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.
As of yesterday, what I can now say about Chemotherapy is: “been there, done that.” Chemo is officially over.
I have waited 20 weeks for the day that my chemotherapy treatments would be finished. That day was yesterday, Monday, November 8. It was another milestone for me on this cancer journey to wellness.
The treatments should have ended two weeks ago, but I had two one-week treatment postponements along the way due to low blood counts.
I am so glad that this major phase, the second pillar of four in my cancer treatment plan, is done. The relief in being finished with chemo has lifted a heavy burden from my family and me. It was far more difficult than I had ever expected with all of the medical issues that arose with treatments.
Its now healing time to let the last of the Taxotere flush out of my body over the next six weeks to prepare me for my third phase of treatment. Phase three will be 16 rounds of daily radiation, which will likely start at the top of Christmas week.
Hopefully, this final chemo treatment and recovery will have fewer complications than last month.
Preparatory Steps to Get Me Through the Final Chemo Round
My doctor, oncology nurse, and chemo treatment nurses all rallied together to prepare me to be physically, mentally, and emotionally strong and healthy for the last round of chemo. Their mutual goal was to try to offset the potential for serious complications as experienced with the other two cycles of Taxotere.
As hard as it has been, the doctor’s recommendation for house-imposed isolation three weeks ago seems to be working to keep me well. Since the isolation, I have not acquired any other infections. I have not had visitors, have not been out in public (except for medical appointments with medical masks and surgical gloves to avoid germ contact), nor have I been in contact with people who could potentially transmit viruses and bacteria, placing me at risk to get sick and unable to fight off the illness due to low blood counts.
As a precaution, we are maintaining the isolation for three more weeks until this last treatment cycle is over.
After starting a new drug early last week after chemo was postponed due to the lingering Thrush infection, the condition finally cleared on the weekend. I had peace of mind going into the treatment without a throat infection. As an added benefit, my body had an extra week to further increase its white cell blood counts to make me stronger and better able to handle the treatment.
I will be on an extended cycle of blood cell boosters after this chemo for 10 days instead of the seven days that has been previously prescribed since the first cycle of chemo. The increase in the dosage from the second cycle has been repeated for this last series of injections.
Generally, most chemo patients don’t need the blood booster injections after the final round of treatment. However, my history of low blood counts and multiple infections (some with fever) despite blood boosters warranted an extra post treatment series of blood booster injections.
With this cycle of blood booster shots, I will start them a day earlier on Day three, which is five days before blood counts expect to dip on Day eight. I will have two extra days added to this month’s injection cycle, which will take me through the period when blood counts are the lowest (up to 15 days after the treatment). This is an insurance step to make sure that my body is stronger to heal better after the final chemo, so that I am in a healthier state to start radiation treatments.
The Final Chemo Day
With all of these pre-treatment precautions, my anxiety levels about the last infusion were lessened by the time I got to the chemo appointment. My medical team and I are hoping that all of the precautionary measures taken will have placed me in a better position to get through the final Taxotere infusion.
As has been the course of this up and down journey, the final round of chemo did not come smoothly. The past two times that I needed to have blood drawn to get my blood levels before chemo, saw my central port fail to work. The chemo nurses diligently tried to get the line working with blood thinner flushes, but to no avail. My blood had to be drawn the traditional way through my arm.
The last chemo treatment I had posed a difficulty to get the port working, but somehow with a lot of manipulation it did co-operate. That was the last time it worked. Consequently, because of the malfunction of the port in the last two blood tests, yesterday’s last chemo treatment was done intravenously through my left arm.
I am scheduled as a priority patient to get the port out as soon as possible, as its no longer needed and can continue to pose a risk for blood clots. Because of the history of a blood clot with the port and other blockages, I will remain on daily blood thinner injections until the end of January, six months after it was installed to ensure that there are no more clotting problems.
Yesterday’s Taxotere infusion threw in some new subtle symptoms with treatment.
The preparatory steroids I took a day and a half ahead of time made me so wired that I did not sleep at all the night before. I finally crashed with exhaustion chills about 40 hours later after 9:00 p.m. last night.
Another possible small side effect with steroids is the potential for an allergic reaction with facial flushing. Off and on during the day, I looked like I was blushing with embarrassment until the level of the steroids finally passed through my system.
Today is Day two of the treatment cycle. So far I am feeling well, but tired from the steroid crash. Typically, I will start to feel the effects of chemo on Day three as this drug has a delayed slow-release action over a number of days. The worst of the symptoms typically will run about 10-14 days starting in the next day or two. By the third week of the cycle, I generally will feel better; have increased energy, and a returning appetite.
I am much calmer today, now that the chemo treatments are completed. I continue to travel further along this road of cancer recovery with Strength, Courage, and Determination.