The drama continues. There were only two potential complications I was aware of and concerned about going into the chemotherapy process: (1) that my veins might give out and I could need a port or a PICC line and (2) a low white blood count could put me at increased risk of infection and postponed treatments. We can now add a third to the list.
Regarding the first, I’m somehow still sliding by with use of my own veins (knock on wood). I mean seriously just sliding by. In last week’s treatment (shout out to Komal for taking me!), the nurse actually called one of my veins a “little bastard” when it stopped giving blood for my blood draw and she had to do a second poke. I told her to not feel bad since literally every single one of my previous appointments had resulted in two pokes as well. She was bummed since she thought she “lost” – I tried to make her feel better by letting her know she actually tied. It’s a good concept though – maybe I’ll drum up a little competition amongst the nurses in the future to see who can “win” by actually getting a successful IV and blood draw with just one poke. Yesterday’s treatment session also resulted in two pokes, but was more stressful. That time, the nurse got a good IV in on the first (meaning it could be used for the chemo infusion), but it wasn’t drawing blood. Not surprising I thought, it always takes two turns. But then, her second attempt failed too! There was absolutely no blood – I asked if it was because there was a valve, and she said she missed the vein. Umm…ok. I thought we were going to have a real “loser” on our hands if this was going to require a third poke. She returned attention to where she had placed the IV though, and after applying some heat and letting gravity do its job, somehow blood began to flow! Whoo hoo! With hopefully just three more treatment sessions remaining, wish me luck that no PICC line will be needed!
Komal – AKA the witness to the nurse calling my vein a “little bastard”
Regarding the second potential complication of infections, we’ve been in good shape so far. In the weekly blood draw, the key measurement is what my neutrophil count is. Neutrophils are the specific white blood cells that fight infection. Chemo is tough on neutrophils and inevitably cause them to fall, so patients take white blood cell boosters to keep them elevated. Above 1.5 is normal, so below 1.5 is low, but only below 1.0 is neutropenic, meaning the body is incapable of fighting off infection. Given the specific drugs I’m currently on for chemo, I was doing self-injections of the booster Neupogen for three days following each weekly chemo treatment. Though my neutrophil count is generally within the normal range due to the boosters, during my first two nadirs (i.e., Days 7-10 of my 21 day cycle which is when my immunity is at its lowest and I generally don’t leave the house) the count was just barely above 1.0. If it had fallen below 1.0, the doctor would have put a hold on my chemo. Given the downward trajectory, I was concerned that my third nadir’s neutrophil count would fall below 1.0. Upon Ash’s suggestion, I raised the question to my doctor of whether I can take Neupogen for four days instead of three to provide an extra boost. It turns out there’s no problem with doing this. In more toxic chemo regiments (like the one I’d be on if I have to continue chemo for two months after the MRI), patients either take one Neulasta WBC booster shot or 7-10 days of Neupogen shots between treatments. So, I now do four days of Neupogen and that kept me above the 1.0 threshold during this last nadir. Score! Side note, you’ll notice a running trend that I am often needing to manage my own treatment plan. You would think my medical team would proactively be telling me that I should begin taking four days of Neupogen, but no, they only agree it’s a good idea when I raise the question.
This brings me to the third, unexpected complication. In addition to my white blood cells, chemo is really tough on red blood cells and platelet counts as well. Over the past couple of weeks, my hemoglobin, hematocrit, and platelet levels have been trending down into the low range. At last week’s appointment, the term “blood transfusion” was being thrown around as if we were just talking about giving me a flu shot. Naturally, I was starting to freak out, and was relieved when my doctor said it wasn’t yet low enough and we could continue monitoring. At yesterday’s appointment though, I found out I’m apparently very anemic with my hemoglobin and hematocrit at extremely low levels. To everyone’s surprise though, I am not (knock on wood) exhibiting symptoms of anemia (i.e., fatigue, dizziness, fast heart rate, etc.) in any meaningful way. Well, no incremental fatigue to what the chemo already causes me anyways. Had I been exhibiting such symptoms, the doctor would have been requiring an immediate blood transfusion. After a lengthy discussion with the nurse where I once again felt like I was managing my own treatment plan (“You can get a blood transfusion.” “I can or I should?” “What’s the worst case scenario if I don’t right now?”), I ultimately decided to hold off since I wasn’t symptomatic and didn’t want to rush into something like a transfusion when it didn’t seem medically critical. The thought of having some random person’s blood pumped into me was also super weird. Unfortunately, since this is a chemo-induced anemia and not iron-deficiency-induced anemia, there is nothing I can do to reverse the trend. If I begin exhibiting symptoms, I could need a pretty last minute blood transfusion. I’m not sure how much blood I would need, but I’d prefer to get it from friends and family than randos. So, if any of you in the Bay Area are a B- or O- blood type and would be willing to donate if needed, give me a holler 🙂
Unfortunately, my platelet levels are also low – low enough to put me at risk of having chemo held next week (ugh!), but not low enough to get a platelet transfusion (which I only realized today exists and is different from a blood transfusion). Please send all your “Let’s Go Plate-Lets, Let’s Go!” positive energy my way 🙂
Shout-out to a couple of my Weddington Way girls, Ilana and Vanessa, for taking me to chemo yesterday with my awesome WW bag (that originally came to my house filled with an amazing care package from the entire WW team – you all rock!!)
Weddington Way peeps – Vanessa & Ilana
Going to chemo in style