New Onset of a Possible Visual Field Deficit

Steve and Terry weren't too alarmed on Sunday evening when Steve developed a mild headache. After all, Steve's body received a lot of chemotherapy last week when he finished his normal round of 300mg Temodar on Wednesday and then began his first round of Avastin on Friday. It was bound to be hard for him and some residual discomfort would be normal, right?

As the next few days progressed, however, so did Steve's headaches and Monday night, Steve began feeling chilled. He had spent his work day in a cool, air conditioned room designed to keep some supercomputers cool so it was understandable. Tuesday, his headache felt worse and he was even more chilled so maybe he would feel better after spending some time under the blankets, which he did after dinner, going to bed early.

Now, unbeknown to us, Steve had been out to lunch with his work buddy, Steve Cox (the same friend who had encouraged Steve to see his doctor about his original word finding problem which led to the discovery of his cancer) and Steve Cox noticed that our Steve was driving too far to the right of the road, actually sometimes hitting the weeds on the shoulder, and our Steve was not aware that he was driving off center. Thursday, Steve Cox let us know about his concern.

On Wednesday, Steve's headache was getting bad and by the end of the day he began to have mild diarrhea. That evening, he misjudged the distance to drive around a stopped vehicle on the road and hit his passenger side mirror, damaging it.  Uh oh, a second event involving vision on the right.

Thursday, he stayed home from work and had a fever. Tylenol helped with the fever.

Terry called Dr. Hu who said Steve's symptoms were likely a viral flu bug. He explained that Steve is more prone to get sick due the chemotherapy lowering his immunity and any infection will exacerbate symptoms from the tumor. He ordered a CBC blood test for Friday and wants Steve to see an ophthalmologist. There is a neuro-opthalmologist at Cedars-Sinai he could see but any one closer can test for visual field and save them the time and trouble of driving in to the city. Terry plans to call Monday morning to make an appointment for Steve.

Steve and Terry agreed that Steve won't drive again until he is tested and cleared by both the ophthalmologist and Dr. Hu. He can carpool with his colleagues to work until then with just a little inconvenience due to differing schedules.

Friday, Steve's blood test results indicated that Steve was fighting an infection with his white blood cell count at 5.8. That is high for a chemotherapy patient and high for Steve. It shows his body is fighting an infection. Today, Steve is starting to feel better. He no longer has chills and his headache is mild.

It's interesting that even with the knowledge that Steve did not see objects on the right side (at least twice) that neither Steve nor Terry have noticed any visual field deficits. It's possibly transitory or perceptual or improved or they aren't observant enough to find it. It will be interesting to know the results of the eye testing.

We hope the testing is done quickly to determine if Steve can safely drive to work again soon.

Steve's next routine lab tests are scheduled for August 21st and his next Avastin treatment for August 29th followed by another doctor's office visit.