Hospital admission - thanks Chemotherapy!

When the temperature rises and the bloods fall...

Now one of the really important things you have to be aware of when you start chemotherapy treatment is the affect that the chemotherapy has on your blood cells and specifically your white infection fighting cells so your bodies ability to fight off infection is reduced as the chemotherapy affects the fast growing / replicating cells in your body of which your blood cells fall under this category.

I remember at my first meeting with the delightful Sarky Sue also known as the Chemotherapy Liaison Nurse that she made Gary and I acutely aware of the effect of chemotherapy on the immune system and the serious risk of infection.  I had my chemotherapy infusion every 21 days which was known as a chemotherapy cycle and I had a total of 6 cycles during my breast cancer treatment.  It was explained to me that between days 7 and 14 of each cycle that my white blood cells which are the ones that fight infection would be at their lowest which would make me much more at risk of infection and potentially serious infections at that.  Now, me being me, I was aware of the risk of infection and I’m aware of risk as it’s part of my daily work life as a Health & Safety Adviser but to be honest I was a bit blasé about it as I thought, I’m young, fairly fit and despite the breast cancer diagnosis, fairly healthy so I didn’t really think that I would be at risk.  As it turns out, I couldn’t have been more wrong and was reminded fairly early on in my chemotherapy cycles just how much of a battering my immune system would take from the highly toxic chemotherapy drugs.

Mid January 2018 and Gary came home from work one Thursday evening and looked absolutely shocking, he’d been feeling unwell all day and when he walked through the door he was shivering and sweating all at the same time.  I took his temperature and it was averaging 39.5°C!  This was a huge red flag warning to me as at this point I was on day 15 of just my second chemotherapy cycle which meant that my white infection fighting cells were still at my lowest point so I was wide open to infection.  Reluctantly I told Gary that he couldn’t stay at home as we couldn’t risk me catching whatever bug it was that he had so his mum and dad who live in the same village as us, agreed that he could stay there overnight.  I felt awful getting him to do this but I just couldn’t risk me becoming ill.  As soon as he left, I went through the house with antibacterial wipes and sprays cleaning any and all surfaces that he might have touched to try and reduce the infection risk but as I was to soon find out it was pointless as I’d already become infected.

The next morning Gary attended the doctors where they told him that he just had some kind of flu / viral infection and to basically take paracetamol to reduce his temperature and keep warm so he returned home on the Friday evening.  That day I’d noticed that I had a bad migraine type headache that just didn’t seem to shift but just put it down to tiredness and the chemotherapy effects.  So the next day I went for a pre-arranged afternoon walk in the cold January air with one of my oldest friend’s and a spot of lunch.  On my return home I noticed that I had some kind of red rash that had appeared across the bridge of my nose but Gary and I dismissed it as the effect of the wind on my skin which had become more sensitive since starting the chemotherapy.  As the day progressed and we got onto Sunday morning the rash was spreading across my checks – almost similar to the kind of rash babies get when they’re teething.  Other than this rash, for the most part I felt OK.

  

One of the things that was drilled into me by Sarky Sue was that if I ever at anytime had the inkling of feeling unwell or if I felt hot or cold was to take my temperature and if it was 38°C or above then the chemotherapy unit had to be contacted for them to make an assessment whether you needed to go the hospital for further investigation and treatment.   So when at 9pm that Sunday night in January that I started to feel pretty warm despite taking off my dressing gown and turning the central heating off I decided to take my temperature and low and behold it was registering 38°C.  We agreed that I would take it again in an hour’s time and if it was still elevated then reluctantly, I would ring the hospital.  So at 10pm with my temperature showing no signs of lowering I rang the out of hours number for the chemotherapy unit.  After being asked several questions I was advised by the nurse to attend the hospital for tests to be carried out and to take an overnight bag with me.  I remember being pretty scared that my temperature warranted me having a visit to the hospital late on a Sunday night but it couldn’t be avoided, my temperature needed to be assessed and to find out what infection was causing my elevated temperature.   Little did I know that Sunday night that I wouldn’t return home again until 4 days later on the Thursday evening.

On arrival at the hospital I was immediately assessed on the chemotherapy admissions unit and after several attempts to get a line in my arm, bloods were drawn to assess whether I had a viral or bacterial infection going on.   At this point my temperature had become raised to 38.5°C but despite feeling warm I didn’t feel particularly unwell and actually thought I was just wasting the hospital’s time.  My heart rate was elevated as was my blood pressure which I didn’t find abnormal as I do suffer with the good old “white coat syndrome” i.e. I detest anything that looks remotely like a medical facility!  The Junior Doctor said that a viral throat swab would also be done to rule out any flu virus given that Gary was showing flu symptoms and with it being January, we were in the middle of winter flu season.   I remember the Junior Doctor asking me if I was allergic to anything and I said yes to Penicillin and off she went.  The Ward Sister then came in with some IV antibiotics and asked me again if I was allergic to anything, again I said Penicillin and she asked if I had mentioned this to the Junior Doctor as the IV antibiotics she was about to connect me up to was related to the Penicillin family of antibiotics.  Next thing Gary and I heard the Ward Sister and the Junior Doctor with raised voices out on the corridor. Five minutes later the Ward Sister came back with two new antibiotics that were “safe” for Penicillin allergy sufferers and hooked me up to them via the IV line.

A couple of hours later around 4am the Ward Sister told me that I was being moved to my own private room to put me in isolation in case that I had an infectious illness going on.  By this time I must admit that I was starting to feel pretty rough but wasn’t sure if it was the supposed infection going on, or whether it was my lack of sleep as I’d not had any sleep since the night before.  I was just about to nod off to sleep around 7am  when a nurse came into the room to tell me that they were going to do the viral throat swab and then send me for a chest xray.

