It just wouldn’t be a Taxotere treatment without another infection and fever.

As I watched the sad stories of fallen soldiers on television coverage of Remembrance Day services, my body was beginning to fight its own battle.

A low-grade fever started at 11:00 a.m. registering 37.5°. It wasn’t a totally accurate reading as I had taken painkillers with acetaminophen for side effects earlier that morning. The temperature hovered at 37.5° for a few hours. At 4:00 p.m., it had climbed to 38°, the level in which chemo infections and fever become a life-threatening medical emergency.

Having been through febrile neutropenia (fever with low blood counts and no immunity to fight infection) three previous times since September 27, I knew I needed to continually monitor my temperature to see if it would remain constant or climb. After an hour or more of 38°, chemo patients need to have the condition addressed by a doctor.

History was predictably repeating itself with this final round of Taxotere.

In early October, on the fourth day after my second Taxotere treatment, I spiked a fever because of an infection. I had a fever with some kind of infection again on Day four of my final Taxotere treatment.

Typically, chemo patients can expect their white blood cell counts to dive on the eighth day of treatment while on Taxotere. For me, the white blood cell counts dipped on Day four of the last two treatments.

Drawing on the past infections, I took my temperature every half hour. Each half hour it was climbing by .1°, an indication that there was definitely an infection somewhere in my body. By 6:00 p.m. it was 38.5°. It was time to call the oncologist on call for treatment directions.

The doctor told me to rush immediately to an Emergency ward as I was in a life-threatening state because of low blood counts, an infection, and a previous history of febrile neutropenia with chemotherapy. I was told to advise the admitting staff that I needed to be seen a.s.a.p., only to be bumped by someone having a heart attack or some other grave emergency.

The treatment hospital I have been going to previously when I had complications had me wait 11 hours, six hours, and 11 hours until the Emergency check-ups were completed. I needed to make a tough decision: which hospital’s emergency ward do I go to? Do I go to the larger hospital where the chemo treatments were, as they could access my medical file? Or, do I go to a local, smaller neighborhood hospital where I might be seen sooner without my patient history?

The doctor on call suggested that a smaller neighborhood hospital might be a better choice. They noted that any emergency doctor seeing me would be able to treat the infection with anti-biotics. Given the poor emergency response times with the treatment hospital I had visited in the past, I chose to go to a smaller hospital, which was closer to home.

When we arrived at Emergency at 6:30, my fever climbed again to 38.6°, and my blood pressure was soaring. The nurse had to take it three times to get a level; each time it was different. I was so hot with fever that my face was flushed, and my ears were beet red.

As directed by the oncologist on call, I advised the admitting desk that I needed to be seen as soon as possible as my febrile neutropenia was a medical emergency. A nurse who knew little about chemotherapy complications assessed me within a half hour of arriving.

They got this part of the chemo emergency protocol right--I was put in an isolated examining room 15 minutes after intake. The other critical assessment component with chemo patients, fever, and infection is that they are to be seen by a doctor within ½ to one-hour maximum after arriving at the Emergency department. We waited two hours for the doctor to do their initial diagnosis and start anti-biotics treatment.

Blood and urinalysis tests were taken, blood cultures were drawn, and my throat was swabbed. I was given oral antibiotics and Tylenol to address the infection and fever. The test results were supposed to be available within an hour; we waited over two hours.

When the results did come back, they confirmed an infection. I was given a prescription that could be filled the next morning. The complete visit took 4.5 hours. This was better than the 11 hours we had waited with an earlier episode of febrile neutropenia a few weeks ago at the treatment hospital.

The next morning, my husband dropped off the anti-biotic prescription at the drug store. An alert pharmacist flagged a drug interaction problem with the prescription because of other cancer and chemo complication medications I have been using. The prescription could not be filled until contact was made with the prescribing doctor.

The pharmacy had faxed the doctor the info at 8:30 a.m. Not hearing back from the pharmacy by late morning, I called to see if the doctor had responded to the prescription issue. They had not, so I asked my oncologist to contact the pharmacy to ensure I got the required medication. The oncologist resolved the issue with the pharmacy by early afternoon, and the prescription was dispensed.

After the prescription was settled, I was finally able to have another dosage of anti-biotics at 3:00 p.m. It was 19 hours since the previous dosage, a scary scenario with low white blood cell counts and a confirmed infection.

I find this drug interaction incident particularly disturbing. I had thoroughly briefed the ER doctor about the anti-biotic medications I have been on previously, so that they could be familiar with my history before issuing the prescription. They also had a computer printout of all of the medications I have been on since treatments started.

This mix-up leads me to assume that the medications history was not thoroughly read by the doctor before the problematic prescription was issued. It makes me wonder if I’ll go back to this Emergency ward in the future.


Bump on Bump

An hour after I took the anti-biotics yesterday, another hell had started. Severe pain side effects were creeping in because of the chemotherapy and blood booster drugs I am on. Generally, I have a high threshold for pain (I had two natural childbirths without drugs), but had to resort to taking a potent painkiller to get relief.

The Taxotere chemotherapy concoction I’m on can cause muscle and joint pain a few days after treatment. The pain lasts four to seven days. As well, the blood booster medication I am using can create bone pain when white blood cell counts start to elevate in the bone marrow. For most people, the bone pain usually occurs in the lower back or hips.

By 8:00 last night, the pain from both drugs had escalated. My tibias had intense pulsating pain. The Achhilles Tendons in both legs were throbbing. My left kneecap was aching, and the top of my foot around the toes was tender to touch. The pain in my hips made me restless, making it difficult to find a comfortable resting position.

The compounding effect of the pain from all of these areas made it difficult to walk. To relieve the symptoms until I could take another painkiller in an hour, we decided that a hot bath might help.

In our house, the trip from the couch to the bathtub is less than 30 feet. The pressure to walk from all of the pain made the trip excruciatingly difficult. I could not bear weight on my feet because of the sore Achilles tendons and could not stand tall because of bone pain. To walk, I had to use both walls in the hallway to support me as I shuffled to the bathroom. Tears of pain washed my face. It has been a long time since I felt this kind of pain.

I was able to take a double dose of painkillers after the bath. Sixty minutes after the searing pain incident, the painkillers started working, and all was well.

The pain side effects will lessen in a few days as I move farther away from the last treatment date. In all, I have 10 more days of potential side effects with low blood counts from this Taxotere treatment. After November 23, I should be past the dangerous period of being infection prone. My life and health should slowly start to get better.

In the meantime, I am vigilantly watching for any potential side effects. The end of chemo treatment counts down one day at a time. I continue to fight my battle with breast cancer with Strength, Courage, and Determination.