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Neutropenic, now cellulitis - HELP

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LRM216 View Drop Down
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    Posted: 14 May 2009 at 9:18am

I had my fist ac chemo 4/30 and one week later went for labs.  Labs were wbc 0.7 and rbc 69,000 - was told by onc that I was neutropenic and could not go to work for a couple of days until blood built back up (yes, had Neulasta shot day after chemo).  Later that night spiked fever of 101.5, fever went down by morning but "cancer" breast became hot and deep red.  (Had Lumpectomy on 3/25, rexcision for clean margins on 4/8).  Called onc and she saw me and had me admitted to hospital.  In hospital 4 days of iv vancomycin and mazapeem (sp?) around the clock.  Due to have 2nd chemo on 5/14 (today) but had to postpone.  Still have cellulitis but it's improving; and am on outpatient iv transfusions every morning for 10 days of Cubicin and on oral Cipro for 10 days. 2nd chemo was rescheduled for 5/21. 

Saw breast surgeon today and althout it's improving he will not allow me to have chemo until completely healed.  May be shortly, may take awhile.  He isn't sure as cellulitis can sometimes take a while to cure.
 
Has anyone had this problem or had to have their chemo put off indefinitely while something healed.  I am petrified as I am triple neg.  1.2 cm IDC, all clean margins and no node involvement.  He hasn't told me it would be a long time, but he did say he could not allow it until infection was gone completely and none of know when that might be.
 
Any advice to quell my fear over not being on schedule with my chemo?
 
Thanks for any input.
 
Linda 
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33
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Jessie View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jessie Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2009 at 10:38am
Linda,
 
I hate to hear you're fighting infection when you should be concentrating on chemo.  But I'm VERY glad your surgeon will be getting the infection cleared up before continuing with the chemo.
 
The second week after my mastectomies, I met the cellulitis monster.  A week in the hospital with IV antibiotics seemed to clear it up.  The next week I went for my first chemo treatment, running a low fever and feeling rough --- a blood test revealed that what the surgeon had identified as simple cellulitis was hiding its cause, a horrid bloodstream infection --- MRSA.  Hospitalized again, this time in isolation, I went into septic shock, heart attack, pneumonia.  Massive amts of vancomycin brought me back.  I survived but it took months to recover.  Three years later I still have some permanent minor issues caused by the MRSA damage.
 
I'm telling all this to say MAKE SURE YOU ARE TESTED FOR MRSA ASAP !!!!!!!   Don't assume you've been tested for it,  and don't take NO for an answer.  The antibiotics you are taking may be keeping it at bay like mine was, but they will not kill it and it will show up when you're finished with them.  Meanwhile you might have taken more chemo, lowering your immune system and making it even harder to survive the MRSA.  Surgeons don't like to talk about MRSA, but it happens in all hospitals and it's very often tragic.  PLEASE be tested for it.  If the test is negative, that's super ! Just blame it on your obsessive friend here.  Wink   But if it's positive, you and your drs need to know it NOW so treatment is begun.  And if it's positive, chemo will definitely take a back seat !
 
Please don't worry that your chemo treatments are getting interrupted or delayed because of infection.  Totally clearing up the infection is paramount at this point.  The risk of dying from a serious infection, once known, is greater than the risk of dying from cancer (even TN) because of not getting the chemo.  This fact was a shocker to me too, but now I want to shout it from the rooftops !!  Shocked  
 
I hope I've frightened you enough to call and get tested - a simple blood test.  I hope it's negative -- or better yet, you write me right back and say you've already BEEN tested !
 
Do all you can -- pamper yourself, rest, eat the healthy foods -- to recover from this infection.  Then you'll be facing the remainder of your chemo in the strongest way possible.
 
Hugs and more hugs,
Jessie          
IDC,Stage I,Grade 3,dx 4/06
dbl mast 5/06,
systemic MRSA post surgery
septic shock, heart attack
triple bypass 1/07
no chemo due to infections and heart issues
so far NED!
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JanetK View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote JanetK Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2009 at 11:16am
I went nutropenic after my first round of chemo. For insurance purposes (the bast@@rds) wouldnt let me get Neulasta unless I got it thru their mail pharm. So, I didnt get my shot til three days later. I was in the hospital fo 7 days. They tested me for all types of infections and kept me isolated until my WBC came up. Fortunately, for me I didnt get any infections. I know its scary, but just do what they tell you to do, take yuor meds on time. and stay away from anyone (including family) that has the smallest sniffle.
My second chemo on time went as well as could be expected. I had severe bone pain from the neulasta. My onc, this time is going to give me neupogen x 7 days to see if this will work better for me. my third chemo is tomorow. drink PLENTY of fluids , eat when you can, sleep when you want to. you WILL get through this, one day, one hour at a time if you need it. Lots of luck, love and hugs.
Janet
TNBC feb 13,2009
2.6x 3.5
neoadjuvant chemo 8 rounds
Lumpectomy successful Oct 09
axillary node dissection Nov 09
still awaiting results
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LRM216 Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2009 at 12:09pm
Firstly, I want to thank you both from the bottom of my heart for your time, kindness, the wealth of information and your concern.  I am forever grateful.
 
