There's little data on how many cancer patients are treated for viral and bacterial infections each year. But health care experts report that the rate of infection among them during winter is higher than other times of the year. Cancer patients are more likely to wind up in the hospital at this time of year than someone who has a healthy immune system, said Ericka Hayes, assistant professor in pediatric infectious diseases at Washington University. "Their risk of having to come into the hospital is higher, and so is their risk of dying from it."
According to Aamina Akhtar, infectious disease specialist at St. Anthony's Medical Center, people who have HIV/AIDS, those who take immunosuppressant drugs to prevent their bodies from rejecting transplanted organs, and those with diabetes also run a high risk of contracting infections.
Transmission rates of germs increase during the winter, because we spend more time indoors, Akhtar said. "That's why they need to avoid places where people congregate, like malls."
Miller was diagnosed with cancer in July. In August, the upper half of his colon was surgically removed. It contained a malignant mass the size of his fist. Cancer cells had spread from the innermost layer of his colon to outer layers and to four nearby lymph nodes. In October, after surviving a life-threatening bacterial infection, he began getting chemotherapy every other week.
His blood counts are checked between infusions and again immediately before each one. When his white blood cell counts plunge, Miller is hyper-vigilant about avoiding germs.
Methods to prevent infection among cancer patients have improved in the last decade. Patients are vaccinated against flu and pneumonia and injected with drugs that boost their blood counts.
But they're still highly susceptible to other viral infections and particularly bacterial infections like strep throat.
"If I had a healthy 20-year-old patient call with symptoms, I'd say go to bed and rest and drink plenty of fluids," said Akhtar. "A cancer patient who is having fever or chills, we wouldn't want them to stay at home and say 'Oh I'll fight this off.'"
Miller could wear a surgical mask when his immunity is low, but he said it looks stupid. So other than going to work, he mostly stays home.
He slathers his hands in sanitizer gel constantly. When friends see him, they inquire about his blood counts before hugging him.
That's what Miller misses most when his counts are low. Hugs.
"I tell friends, 'You can come over if you are not sick and haven't been around anyone who is sick. And even if you aren't sick, you can't touch me or anything in my house, and you cannot use my bathroom. You'll sit on the couch and not move,'" he said, laughing.
Last year this time, John Finger was getting chemotherapy treatments for Stage 4 non-Hodgkins lymphoma that began in his lower spine and spread to his abdomen.
Among other things, his friends and family would open doors and press elevator buttons for him.
"Everyone learned right away, the less things I touched the better," said Finger, 55, of St. Louis. "I had a lot of people looking out for me."
Chief among Miller's support network is Bruce Shoults, owner of three local franchises of the Great Frame Up. Miller is manager of the Central West End location.
By Shoults' estimation, Miller is trying to maintain as normal a life as possible. Shoults helps him do so by driving him around and telling other employees not to sneeze, cough or even breathe in the general direction of Miller when his blood counts are low.
Teresa Deshields, manager of psycho-oncology services at Siteman Cancer Center, encourages patients to stay as active as possible, because research has shown that those with social support have better medical outcomes than those without.
"But then you have an oncologist telling them they need to be careful about being around people, that they're very vulnerable," Deshields said. "We're sometimes working at cross purposes."
She recommends that friends and family members step up and take on the onus of protecting the patient.
"When people wear a mask, the whole idea is to protect the patient, but the public doesn't think that. They think [the patient is] contagious," she said. "Family and friends can wear the mask if they have a cold. Or they could offer to connect by Skype or phone if someone is sick. Just whatever they can do to keep the patient engaged."
Health experts also recommend that those who live with or care for cancer patients get vaccinated.
Miller has also been dealing with extreme cold sensitivity in his extremities, a side effect of one of his chemotherapy drugs.
When he finished his four-hour long treatment one bitter cold afternoon he began putting on layers of clothing over his T-shirt and pants: first a scarf, then a fleece-lined hoodie, wool pea coat, ski mask, hat and two pairs of gloves. By the time he walked out, only his eyes and upper nose were visible.
Oncologists began using the chemo drug oxaliplatin about seven years ago to help boost the effects of the drug 5-FU, the established treatment for colorectal cancer. Oxaliplatin causes a form of neuropathy that makes the nerve endings in Miller's skin painfully sensitive to cold air and surfaces.
But studies, including one published recently in the Journal of the National Cancer Institute, show that oxaliplatin bumps survival rates by up to 23 percent. So Miller is willing to deal with the side effects.
At home, he keeps the temperature at 80 degrees and wears shoes, because the hardwood floors sting his feet in socks. When he constructs frames at work, he wears thick gloves because the metal is extremely cold. And when he eats, he uses disposable plates and flatware for the same reason. Plus, then he doesn't have to wash them and get his hands wet.
"The shower is most interesting, because your whole body is wet and the floor is cold," he said.
Despite it all, Miller feels fortunate that he's enduring the cold sensitivity during winter rather than summer. He knows it's cold outside and warm inside, and he can dress accordingly, he said. In the summer, he never knows which restaurant or store will be blasting air-conditioning because he would be overly sensitive to it. And ice tea, his favorite summer drink, would be out of the question.
He also feels lucky that he's in the final stretch of treatments.
"There's a gentleman here who has been going through this for 11 years," Miller said. "I can't imagine that, being a shut-in for 11 years."
(c) 2012 the St. Louis Post-Dispatch
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