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Febrile Neutropenia (What is that tune?)  

Febrile Neutropenia (1) May 2006

Well, I have had an exciting hands-on experiential guide to just why the different chemotherapy guides & advisory leaflets have BIG BOLD BLACK WARNINGS about coming in to the hospital if I run a temperature:
Febrile Neutropenia
Bloods 27/5/06 Na 135, K 3.2, Cr 95, U 4.1, Hb 86, Plt 268, WCC 4.2, Neut 2.3
MSU + throat swab - 0 growth, blood culture pending

xx yo F who had a recent L mastectomy & commenced chemotherapy 12/7 ago (12/5/06) presented with 2/7 Hx, non-productive cough, lethargy, sinus congestion + 1/7 Hx fever. Her bloods revealed febrile neutropenia & she was commenced on IV fluids + IV Gentomycin + Cafeprime(sp?). Her blood profile responded and after 3 days of IV AB was changed to oral Augmentin Duo Forte + Ciprofloxacin. She has remained afebrile for 3 days.

    (1) F/U Bloods - Thursday 1st June, 2006
    (2) HOAC - Friday 2nd June, 2006
      continue chemo

    (3) Oral Augmentin Duo Forte + Ciprofloxacin for 4/7

After coming down with a standard change-of-season cold from running around moving house, furnishing flat, etc, I tried to take care of it in the usual way, but more carefully than usual, with rest, warmth, fluids, garlic, vitamins, etc. Didn't work, temperature ended up between 39.2C and 39.8C — well over the 38C where I head for the hospital — and being taken into the Emergency Department after midnight Wednesday (Thursday, ~1am), I thought I would only be there for 24 hours to bring down & stabilize my temperature.
Well, I now know they need you to be between about 36.5C and 37C (afebrile) for 24 hours, so that was already a poor hope, but after about 18 hours in ED (aka A & E, for Accident & Emergency; luckily not very close to Bringing in the Dead, which I'd only seen recently), they could only really get stuck into treatment once I was in my little isolation box, back up again on the 8th floor.

In fact, there was not much treatment available because it's a virus infection and, from the cultures (throat swab, urine & blood samples), hadn't any bacterial superinfections. That is one main thing they're worried about because of the supressed immune system; once you get something that brings you down a bit, it's very easy for whatever opportunistic bacteria are around to leap on board and start making gravy. So they kept me on a drip, pumped full of a variety of antibiotics to stop anything getting ideas above its station, but also, warm, well fed, with a constant drip-fed supply of fluid, glucose & electrolytes, which was pretty much all they could do to support me through the viral cycle, and that took about 3/4 days. Bit of a shock to everyone, scotching various plans. It was also a shock to me to hear that I'd actually passed out for a minute or so in the waiting room; not fainted, which I remember doing in hospital after a previous operation — like grey flowers blooming across my field of vision, then darkening — but going stiff instead of limp. I have a complete blank there, just remember feeling sick & giddy & one small "blurt" of vomit, which according to witnesses happened just after the seizure. Probably fairly important in getting a quick admission, but not something I'd like to try again.

Meanwhile, one courageous friend had gone into the flat with bags, tongs & a facemask to deal with the perishables. Having moved in on Saturday night and started feeling the cold coming on Monday evening, shopping for a bar-fridge, tho of highest priority, was not completed. I'd been getting little cartons of milk, to be used over a couple of days (it is chilling down to winter), small quantities of fruit & vegetables, smallgoods, etc. It was very comforting to not have to face the lettuce & spring onions trying to break out of the cupboard, or the remains of the milk & sliced ham waging biological warfare. Alas, the other soup vegies & smoked hock, ready for the second saucepan of soup also departed along with the remains of the cheese & the utterly untouched formerly-fresh loaf of bread, now a fungus jungle. Knowing this, I was strong enough to pick up milk & bread on the way back from hospital, but didn't have enough funds (took minimum to hospital) to add more. At least I had the tinned baked bean supply & usable margarine. Am seeing if I can make an edible pumpkin soup with onions, dried mixed herbs & barley, but no meat, greens or other aromatic vegetables.

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