Tag Archive | blood counts

Darn it, more drugs

I had a check-up with my oncologist on Monday just to see how things were going. I had bloodwork a couple of days before, which came back mostly fine. I am slightly anemic, so Dr. Li recommended I start taking iron pills. I’m not too thrilled about it, but considering my multi-vitamin doesn’t contain iron (I was really surprised about that fact), I’ll probably do it. I only need one a day (or maybe every other day), which should minimize its constipation effects.

I did ask Dr. Li what he was looking for in my bloodwork (beyond the general blood counts). He explained that he’s watching to make sure my liver functions and kidney functions aren’t damaged, which would show up with some abnormal results. He’s also looking for high calcium levels, which is often a sign that the cancer has metastasized (especially to the bones) and can be a big problem. Luckily, all those chemical values were normal.

The two bad news items all had to do with the length of treatment. I asked Dr. Li how long I’d have to keep my port after my Herceptin treatments were over. His response – one to (preferably) two years. That’s the time frame that the cancer is mostly likely to recur, so the typical practice is to just leave the port in so it’s already available for treatment. That makes logical sense, but once again I was disappointed by the amount of time it takes to be done with all this cancer stuff. One to two years with my port means I’m pretty much done with my hockey career, and that is not a good thing.

Bad news number two is Dr. Li is recommending I take Tamoxifen, for the next ten years. Again, intellectually, I understand why he’s recommending this course of action (it potentially decreases the recurrence rate of the cancer with limited side effects) but TEN YEARS? I just want to go back to my old life, and it’s not happening any time soon.

And, on top of all that annoying news (it’s not really bad news – evidence of cancer is about the only bad news), I had to sit for an hour waiting for my Herceptin treatment because a new person at the Cancer Center screwed up the pharmacy order. All in all, not one of my better days at the Cancer Center.

Last chemo!!!

You can’t see me, but I’m doing a little chair dance today. My last cycle of chemo is currently infusing to my body, and I am very happy about that. I won’t consider chemo to be over until all the side effects have cleared out, but today is a momentous occasion nonetheless. I will continue to come to the RCC every three weeks for a year in order to get my Herceptin infusions, but that is a biological and not chemo. Those infusions will be much easier than chemo. The infusion itself is only 30 minutes, I won’t need bloodwork or to meet with Dr. Li prior, and I won’t see all the chemo side effects.

This is the IV stand an infuser for the eight drugs I get each chemo cycle.

This is the IV stand an infuser for the eight drugs I get each chemo cycle.

I met with Dr. Li yesterday to get the results of my blood work and MuGA test. My red blood cell count, hemoglobin and hemocrit all came back higher. They’re still lower than the normal range, but higher than I’ve had in the past. My liver enzymes are still high, but at least they didn’t go up. I was disappointed the levels didn’t go down, since I was good and didn’t do too much physically this time. Dr. Li said I was fine, though, since they were stable and the other liver measurements were within normal ranges. My MuGA came back with my heart function at the maximum measurable level

StatsGuy came with me to chemo since it was the last one, and we celebrated just a bit by ordering lunch from the Panera in the plaza across the street.

Me and StatsGuy sitting at the RCC

Me and StatsGuy sitting at the RCC

Now that chemo is about done, I’m moving on to the next treatment – surgery. I meet with Dr. Engel two weeks from today to find out how much surgery he’ll be doing and the time frame. I’m hoping for early December for the surgery – StatsGuy won’t be teaching and I have family events scheduled for Christmas.

Chemo #5

Unfortunately, not as fun as Mambo #5, but my sister came with me this time and made it as fun as it can be. Sarah and I don’t get to visit for hours uninterrupted and even talking on the phone is a lesson in Mommy Conversations, since one of her kids (being still on the young side) likes to interrupt every minute or so. All the chatting certainly made the chemo go by quickly. I was sure I had another drug to infuse, but nope – all done. Starting at 8am also helped it go faster, I think, since I was done by 1pm. Lots of time to run some errands on the west side of town afterwards.

