Thursday, 12 July 2012

Can I see your bum?

I'd been home for nearly a week after my first IVE chemotherapy when I needed to go for my first check-up for this round of treatment.  It went fine really, as I didn't have that much to say beyond mentioning I'd had some of the expected/typical side effects: tired, out-of-breath, nauseous and loss of appetite/weight.  The only additional things that were a bit unusual for me were that I had been itching quite a bit, and I had a bunch of marks/discolourations on my skin, which for the most part were on the edges of where the various sticky dressings and sensors had been.  I asked whether the itching was a slight allergic reaction to those sticky dressings and sensors, which had perhaps been made worse by scratching, and the doctor said it was a possibility, but the itching could have actually been a side effect of the Allopurinol I'd been prescribed.

As expected, the blood test performed upon arrival at the check-up showed that the chemotherapy had affected the levels of hemoglobin, white cells, platelets and neutrophils in my blood, as they were all low now (some more so than others).  I had already been prescribed injections for boosting my white cell count and neutrophils, but the doctor mentioned that given my platelets level it was worth arranging another check-up for a few days later just to make sure they don't drop too low, as it may be that I would need to have a platelets transfusion.  I also discussed with the doctor when I would be having the hickman line inserted, as all I knew was that it would be before my next session of the IVE chemotherapy; The doctor did try to find out the exact date and time, but was unable to do so there and then as the relevant person was otherwise engaged - I did find out that my next IVE chemotherapy may start a bit more than three weeks after the previous one though, as it may take me a few extra days to recover; the treatments that I'd had for my previous run-ins with Hodgkin's Lymphoma could mean I require that bit more recovery time (it makes sense that the treatments would take their toll).

I went home thinking that I'd be back in a few days to have another blood test, which would perhaps mean having a platelets transfusion, and that I'd then most likely find out when I would have the hickman line inserted too.  However, later that evening I started to feel a bit cold and tired, so I went and laid on the bed for a bit under a blanket, where I ended-up staying until it was time to call it a night, but when I then checked my temperature I found it was quite high: It was about 38.7°C, and if it goes over 38°C I'm supposed to contact the hospital.  It was quite late on now, so it took a bit of time to get in touch with someone at the hospital, but when I did I was asked to come in, as I'd likely picked-up some kind of infection, and would probably need to be on antibiotics for a few days so that I could recover.

After packing a few things and driving to the hospital it was about 1:30am when I was admitted to the ward, where a nurse tried to put a cannula in one arm, and a doctor tried to take a blood sample from the other (as I've mentioned before, my veins are not so good any more); The doctor had prescribed an antibiotic, which the nurse would inject via the cannula, and the blood sample was for sending off for analysis (presumably to identify the type of infection, just in case I needed a different antibiotic).  The doctor did ask whether I'd noticed any other symptoms, but the only one that came to mind was my teeth aching a bit when biting/chewing.  I also mentioned to another nurse that there was a small area at the top of my right leg (just below my bum) that was a bit tender and slightly pink/red, hence she wanted to have a look; After looking, she asked a colleague to look too, and decided to leave it for now and just keep an eye on it.

As it turns-out, hospitals are quite keen on regularly checking the pressure points of inpatients these days, just to make sure that they are not getting bed sores, so with your consent this means checking your heels, elbows and bum.  Fortunately, I get the feeling that a bit of common sense comes into though, as if they know that you're regularly walking around the hospital ward etc, then it's clear that you're unlikely to get bed sores, as you've not been laid in the same position for prolonged periods.  Unfortunately for me though I had this tender area at the top of my right leg, and that was close enough to a pressure area that it meant for the next week I was regularly flashing my bum to numerous nurses!  Some nurses came to have a look just out of curiosity, as the tender and pink/red area later turned into what looked like a pretty large and angry spot, which I have to say was quite uncomfy at times, but others were just doing their duty, so to speak.  I even had felt tip lines drawn around it later on to make sure it was getting better, so it ended-up looking a bit like a target.  I don't think it was ever decided what it actually was, as several things were suggested, but if it was a bite the last thing that I needed was a target drawing on me - Mosquitos are a pain in the ass (ba dum tish!) at the best of times; never mind when your immune system is compromised.

