What fresh hell is this?

Day 83 

General status update: today it’s all about my nose…

Nose: see below

  

In a new, painful and truly humiliating development, MY NOSE IS FULL OF COLD SORES.

Ah, FEC, the gift that keeps on giving and giving and giving...

A strange 'blister in the nose' has blossomed overnight into a cascade of cold sores descending from well inside my right nostril down to the edge of my nose. I had absolutely no idea that it was even POSSIBLE to get cold sores in your nose. I must say I don't like developing new side effects at this stage one little bit. I feel I've paid my dues with the frigging side effects, what with being the 2013 FEC All England Extreme Nausea Champion, not to mention the 74 days of suffering before getting relief for my Toxic Swamp Stomach. But no, now we're getting the Free Bonus side effects - lovely.

This is probably my punishment for still having hair and eyebrows, which is manifestly unfair on all the other girls - just to even things out, the Chemo Gods have sent the Fecking FEC Fairy to wave her magic wand over my nose...

I’ve got mouth ulcers, too, and a touch of cystitis, so I’m well on the way to ticking every box in my I-Spy Book of FEC Side Effects – I think you have to have experienced all of them to get your special badge at the end of chemotherapy. Now. I’m just waiting now for the conjunctivitis to strike, and then I'll have the full set..

As if this weren’t enough, we’re now getting to the really exciting part of the chemo cycle again, the ‘nadir’: the point when white blood cell counts are at their lowest after a chemotherapy treatment, the patient is significantly immuno-compromised, and there is a high risk of contracting an infection. As regular readers will remember, this is the point at which I acquired a respiratory virus a month ago, became neutropenic, and was forced to delay my fourth dose of chemo for a week.

My oncologist was concerned that this shouldn’t happen again, so last week after FEC4 I was given an injection of something called Pegfilgrastim, which Wikipedia defines as: 

‘a long-acting colony-stimulating factor produced by recombinant technology and used as an adjunct in patients with bone marrow suppression caused by antineoplastic therapy.’

This is, even now, stimulating my bone marrow to produce more neutrophils to fight infection, and the reason I’m mentioning it again is that I’ve just found out how much it costs the NHS for one injection: £714.24, to be precise. I was astonished at this, but R explained that the cost is so high because the stuff is a freshly cultured biotechnological product (made from E.coli, I seem to remember) rather than just a cheap chemical.

It gives one pause for thought, though, the cost of that injection: that’s a lot of money to throw at strengthening one person’s immune system for a week or two. It’s a demonstration of just how dangerous chemotherapy is, just how vulnerable it makes you to life-threatening infections, that the NHS is prepared to shell out that much money, without blinking, to keep me safe while the chemo drugs have wiped out my immune system.  The costs that it avoids are those of admitting you to hospital for a week or two if you do get an infection, and this is very common: today I was looking at the section of the Breast Cancer Care UK forums for people who started chemotherapy last month, in February, and saw that they have been dropping like flies, with a number  of the group already in hospital with infections. This is a very infectious time of the year.

I’m not someone who needs reminding of the danger of chemo, of course, given that my former husband died at the age of 32 from a lung infection after aggressive chemotherapy for leukaemia, but it just occurred to me that it would be interesting to check out how many chemo-related deaths there are these days.  Googling it, I found that hard data are difficult to come by, but I’ve just down-loaded what looks like a fascinating report, published in 2008, by NCEPOD – the National Confidential Enquiry Into Patient Outcome and Death – into chemo-related mortality.

Ploughing through that will keep me usefully occupied over the next few days, while I try to avoid all sources of infection, and fret anxiously in case one is incubating already. I’ll report back with the highlights in due course….