30 Nov 2012

Febrile Neutropenia

Some of you may recall that my hypersensitivity to front line drugs causes me to receive desensitisation infusions - i.e. very long, very slow chemo in hospital with one-to-one nursing.   I am at high risk of adverse reactions and so they take extraordinary precautions.

I jokingly call these infusions my "spa chemos" - as they are a relaxing (just kidding) two-day event, meals served in bed, highly attentive nurses, mind-numbing drugs and no problems recovering afterwards - until recently - when my husband picked me up after my hospital stay and was suffering with what was obviously a very bad cold.

If a chemo patient can't remember anything else - they must remember the cardinal rule to take their temperature regularly.  WHY?  Elevated temperature is an indication of infection.

 The rule is 38.3C or 101.5F - get to the hospital!

After three days of monitoring a low-grade fever, my temp hit 38.9C (102F) - I'd gotten the cold.  It was a Sunday morning, so off we went to the hospital emergency room

In the ER, dear hubby was sent in one direction and me in another.  He was diagnosed with bronchial pneumonia and given a prescription for antibiotics.   I was told that I had a common cold/sinus infection, go home, continue monitoring my fever, take Tylenol, rest...antibiotics?  No.  We don't do that.  Hmmmmmmmmmm.  I made it clear to the doctor that it was day three after chemo...sure, all blood work was still within the normal range but I had a fever...no antibiotics?...nadir just days around the corner...husband with bronchial pneumonia...a recipe for disaster!

Nadir is the point at which your blood cells - red and white - reach their lowest levels as the chemo wrecks it's most savage attack.  Translation - you have a severely compromised immune system with zero ability to fight infection.

At home, day 6 - nadir - my fever topped 40.2C - an alarming level even for a healthy person, let alone someone trying to recover from chemo.  I was once again off to the hospital.  But no, common sense or delirium must have prevailed, because I had the foresight to call the Cancer Clinic and alert them to the situation before once again leaving my life's decisions in the hands of a fresh-faced ER doc who doesn't "do" antibiotics.  I was told by my oncology nurse to come to the Cancer Clinic immediately - do not pass GO - do NOT go to the ER.

My oncologist was waiting and shocked at my condition. I was immediately admitted to hospital.  Diagnosis - febrile neutropenia - a fever of over 38.3C and neutrophil count of 500 or less.  My white blood count was actually .1 at admission and my neutrophil count 300... barely registering. (normal ranges can be from 4-11 for WBC and 1,500-9,000 ANC)

Death by the common cold was exactly what I was facing.  Antibiotic IV's were hung, mega doses of acetaminophen, bone marrow stimulants, pain meds, anti-blood clot shots to the tummy (ouch!) all bombarded me.  I couldn't breath - was coughing out blood - had laryngitis - was literally looking over the edge and wondering if this was it?

Four days and four nights later I was discharged.  Two courses of antibiotics later, all was well. But what an incredibly difficult series of lessons to be learnt.  Yes, take your temperature frequently when you're undergoing chemotherapy.  Yes, go the the ER with a fever if your cancer clinic isn't open.  No, don't take "no antibiotics" for an answer.  No, don't trust that when the ER personnel say that they'll notify your oncologist that they actually do. 

Yes, understand that while undergoing chemotherapy treatment, you can actually die from the common cold.