something similar.
The doctor mentioned two possible new medications: an mTOR inhibitor, though it may not work as well on patients who have had liver transplants; and Belatacept, which is an infusion that you get once a week for 30 minutes, though my doctor seemed less sure of its effectiveness in cases like mine.
Next week should be interesting. I’m going to get my hair cut on Tuesday and try to get done what else I can in case I have lab results later in the week that hole me up either in the hospital again, or at home dealing with a new drug.