Jessie:  I am so very sorry you have had to suffer in the way you have.  I guess it's just not enough that we get cursed with this disease, then find out we are triple neg, and expect only to have to climb those mountains, but instead get hit with even more.  Not that I was looking forward to my second treatment, but I was greatly dismayed and very scared when the BS today told me no way are you going back to chemo until this is completely dealt with.  You have made me feel so much more reassured.  I am improving, have no fever after that first night prior to my hospitalization, no abscess formation, and tons and tons of iv antibiotics which I am still undergoing until next Wednesday.  Do this every a.m. before I head off to work (which I must do to support myself and 13 yr. old granddaughter.).  My blood counts continued to go up each day in isolation and when released 4 days later, were back to normal.  I am so happy for you that you are NED after all this and pray that this continues for at least 100 more years!  Also, have been tested for MRSA - clean, thank God.  Only thing I had was a "gram negative rod" which the Infectious disease doctor has me on these drugs for.
 
JanetK:  And to you as well, my sincere sorrow that you too had to experience what you went through.  I hope this remains behind you forever and it is clear sailing from this point on.
 
Again, hearfelt thans for coming to my aid - may we all have long NED lives.
 
Love,
Linda
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33
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Post Options Post Options   Thanks (0) Thanks(0)   Quote peach Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2009 at 2:44pm
Linda,
 
So sorry to hear you are having to deal with a set back.  I don't have any personal experience with cellulitis but just wanted to let you know I'll be thinking of you and hope you are feeling better soon.
 
Pat(your Georgia friend)Smile
Dx 5/07 TNBC
IDC Stg.2, Gr.2,
Sentinel node 0/1 BRCA-
Lumpectomy,Chemo(AC-T DD)Rads
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LRM216 Quote  Post ReplyReply Direct Link To This Post Posted: 14 May 2009 at 4:24pm
Pat - I didn't forget you, honest.  Just been so busy with all this crap I am going through right now.  I will call you over the weekend.  Promise.
 
Linda
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33
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Post Options Post Options   Thanks (0) Thanks(0)   Quote peach Quote  Post ReplyReply Direct Link To This Post Posted: 15 May 2009 at 5:00am
Linda ,
 
Your plate is looking pretty full, don't you worry just take care of yourself now,  that's most important.  I'll be gone this weekend but look forward to hearing from you soon, when you're feeling better. 
 
Hugs to YouHug
 
Pat 
Dx 5/07 TNBC
IDC Stg.2, Gr.2,
Sentinel node 0/1 BRCA-
Lumpectomy,Chemo(AC-T DD)Rads
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LRM216 Quote  Post ReplyReply Direct Link To This Post Posted: 15 May 2009 at 6:59am
thanks, Pat.  Enjoy the weekend and I will speak with you soon.
 
Linda
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33
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Post Options Post Options   Thanks (0) Thanks(0)   Quote runawaybunny Quote  Post ReplyReply Direct Link To This Post Posted: 15 May 2009 at 8:11pm
Hi Linda,
 
I had an infection around my left expander which popped up right before chemo began. And it was hot and "glow in the dark red".
 
The infection actually delayed the start of my chemo for 2 weeks, but my onc was unwilling to put off chemo indefinitely.
 
Was on Keflex postop, then Bactrium. I began chemo, infection did not go away. Was put on Zyvox, but Zyvox+chemo made me very neutropenic and didn't quite eradicate the infection. Finally, I was put on Daptomycin for six weeks, silmultaneously with chemo and it cleared it up.
 
I think (correct me anyone) that Daptomycin is a newer IV antibiotic than Vancomycin. Daptomycin can also be given once a day instead of twice daily like Vancomycin.
 
My infectious disease doctor said we now assume that half of these infections are most likely MRSA unless you can get a culture to confirm exactly what it is. That's difficult if the incision is healed up.
 
I'm sorry you have to go through fighting an infection on top of everything else!
 
