One of the problems with leukaemia is being neutropenic, this means not having the white cells that fight infection. The disease causes this as does the chemotherapy used to treat it.
In the aftermath of each cycle of treatment there is a period of two to three weeks waiting for the white cells to reappear. During this time I am very vulnerable to infections. This is even more true after transplant. The consultants say that everyone gets infections during this time. I've done my best to confound them but have failed completely.
The latest episode was earlier this week. In my experience they come on very quickly, sometimes over the course of a few minutes, sometimes over an hour or so. The absence of a proper immune system means the body doesn't react very much to infections so they can sneak up on you without you realising. However the one thing that can be counted on is a rise in temperature and this is what I experience. A rise to 38C is a called a "spike" and triggers a rapid series of reactions and responses.
For me that usually means rigors which are truly horrible to experience, violent shivering and shaking of my whole body and teeth chattering uncontrollably. Feeling hot and cold and headaches are an unwelcome accompaniment. Racing pulse and sometimes a drop in blood pressure occur as well. It feels like suddenly being dragged into a maelstrom.
Luckily the ward staff know exactly what to do and are absolutely brilliant. Lots of samples are taken to look for infection, the doctor is called, two different antibiotics are started immediately, paracetamol is given sometimes orally, sometimes IV. Cruelly they strip the covers off the bed and switch on a fan. All this happens very quickly, usually within an hour or so. After that it's watch and wait a little with frequent monitoring of BP, pulse and temperature etc. Mostly things start to improve within the next hour especially the rigors. This time it took most of the night and several visits from the doctor. This left me very tired and feeling very rough. My BP refused to come back up till the following evening despises gallons of IV fluids but eventually it all settled down and I'm now back to "normal".
(It turned out later that this was septicaemia, an infection living and multiplying in the blood stream. Luckily I was put on the correct antibiotics immediately.)
In about seven to fourteen days I should start to see the return of white blood cells and then the risk of "spikes" drops away very rapidly thank goodness. When I'm in the middle of a spike it seems like hell, it is hell, but when it's over it seems a small price to pay for having a good chance of surviving leukaemia.
* Elvis Costello - "Spike" 1989 album
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