“Dropping off the cliff”

So last night I officially “dropped off the (chemo) cliff” and caught an infection for the first time. I’m writing this post 5 floors up at St James’ Hospital, Leeds in the Bexley Wing, J95 Assessment Unit. 

    

I’ve mentioned in previous posts the impact chemotherapy has on your immune system. This is due to the chemo drug killing all fast growing cells, including both bad cancer ones and good healthy ones. It also kills white blood cells which fight infection. Neutrophils (a type of white blood cell) in particular lead the immune systems response to infection. If your neutrophil count drops below 1,500 neutrophils per microlitre you’re at a greatest risk of infection. A very low count can be life-threatening. So it’s no wonder that the talk on the Oncology Assessment Unit is all about neutrophils!

Oncology Assessment Unit

Before you start chemotherapy you are given a card with two important ‘hot line’ numbers: one is to call “in hours”, Mon-Fri 9-5 and one is to call “out of hours” which is basically any other time outside! You are advised to call if you start to feel unwell or if you’re seeking general advice. You are also advised to regularly check your temperature throughout your chemo treatment and to take a baseline reading before you start. My baseline is 35 and you’ll see from my chemo diary that it’s been fluctuating between 35-36.8. The protocol is that if it is 37 degrees or over you need to call the number and then go in to the Assessment Unit as it could be a sign you’re getting an infection. 38 is classed as a fever in an adult but at 37 they’d rather not take the risk that it’s going up.

The Oncology Assessment Unit are a 24/7 unit whose aim it is to see, assess, triage (if needs be) and treat patients who are ill from either cancer or cancer-related treatments. They have quite strict waiting time and quality targets in place: 4hr A&E waiting time, reviewed/triaged in 30 mins and commence antibiotics in 60 mins. They also have an Acute Admissions Ward for any patients that require a longer period of monitoring.

So far during my treatment I have called the ‘hot line’ three times:

1. When my sutures started to protrude from mastectomy scarline 5 days after my first round of chemo. Outcome – 45 min telephone consultation and follow up assessment in the breast unit.
2. When my teeth started to go black 12 days after my first round of chemo 😳. Outcome – attendance at the Assessment Unit. Bloods taken. No gum infection. Conclusion – aggressive mouthwash + EC chemo drug = discolouration of teeth! My dentist removed the following day and I was advised to lay off the mouthwash.
3. Last night after I had a reading of 38.4 on my thermometer and after I’d been feeling fluey for a few days. Outcome – instant admission to the ward for monitoring, IV antibiotics, blood tests, chest X-rays etc. My neutrophils were 1,360 per microlitre ☹️.

The cliff

“Dropping off the cliff” is term used to describe the period 7-10 days following chemotherapy when your immune system is at its weakest and most vulnerable to infection. After the 10 day period your immune system should start to strengthen, but it won’t fully recuperate in the 21 days you have until your next round of chemo. The result of this will be that your immune system is likely to gradually weaken after each round because you’re starting each round from a lower benchmark.

My child-like (🤣) drawing below crudely demonstrates the weakness (or drop) of the immune system following chemo 1 and where it is on entering chemo 2.

24hrs later…?

I’m feeling much better 😁

• I’ve had 3 rounds of IV antibiotics, 
• my temperature has returned to the normal 35 degrees,
• I’m fully hydrated, 
• my blood pressure is spot on,
• I’ve eaten a twister 😜
• my kidneys and liver are functioning, 
• my chest is clear, 
• my iron count is grand, 
• my legs are not swollen, 
• AND my neutrophils are on the up 👍

Have I had amazing care again at St James’ Hospital? Absolutely. Do I want to go through this rigmarole every time I have chemo? Absolutely NOT! Let’s see 🤞.

Liz Spice, 21st September 2017