It didn't take long to determine through Google searches and the subsequent drill downs to find the suspected link between the Epstein Barr Virus, "Glandular Fever" (Infectious Mononucleosis (IM)) and Hodgkin Lymphoma.
Epstein-Barr Virus (EBV) is a type of virus that infects many people around the world. It is related to viruses that cause cold sores and chickenpox. Infection with this virus usually occurs in childhood as a throat infection, but can occur in adolescence or adulthood. In adolescence and early adulthood it causes "glandular fever." EBV has a unique set of genes that causes a growth activation of the cells that it infects. EBV mainly infects B-Cells, which is a type of white blood cell. While most of the time the infection causes little damage, sometimes the growth activating genes may cause the infected B-cells to turn into cancers in certain people. The most common cancers caused by EBV are lymphomas. There are at least 3 types of lymphoma that have a definite link to EBV infection but 2 of them have to do with transplant and post-transplant patients or are related to Malaria, neither of which apply in Geoff's case. What I did find, though, was find a strong link between EBV and Hodgkin Lymphoma, especially in young males.
Statistically, in western countries, nearly 40% of individuals diagnosed with Hodgkin Lymphoma are also currently infected with EBV. The infection rate may be even higher in many other parts of the world. The exact process by which EBV may cause Hodgkin Lymphoma is not well understood, but it is evident that EBV has an important role to play in the development of this cancer. At the same time, nearly 90% of adults between the ages of 35 and 40 in the countries studied have been infected with the EBV at some time in their life. They obviously do not all develop Hodgkin Lymphoma and although glandular fever or IM is much more common, not everyone infected with the virus develops that disease, either. This statement, which I found on the website for the Centers for Disease Control was chilling, "There is no specific treatment for Infectious Mononucleosis, other than treating the symptoms." Apparently the IM does not react positively to antibiotics and there are many documented cases of adverse reactions to antibiotics by IM patients. There are also issues associated with the determination as to whether the infection is recent, whether the patient had been infected at some time in the past or what is referred to as a "recurrent" infection.
Based on this initial research combined with the information I had pieced together from the hospital and the coroner's office I began to develop my own theory. Geoff had been feeling poorly for 3 weeks prior to his death, complaining of tonsillitis and extreme tiredness. At some point a few days before he first collapsed he had been diagnosed with "Glandular Fever" and told to rest, take in fluids and use Tylenol (Panadol) to control the fever. The normal course of Glandular Fever is that there's about a 4 week period of acute symptoms followed by 4 to 6 months of progressive improvement and that there is no known treatment, just the palliative things that one can do for the symptoms. I surmised, then, because Geoff's immune system was most likely still compromised from the chemotherapy and radiation in 2008 he wasn't able to fight off the infection like one would have expected from the healthy 26 year old man he appeared to be. As I did additional research I became more and more anxious about meeting with Geoff's doctors. My previous knowledge about Lymphoma as a result of my own bout in 1998 (not Hodgkin but Diffuse Large B-Cell) was that Lymphoma, in and of itself, rarely kills quickly. My oncologist had told me then that more patients die from the treatment regimen or opportunistic infections than of the disease if identified early enough. My belief would have been that even if the Lymphoma had returned, as the coroner was suggesting, that it would not have, acting alone, caused the obvious devastation that had occurred in Geoff's case. The interplay between the Lymphoma and the glandular fever was something I was not familiar with but was anxious to learn more about. At one point Robin informed me that she had been able to secure an appointment to meet with Geoff's doctors on Monday afternoon, October 11. I wondered what they were going to be able to tell us to help us understand how this tragic event could have taken place and whether or not they felt they had done everything possible in Geoff's best interest.
In the meantime, Melissa and Jo were working feverishly on the booklet that was to be handed out for Geoff's service. The church let us know that Wednesday afternoon, October 13 was available and we would be able to nail down the details at our meeting the next day with the priest. Candi was busy pouring through old photos of Geoff that we might use in a slide show to be presented after the service during a wake. Telephone calls and emails were flying around relative to the catering for the wake, the obituary that was to be placed in the Sydney Morning Herald, the time for the viewing of Geoff's body at WN Bull and many other details. We talked among ourselves as to how many we expected to attend the service so as to have enough of the booklets printed and the consensus was we thought about 60 would be appropriate. Candi and Robin prepared dinner for everyone with Jeanette and Maggie's help from the generous and delicious Lebanese dishes that JoJo's mother had prepared and sent to the house. We finished off a few bottles of Australia's bounty from the Margaret River (Red and White) along with our dinner. Exhausted, Candi and I were driven back to Darlinghurst by Robin. She dropped us off at the front door, said goodnight and drove off as we opened the two doors to the townhouse. Melissa had come along for the ride and to keep her mother company on the return trip.
It was Friday night in Darlinghurst. The unmistakable "thump, thump, thump" of musical bass reverberated outside the windows from a not too far distance. The occasional partiers stumbled past the unit communicating to anyone in too loud of voices. Cars moved up and down the street looking for parking spaces which were at a premium on a weekend night. Candi and I readied ourselves for bed, gave each other hugs and retired to our bedrooms. I heard the steady pattering of raindrops on the metal roof as I tried to sort out my thoughts from the day. I was exhausted but apparently not tired enough as I found the relief of sleep fleeting while my mind was racing.
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