It may come as no surprise that the whole flashing of my bum thing became a bit of an ongoing joke with some of the nurses that I saw more regularly, which at least brightened-up the day for me (if not for them).  One nurse did say something along the lines of: "Can I see your bum? I know it's a pain, but it's procedure these days, so I need to cover my ass!".  In fact, it was that nurse that late one evening (when no-one else was around) was walking down the main ward corridor as I was walking the other way, so I just turned around and bent over - You'll be pleased to know that no flashing was necessary for it to get a laugh!  Bum jokes aside (well, nearly!), I did end-up on another antibiotic for whatever it was at the top of my right leg, as one of the doctors prescribed that after taking a look, and that did seem to do the trick, as in a day or two it thankfully started to get better.  I also ended-up on an air bed, instead of the usual hospital mattress, as they are supposed to help with bed sores; I did find the air bed a bit uncomfy and noisy at first, and I'm not really sure whether it helped or not, but either way after a few days I'd got used to it.

Getting back to the infection for which I was admitted, I simply stayed on the same intravenous antibiotics that I was originally prescribed for about a week, as the blood test showed that they should do the trick; The antibiotics were administered a few times a day, which only took about five minutes or so each time, but I was also given saline solution inbetween to ensure that I was well hydrated.  The first day I was on the antibiotics I felt a bit tired (perhaps due to the lack of sleep I got the night I was admitted) and nauseous, but the next day I was fine really, except for the typical and delightful side effect of diarrhea - That gradually got better as the week progressed though.  During that time, I did have a couple of platelet transfusions too, as the daily blood tests showed that they were getting really low, but other than that my stay was pretty uneventful - I'd say the worst part was probably coping with the boredom, but luckily for me the Teenage Cancer Trust recently opened a kind of mini-ward for teenagers and young adults, which is kitted-out with games consoles, laptops, a pool table, a juke box, big TVs with bluray players and several comfy chairs, so that helped keep me entertained a bit!

When I said my stay was pretty uneventful, I did kind of skip over one side effect of the chemotherapy that some people find really hard to cope with: Your hair falling out.  I have to say it doesn't bother me at all, as other than my eyelashes and eyebrows, I'd quite happily have no hair whatsoever; It's great not having to bother shaving!  Having said that, it is a bit of a pain when it first starts to fall out though, as it can end-up everywhere.  I first noticed it was falling out in the shower, as simply running my hand through it was enough for my hand to be covered; Fortunately my hair was short anyway, as after the previous treatments it had never really grown back properly (it was much thinner), so I had to keep it short to avoid it being noticeable.  After I got out of the shower, I just shaved off what was left, which was still quite a bit of it at this point, but it was no use prolonging the inevitable, and avoided me leaving a trail of hair everywhere.

I would have probably completed the antibiotics and been discharged after about five days, rather than a week, had it not been for needing to get a hickman line inserted.  Discharging me earlier would have meant me travelling back and forth between home and hospital a fair bit, as I needed more platelet transfusions shortly before the procedure, and the line redressing a day after the procedure - The other factor was that given my blood test results and that I'd been on antibiotics for an infection, it made sense to stay in that bit longer just so that I could be monitored more closely for any problems.  There did actually turn-out to be a slight hiccup the morning I was going for the hickman line to be inserted, as the platelet transfusions took maybe three times as long as normal, due to the cannula in my arm being on its last legs, so that meant I missed the transport to the nearby hospital where the procedure would take place.  However, in the end that proved to be a good thing for me, as I was taken there and back in an ambulance instead, and that meant rather than waiting for when the transport is scheduled, I could pretty much go when I was ready.

The insertion of the hickman line went fine, so a day afterwards (once it had been redressed) I was on my way home.  I did have an appointment for a few days later to get the line flushed, but other than that I just had to come back in about a week for the next session of the IVE chemotherapy.  I actually ended-up coming in a day early for the line flush, as it had been bleeding a bit, so needed redressing again, and because of the bleeding had another blood test, but the results were fine and everything else went to plan.  In case you're wondering, the line is supposed to be flushed when not in use for several days, as this prevents blood clotting in the line; The flush essentially just involves removing a bit fluid from the line, pushing through some saline solution, and finally inserting enough heparin into the line to prevent blood clotting within it - At the same time as the line is flushed, the connector(s) used to administer drugs etc are typically replaced too.

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