HUGS,
Catherine
 
Left breast, DX 4/87 DCIS,18 neg nodes, lumpectomy,radiation, Stage 0
Left breast,DX 6/08 TNBC, 6mm grade 3, Stage 1, bilateral mastectomy w/recon, AC X 4, Taxol X 4,BRCA-neg.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LRM216 Quote  Post ReplyReply Direct Link To This Post Posted: 16 May 2009 at 3:26am
Hi Catherine.  Hope you are well and strong now.  I am sorry to hear that you too had to go through all this on top of beginning Chemo.  I am still having the iv infusions every a.m. until this coming Wednesday.  My onc called me yesterday after she spoke with the BS who halted the chemo until my infection is completely cleared up, and informed me that he would be seeing me this Weds. instead of Thursday as scheduled as she wants him to check me again and clear me for chemo this Thursday, which would keep me on a 3 week schedule.  Since my infusions go until Weds, I am a little nervous about this.  I feel better but still want blood tests to make sure the infection is cleared up and am afraid of going neutropenic again after this second chemo.  My infusions are Daptomycin (which is the generic name for Cubicin, which is what I have been getting for the iv infusions.  I was cultured for MRSA but it was negative.  I have "gram negative rod" bacteria.  I see the infect. disease doctor this tuesday so hopefully will know more.  As I certainly don't want to delay my chemo, I also don't want to be pushed into unless I am cleared up.  I don't want to go through that pain and the hospitalization again if I can help it.  Just kind of feel that she is rushing me back into the chemo.  I guess I will see  what's going on when I see the doctors this week.  Thanks so much for your info and response, it is much appreciated.  I hope you stay well and that all is uneventful for you from this point on.
 
Hugs,
Linda
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Jessie Quote  Post ReplyReply Direct Link To This Post Posted: 16 May 2009 at 5:40pm
Catherine,
I'm glad that your infection(s) are clear and you are continuing the chemo. 
 
You've made my day !  I hadn't heard about the daptomycin antibiotic being used for MRSA.  3 years ago when I had systemic MRSA, it was vancomycin I took.  I had a horrible reaction (red man's syndrome) but had to complete the full 14 days anyway.  I was told that if I had to take vancomycin again, the reaction could be even worse.  I've wondered what would happen if I were to contract MRSA again.  Maybe daptomycin is a possibility now !!  I googled for its side effects and they seem pretty bad, but at least "red man's syndrome" wasn't listed.
 
But thanks Catherine, I'm thrilled to know that there IS an alternative to that awful vancomycin !!
 
Jessie  
IDC,Stage I,Grade 3,dx 4/06
dbl mast 5/06,
systemic MRSA post surgery
septic shock, heart attack
triple bypass 1/07
no chemo due to infections and heart issues
so far NED!
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Post Options Post Options   Thanks (0) Thanks(0)   Quote runawaybunny Quote  Post ReplyReply Direct Link To This Post Posted: 16 May 2009 at 6:05pm
Hi Jessie,
 
Just a clarification, I finished chemo 12/5/08 but I was on Daptomycin concurrently with my chemo regimen, one daily IV for 6 weeks from the first week in October through Thanksgiving. My onc said if this didn't work, he wanted the expanders out so he could continue chemo.
 
The Daptomycin had almost no side effects. My infectious disease doctor worked with my onc and they decided could I do it. So, I had to hook up to my port daily for the IV and the infusion center also switched out the IV access weekly so that wouldnt get infected. I was so thankful it worked.
 
But my plastic surgeon decided not to do any expansion until chemo was finished and we were certain the infection was gone. They are nothing to play with with.
 
Hugs,
Catherine
Left breast, DX 4/87 DCIS,18 neg nodes, lumpectomy,radiation, Stage 0
Left breast,DX 6/08 TNBC, 6mm grade 3, Stage 1, bilateral mastectomy w/recon, AC X 4, Taxol X 4,BRCA-neg.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LRM216 Quote  Post ReplyReply Direct Link To This Post Posted: 16 May 2009 at 6:23pm
I had continuous rounds of iv vancomycin and mazapeem (sp?) for the 4 days I was in the hospital and I am now on day 6 of 10 daily iv infusions of the daptomycin (Cubicin) and I have had no side effects whatsoever from any of the drugs.  Too bad I didn't have the same luck with the first A/C - as that's what knocked me out of the park.  My reexcision was pretty nasty and I was still recovering from it by 2 weeks when we started the chemo, so without any immune system my breast developed the cellulitis and whamo - into the hospital I went.  Onc wants me to start the chemo again this Thursday to keep it at a 3 week cycle, but I do not think I am ready yet, especially since my last infusion will be this Weds. and no blood tests yet.  So I am extremely nervous about starting that soon.  Will wait to see what the infectious disease doc and BS have to say this week.
 
Linda
Linda - diagnosed at age 62
Diag 2/23/09 IDC 1.2 cent. IDC right breast,Stage 1, Grade 3,0/1 nodes - Triple Neg
4 DD AC every two weeks, 1 Dd Taxol, then 3 Taxotere every three weeks - rads x 33
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