Every good story has to have certain elements.  An interesting cast of characters, a plot line with ups and downs. Challenges and resolutions to those challenges.  Setbacks and triumphs.  Perseverance and resilience. 

I guess if I had simply sailed through six chemo treatments with absolutely no problems, it would have made for a boring story.  A successful one, but boring.  The combination of nutritional ketosis and therapeutic fasting around treatments has been powerfully effective in keeping me protected from side effects and has hopefully potentiated the chemo’s effectiveness.  But the Week 2 effects of the medications are still there, as the chemo drugs percolate away in my system.  Hair loss and bone marrow suppression are the main ones.  Hair loss has been almost total, although I still have some stubborn hair follicles on my head, producing a light fuzz of white hairs.  I have a grand total of 9 eyelashes left – I counted last night… 

The cold that I blogged about earlier this week turned out to be more than a cold.  I had gone back to work 8 days after my Cycle 5 chemo treatment, per my usual pattern.  That was last Friday.  Cold symptoms started on Sunday morning, and I visited Emerg with a triggering fever of over 38.0 on Sunday evening.  Monday morning, I still had moderate cold symptoms, but I was feeling well enough to entertain a friend for morning coffee, then head into town to run errands and pick up my prescription for the three antibiotics I had been ordered.  That’s when I got the call from work that they had just found out that they had Influenza A in one wing.  There was no inkling on Friday – it was just a normal work day…  I had been up on that wing, but not in contact with the afflicted residents.  However, there niggled in the back of my mind that, perhaps, what I had was not just a cold…

Influenza A is a serious viral infection.  It’s the one that we take the flu shot to prevent.  It’s a constantly mutating virus, so a moving target to try and prevent.  It usually hits people like a truck, sending them to their beds for days with body aches and severe upper respiratory symptoms.  Usually for a week or so. 

From https://www.ontario.ca/page/flu-facts

“Complications from the flu can include serious conditions, like pneumonia or heart attacks and, in some cases, death. Flu causes about 12,200 hospitalizations and 3,500 deaths in Canada each year.”

In long term care, where I work, it’s considered the most serious of the respiratory outbreaks.  And crazy contagious, able to live on surfaces up to 24 hours.  Infection control swings into high gear when an outbreak is identified. So just being on the wing with the outbreak, even before symptoms were identified, was probably enough for me to pick up the virus, simply from the stairwell code buttons or a doorknob.  And with my immune-compromised status, I was wide open for business…

On Tuesday, I woke up with more cold symptoms and made the wise decision to not go to work.  As the day wore on, I was feeling progressively worse and my fever started to slowly climb again – at first low-grade 37.4-37.8, but by supper, I was again hitting over 38.0, the fever card cutoff, so we headed back into Emerg.  This time, I made it clear to the triage nurse that I had potential exposure to Influenza A, and I was immediately ushered to a back hall to wait, away from the crowded waiting area.  Again a full round of blood tests, xrays and swabs.  My immune cells were down even from 2 days prior, so I was admitted to hospital for IV antibiotics. 

I woke the next morning, in my private isolation room, to a fully PPE-garbed nurse telling me that my nasopharyngeal swab had come back positive for Influenza A.  So it wasn’t just a cold… There I was, an infectious Typhoid Mary, isolated to my room in the middle of the new baby ward…

Luckily my fever came down and stayed down.  I was given IV antibiotics every 6 hours, but was allowed to be disconnected from the IV pole in between.  I had no energy for anything much except coughing, sneezing, blowing my nose and napping.  I went through a full Kleenex box that I had brought in with me (do you know how abysmally bad the institutional tissues are???) in about 16 hours – that’s 126 noseblows!

I have had blood drawn 4 times in the past 5 days and it has been fascinating (and concerning) to watch the daily plummet of my values as the nadir (lowest point) approaches.  My neutrophils were at 1.1 on Sunday evening, 0.6 by Tuesday evening, 0.4 on Wed morning and 0.2 on Thursday morning.  Hemoglobin (measuring the oxygen carrying capacity of my blood cells) fell to a low of 86, way below the cancer centre’s cutoff level.  Platelets (my clotting factor) are also way low, dropping with every test.  It’s a clear picture of the impact of the chemo drugs during week 2. 

It’s very interesting to go through a significant infection without a fully functioning immune system.  Much of what we consider to be the effects of the virus or bacteria are actually the effects of our immune system switching into full-on assault mode.  Fever, chills, muscle aches, nasal congestion and discharge, coughing, sneezing – all are immune system side effects as the body’s defenses work hard to kill off the invading organisms.  So, having a compromised immune system actually means less of these symptoms and an “easier” course, but this is not necessarily a good thing.  The bugs themselves can run amok and cause more serious illness, even death.  Medications become a more important adjunct treatment in this situation.

My own course of Influenza A infection has been lighter than usual because of this dampened immune response.  I had two days of mild throat irritation and post-nasal congestion, but no sudden onset body aches and fever like normal.  And now, on Day 6, I’m pretty much symptom free.  That’s pretty amazing, but entirely due to the high level of medical and drug intervention.  I can’t take personal credit for any of it.  I have gone from taking zero pills per day, to currently taking 17 pills per day!  Wow! 

There’s a chance that my next chemo might be delayed by a week, if my labs don’t improve enough, or if the London folks think that I need another week to recover…

I am so thankful for the excellent health care at my local hospital and the loving care of my family and friends who supported me through this setback.  I am also thankful that my workplace takes infection control so seriously to protect their residents, their staff and me. I know that some people spend most of the course of their chemotherapy feeling poorly and I have been extraordinarily fortunate that most of the time I feel great.  But this setback has given me a glimpse of just how toxic chemo is and again reinforces the power of my nutritional interventions in supporting my body through this time.