I Didn’t Expect THAT: Chemo Nails

I’ll be honest, I’ve been putting off writing about what chemotherapy did to my fingernails. While I’ve wanted to provide frank accounts of my cancer treatment experience, this particular side effect was nasty, miserable and completely unexpected.

Given that I ultimately decided to post this, there are three points I need to make: (1) be forewarned, there are a number of ugly images on this page; (2) just because it happened to me doesn’t mean that it’s going to happen to you; and (3) I suspect that I could have avoided ending up in the ER, and I’ll explain how at the end.

So here it is: the most painful experience associated with my chemotherapy actually came after I was done with chemo, and it deserves a bit of an introduction. You may be aware that how chemo works is by killing off rapidly dividing cells, which is why people lose their hair and the lining of their GI tract. Fingernails are also affected, often turning black, and for some patients, falling off altogether.

July 30, 2017: My left hand’s fingernails at the time of my fourth infusion.
Same day, right hand. The chemo drugs were beginning to leave their mark on my nails.
August 13, 2017: a few days after my sixth and final course of chemo, the nails were looking worse.

My nails didn’t fall off but they really took a beating and ached a lot, almost as if they’d been slammed in a door (not the actual “slam” experience, but the aftermath). Many of them, particularly on the left hand looked like they were starting to detach, retreating into the nail bed.

August 23, 2017: the nails are looking progressively worse.
Same day, right hand.

Several weeks after my last infusion I noticed a little something under the nail of my left ring finger, like a bit of swelling. It didn’t look like much of anything to me, nor to my oncologist during a Friday, September 25 appointment, although he lamented that I might lose that nail.

August 23, 2017: I noticed some swelling under my left ring finger’s nail and figured that it was starting to lift off and that I’d eventually lose it.
Another view of that “bubble” under the nail.
August 25, 2017: HOW could I have possibly NOT been worried about this?
These photos were taken in the evening after my August 25th oncologist’s appointment, and because he hadn’t been immediately alarmed, neither was I. Just my luck, the 25th was a Friday, and good old “I-don’t-want-to-be-a-bother” me figured this type of thing was normal and I’d wait to see how things looked on Monday.

Saturday, September 26, the increased swelling looked like a good-sized bubble under that nail. Sunday was worse, with far more pain. By that night I was in serious agony and even though I had already dubbed one of the nights after my first chemo infusion as the worst of my life, Sunday night definitively stole that title.

By early Monday morning I was in excruciating pain and paging my oncologist who exclaimed, “Hie thee to the ER!” I had a full-blown infected finger and there was a red line traveling down my hand and into my arm, meaning it was on its way to becoming systemic. I have no idea what I was thinking, not contacting my oncologist over the weekend, but the infection evolved very quickly. Had I known…

August 28, 2017: need I say more? In the space of a couple of days, everything turned nasty. And I do mean, nasty. My nails may have looked ugly before, but nothing compared to this. This was a bad situation getting worse. The pace of deterioration was accelerating and waiting in the ER was excruciatingly painful.

At the ER, healthcare workers winced when they saw my finger. I was miserable by the time they took me in, gave me IV antibiotics and (against my better judgment) morphine, the latter of which did nothing other than make me nauseated by the end of the day. I don’t understand how people get addicted to that stuff.

True relief arrived in the form of three lidocaine shots to the affected area. With the pain gone and the antibiotics at work, the ER doc lanced my poor finger and drained all the pus (no, I did not watch).

August 28, 2017: the worst part is over. And I’m not dead!
This is one week’s worth of antibiotics. Since the doc didn’t know whether the bacteria were gram+ or gram- he decided to err on the side of caution. I was popping pills every few hours.

Once that was done, I was bandaged up, got a couple of prescriptions for 7 days of heavy duty antibiotics and sent on my way.

With all this going on, my right hand wasn’t experiencing the same agony. It was a classic case of “one hand didn’t know what the other hand was doing”. My right was living in blissful ignorance.

So here are two interesting points: (1) even after all this, I did not lose that nail; (2) of my ten fingers, only one nail became infected. For this second point, I have a theory: since I’m mainly vegetarian and was eating copious amounts of veggies during chemo, I had been instructed to clean all the raw stuff with a vinegar and water solution. I did that mainly with my right hand.

Interestingly, the fingernails on my right hand hurt less and had fewer issues than the ones on my left.

I wouldn’t be surprised if the acidity of the vinegar and its antimicrobial properties were the reasons for this. Obviously, I can’t guarantee that this made a difference, but were I to go through chemo again, I’d be spending more time dipping both hands into vinegar and water.

While being diagnosed with cancer was terrifying and going through chemo was miserable, the strange reality is that this fingernail episode probably posed the most immediate risk to my life. My husband recently admitted to me that he was afraid that after enduring six rounds of chemo, I’d fall victim to sepsis. So ironic that a cancer patient would almost be done in by an infected nail!

Most amazing is how my body healed all those insults to my hands, and within a number of weeks, the signs of that infection had faded. See photos of the healing process here.