Gary stayed with me until mid morning when he decided he was going home to get some sleep for a few hours and to bring me some more belongings as it was becoming evident that I wasn’t getting out of the hospital anytime soon.  For the rest of the morning and afternoon I desperately tried to get some sleep but just couldn’t drop off, part of it was fear, part of it was the fact that my room was opposite the ward kitchen so it was noisy as anything.

Gary returned around 5pm and the Ward Sister informed me that they were keeping me in and I was being moved onto a different ward and would be placed in isolation as they still hadn’t had the results of my tests through.  I was taken by wheelchair which I hated to the new ward, J98, which I would later find out would become my home for the next three nights.

Given my white coat syndrome and dislike of hospitals, I asked the new Ward Sister if Gary was allowed to stay with me overnight and she refused on the grounds that they only do it for “children and very ill patients”…..clearly I wasn’t either.  It was the first time I became teary but the thought of being left, on my own, still with a high temperature, in isolation and feeling pretty crap just hit me.  I was 39 and scared of being left at the hospital on my own, I felt really vulnerable.  That may sound crazy to others but my fear of hospitals runs pretty deep.  The room that I had was on the corner of the building and was massive with a huge bathroom – bigger than some hotel rooms than I had stayed in!  I did manage to sleep overnight albeit I was sweating and shivering at the same time as the room felt cold overnight.  Now I’m not sure whether that was my fever making me feel like the room was cold or the heating just wasn’t working.

On the Tuesday afternoon, my Oncologist and another Junior Oncologist came to see me all gowned up, with gloves and face masks as part of the infection control procedures.  I felt like a leper every time someone came in to see me.  The Oncologist confirmed that my throat swab had confirmed that I tested positive for the B strain of the Flu virus and that I would be continued on the antibiotics to reduce any chest infection risk and was to be given Tamiflu tablets also as a precautionary measure.  My neutrophil levels (white infection fighting cells)  were still very low and hadn’t risen from the night I had come in so I wasn’t going to be allowed home until they had risen and were back in the “safe” range.  On top of all this the Oncologist also informed me that my blood sample in the laboratory had shown a potentially dangerous bacteria similar to the MRSA bacteria and so until the culture had been allowed more time to grow, they couldn’t let me leave the hospital.  As soon as I heard MRSA I remember thinking “shit! this is serious, I could potentially have a life threating illness going on and my white infection fighting cells were through the floor.  This isn’t good!”  The Oncologist assured me that because the culture that had grown was only a small amount, the laboratory believed it was cross contamination either from the person that had taken the sample or when the sample had arrived at the laboratory.  That in itself was scary, that I was in the hospital and they couldn’t even take a sample without there being a lack of hygiene and procedures.  As Gary left that evening I started crying.  I was scared.  I was scared that I was being left at the hospital again on my own in isolation with a potentially dangerous infection going on in my body.  That evening I couldn’t bear to be alone so I spoke on the phone to two of my oldest friends to try and take my mind off it and calm me down….which it did. 

Over the course of the next day I had visits from my aunt and uncle and my brother and sister in law in between me watching endless films on my tablet.  I was starting to get bored of the same isolating four walls which had now been my home for the last 48 hours and by Wednesday afternoon I was starting to feel better, my nose rash had almost gone and  my temperature was  still hanging around just under 38°C even with four hourly paracetamols to reduce it down.  Wednesday was also the day I almost flooded out the bathroom taking a shower but we’ll say no more about that!

Wednesday morning I asked one of the nurses if my blood tests were being taken to check my neutrophil levels and she said that one had been requested and would speak to one of the doctors to arrange it.  By early Wednesday evening my bloods still hadn’t been taken and when the Oncologist came to see me she was really annoyed that the lack of blood test had now stopped me potentially going home.  Needless to say within 10 minutes of her leaving my room, a nurse came in and took my bloods.

By the Thursday afternoon I was starting to feel better still and the Oncologist came to see me to tell me that my neutrophil levels had doubled since my admission and the MRSA type infection that had been growing in the laboratory was as a result of cross contamination and wasn't an infection I had. Talk about relief!  I was now OK to go home that evening.  I felt elated, I was so happy that I was able to go home, I had missed my own bed but I missed my dogs a whole lot more!  I was also strangely nervous about leaving the hospital as my temperature was still in the mid to late 37°C range and didn’t want anything to go awry once I was home.  Its strange how you get used to the daily routine of a hospital and seeing the same staff on a daily basis.  The food servers got to know me very well and by day two were making my weak, black decaf tea to perfection – I didn’t even need to ask for one!

Gary came to pick me up to take me home on the Thursday evening and it was weird actually venturing outside the room that I had been in for 3 days but it was great to see civilisation!  On my way out I had several ward staff wish me well and told me in the nicest way that they didn’t want to see me again! 

We drove straight to Gary’s mum and dad’s house to pick up Jake and Milly who had been there during the day whilst I had been in hospital and both of them went absolutely mental when they saw me.  You really just can’t beat the unconditional love from dogs, it is one of the best feelings in the world and I couldn’t wait to give them both a cuddle.

My time in the hospital was scary as it brought home the stark reality of just how toxic and dangerous chemotherapy drugs can be to the body and how much they affect your infection fighting cells.  It made me realise that I wasn’t being paranoid at regularly taking my temperature whenever I felt a little warm or under the weather.  If I can offer any advice to anyone undergoing chemotherapy it is to listen to your body and keep a thermometer with you at all times as infection can take hold very fast when you’re immuno-compromised through chemotherapy.