After each session of chemotherapy, we are itching to bring Mason home. Finally, back to some normality, fresh air, his own bed, toys, and freedom to run around the garden. The first couple of days are always a relief, for us, it's just a chance to all be back together as a family, and for Mason, to be disconnected from his lines and able to roam around burning off his energy!
During our introduction to his treatment plan, we were cautioned that the week or two that followed each session were very important for us as parents, to monitor how he copes and whether his temperature spikes as a result. If his temperature pops above 38dC it is a sign that he is becoming neutropenic.
That's a new word, what does 'neutropenic' mean??... it's not as if anyone skipped a day off school with it?
Essentially, the chemotherapy Mason is having can reduce the number of blood cells made by his bone marrow. His main white blood cells that fight infection are called neutrophils. When they are low, he is neutropenic, basically has no immune system, and is highly susceptible to infection. This means that picking something up like the common cold (Rhinovirus) could be very uncomfortable and sepsis would be critical. It appears to be very common amongst other paediatric oncology patients.
MacMillian link Resistance to infection is usually lowest 7 to 14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due. Developing an infection when you have a low number of white blood cells can sometimes be a serious complication of chemotherapy. Your doctor may prescribe you antibiotics and other medicines to take during chemotherapy to prevent an infection. These are called prophylactic drugs. Or you may have injections called G-CSF to encourage your bone marrow make more white cells. [Macmillian, 2021]
We saw Mason gradually becoming weaker throughout the week up to the sixth day, this is when his temperature would spike, and upon waking in the morning he was clearly struggling, unable to stand, shaking, and looking like he’s finding it hard to focus his vision. Ring ring….Rainbow ward, yes Mason's temp is up and we’re seeing some symptoms…..okay bring him in!
This is the point at which you’ll thank yourself for pre-packing your bags and car with everything needed for another four-day hospital visit, fresh clothes, bedding, food for Mase, and snacks for us. Upon reaching the ward we’re shown to a room and because of these times of covid we must isolate together until Covid results return, this should take less than 24hrs. Little man is linked up to his lines again and issued a course of IV antibiotics with close attention from the specialists.
Mason became neutropenic after each of his first four rounds of chemo, each, was always on the sixth day. From a parent’s perspective, we always planned to revisit the ward for these – hoping we wouldn’t need to as these trips were equally as taxing on all of us as the chemo treatment itself.
The positive thing to focus on here was each time we ventured back to the ward for support, we would leave 4 days later with the antibiotics having successfully worked and Mason's immune system starting to build back up again. We could confidently look forward to having the next weekend free before thinking about the following round of chemo the weekend after.
We’ve included a brief link above from MacMillian as an overview of this side effect which is one of the first places we looked, and a link below to a video that was recently uploaded from Kurzgesagt which gives an awesome snapshot of the immune system and touched on Neutrophils and their role a little at the beginning.
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