Tag Archives: Chemotherapy side effects

Doctors as Detectives

During my prolonged treatment and recovery from acute myeloid leukemia, I spent many weeks in the hospital with a severely suppressed immune system as a side effect of chemotherapy. This condition is an open invitation to any infectious agents who happen to be in the neighborhood, and I had my share of them.  They included colitis, E-coli, the cytomegalovirus, and several others that were never definitively identified.

I was also on numerous medications, including prophylactic antibiotic, anti-viral, anti-fungal, and anti-rejection drugs as well as other drugs to blunt the side effects of these initial medications.  These drugs nonetheless produced some nasty side effects on their own or in interaction with each other.

The upshot was that on any given day, I would experience symptoms that included fevers, headaches, intestinal indignities, rashes, blurred vision, light-headedness, muscle aches, bone pain, and even persistent hiccups. It was on these occasions that I became acquainted with one of my now-favorite medical specialties known as infectious disease doctors.

I’d only known them as heroic figures in melodramatic movies about plagues threatening all humanity.  But on a more mundane and realistic level, they were also everyday heroes who often provided me relief from a myriad of infections and side-effects.

Their visits would be prompted by my report of unpleasant symptoms or obvious signs like spiking fevers. They would then begin looking for clues like detectives on the trail of a suspect.  They would consider all the medications I was taking as well as their doses and scheduling.  They would listen carefully to my recitation of symptoms. They would prioritize which medications were necessary and which could be eliminated or replaced with others. And they would order blood work, stool samples and other tests to nail down the culprits.

It would often take several days to grow and identify infectious critters in the lab, and sometimes a definitive diagnosis remained elusive.  Even so, their experience, their listening skills, and their hunches often led to solutions that relieved not only my symptoms but their underlying causes.

While it was unpleasant to weather so many infections and side-effects, I came to welcome visits from these doctor/detectives who so often cracked the case, identified the villain, and brought me relief so I could focus on healing and recovery.

Steve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his memoir from Written Dream Publishing.

Facing Chemotherapy 3: Your Own Worst Enemy

Chemotherapy kills fast growing cells and hence can be effective against cancer.  But it does not discriminate between healthy and malignant cells.  Hence, the trade-off for killing cancer cells is killing fast-growing, healthy cells as well.

The most serious side effect may be chemotherapy’s impact on the immune system. It drives down white and red blood cell counts as well as platelets. Low platelets can lead to unusual bleeding and low red blood cell counts can bring fatigue. Perhaps most important, low white blood cell counts leave us vulnerable to infectious agents we might normally resist and never even notice.

To counter this heightened susceptibility to infection, patients receiving chemotherapy must take various precautions to minimize their exposure to infection. Wearing masks, washing hands, limiting contacts, and even isolation rooms are just some of the precautions that patients routinely take.

As important as these practices are, they rest on the premise that infections arise from external sources.  This was how I interpreted an E-coli infection I acquired several weeks after receiving induction chemotherapy for my leukemia. I blamed the hospital environment for my misfortune until my doctors offered an even more plausible explanation.

Much to my surprise, most of us have E-coli bacteria peacefully residing in our gut throughout our lifetimes.  With a healthy immune system, these bacteria are well controlled and produce no troublesome symptoms. It is only when we are immunosuppressed that these bacteria can morph into major infections requiring aggressive, antibiotic treatment.

The same dynamic played out after my transplant.  I was given anti-rejection medication to allow my transplanted stem cells to take root and construct a new immune system.  This also caused immunosuppression and opened the door to another critter known as the cytomegalovirus. It is a common virus that resides in many of us but is usually well controlled by a healthy immune system.  When that system is compromised by anti-rejection medication, the virus can break out and require proactive treatment with anti-viral medication.

My encounter with E-coli taught me to never scoff at adult diapers again.  But more importantly, I learned that for all our well-intentioned efforts to minimize exposure to external agents of infection, sometimes we turn out to be our own worst enemy as “auto-infections” arise from deep within us.

 

Steve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his memoir from Written Dream Publishing.

Facing Chemotherapy 2:Wait for it

When I received my first round of chemotherapy, I anticipated some nasty side effects.  What I didn’t realize, however, is that they take a while to show up. This led to a false sense of confidence about how well I was weathering my treatment.

My stereotype about side effects was evident in a question to my nurse as I was about to receive my first chemo infusion. I asked if I couldn’t get to the bathroom on time, where do I throw up? She smiled and said that was unlikely due to the premeds they used to control nausea.  What she didn’t say is that such side effects would take some time to appear. When I still felt fine a week after my treatment concluded, I got a bit cocky and smugly thought “I’ve got this.”

It was another few days before the expected effects appeared: depressed blood cell and platelet counts, nausea, fatigue, hair loss, several unidentified infections, colitis, an E-coli infection, and a full body rash. My smug confidence was replaced by a humbling awareness that I was every bit as vulnerable as I first thought; it just took a little longer than I expected. While the timing surprised me, my doctors just nodded as if to say this is what we expected all along.

A couple months later, I received multiple infusions of high dose, consolidation chemotherapy to keep me in remission until I could have my transplant. Perhaps because of the higher dose, it took only one week for a low-grade fever to appear. More disconcerting was some rectal bleeding that convinced me to head to the emergency room.  There, my white blood cell count registered .3 (normal = 3.8-11) and my platelet count was 4 (normal = 140-450).  The ER doctor simply said “there’s nothing there” to fight infection or control bleeding. He booked me for a week-long hospital stay and multiple platelet transfusions to control the bleeding.

I consoled myself by thinking that with this response, they must have given me top shelf chemo that would also be effective in bridging me to transplant. But I learned never to be smug about these matters again.  When facing chemotherapy’s side-effects, don’t celebrate early.  Instead, just wait for it and weather it as best you can.

 

steve bSteve Buechler is a recently retired sociology professor and cancer survivor.  In 2016, he was diagnosed with acute myeloid leukemia and successfully treated with chemotherapy, radiation, and a stem cell transplant. He has since become a big advocate of writing stories as a survival strategy in the face of life-threatening illness.  His own story is available in “How Steve Became Ralph: A Cancer/Stem Cell Odyssey (with Jokes),” his memoir from Written Dream Publishing.