Me and my sister, Sarah.

Me and my sister, Sarah.

Bloodwork came back on Wednesday with no surprises. My anemia is still holding steady, with white blood cells and platelets in the normal range. My liver enzymes were still high, though. One had gone down a bit, and the other up just a touch, but since my alkaline phosphate and bilirubin levels were normal, I could still get chemo. Turns out, damaging my muscles, whether through heavy exercise or bruising, can also raise my liver enzymes. So, you’re saying I shouldn’t have dug out that root ball from a bush in front of my house? Maybe you should have warned me about that exercise connection a bit earlier. Once I feel fine, I go back to my normal levels of activity, which tend to be on the high side. Ah well, at least I know better for my last chemo treatment. Maybe I can get those liver enzymes to go down again.

The other thing I learned was not to take my Zofran the day after chemo since it can interfere with some of the anti-nausea drugs they infused in me during chemo. Luckily this time I didn’t start to feel nauseous while the chemo drugs were going in, which puts me ahead of the game from last time. Speaking of last times, there’s just one chemo cycle left. I’m having a big party when this part of my treatment is done!

Chemo four of six

Subtitled: In which there is good news and bad news

Good news: This cycle of chemo means I’m two-thirds done

Bad news: I don’t really count it as done until the side effects are gone, and the nausea started early this time. I felt a bit nauseous once the chemo drugs started going into my system, even with all the anti-nauseous pre-meds they pumped into me. Today is the same, but that’s typical.

Good news: My white blood cell count went up, and my platelets are still in the normal range.

Bad news: My red blood cell count is now low, and my hemoglobin and hemocrit levels remain low.

Good news: While the hemoglobin is low, it is stable, and my iron levels are normal, so no more iron infusions on the schedule, and I won’t need a blood transfusion any time soon. That means my chemo only took five hours this time – the shortest one yet!

Bad news: My liver enzymes went way up, even higher than that first time when they were high. Unfortunately, I didn’t have those values when I saw Dr. Li on Tuesday, so I’m not sure what it’s going to mean for the last two cycles of chemo. Questions to ask the next time I see him (and I’ll have new bloodwork at that point, so we can see if they continue to go up). The frustrating thing for me is there’s really not much I can do to improve my liver, beyond not stressing it out with other drugs to detoxify, which is why I’ve given up alcohol for chemo and only take Tylenol as a last resort (which I haven’t needed since my surgery for my port).

And I’ll end on unmitigated Good news: The breast MRI showed that the tumor which was taking up nearly my entire right breast has almost completely disappeared. There’s just a residual piece about one cubic centimeter in size, and that was after only half the chemo cycle. The last half of chemo should wipe that right out, which significantly improves my outlook. Here’s to good drugs!

Half-way through chemo

Today’s my third round of chemo, which means I’m half-way through chemo. I won’t really count it as half-way done until I’m side effect free, but I have only three more times I have to come in for chemo. That fact definitely counts as a good one. StatsGuy came to sit with my today, so it’s been very quiet as we both sit and work. I get interrupted by the occasional “Can I get you anything?” from the nurses or StatsGuy.

I found this hat in Montreal. It's reversible and solid black on the other side.

I found this hat in Montreal. It’s reversible and solid black on the other side.

I saw my results from the latest round of blood work. Good news, my liver functions seems to have improved. My AST (aspartate transferase) levels dropped back to normal, and my ALT (alanine transferase) dropped thirty points. The ALT is still high, but at least it moved much closer to normal. I guess the lack of alcohol and occasional avocado consumption seems to have paid off. I’ll keep those changes up for the foreseeable future.

Unfortunately, my hemoglobin and hemocrit levels are still low. In fact, the low iron levels messed with the red blood cells enough so they came back abnormal in morphology and RDW (red blood cell distribution width). To combat the low iron levels, Dr. Li prescribed Venofer (iron sucrose) on a weekly basis. Therefore, I get ten drugs through my port today, instead of the usual nine, and I have to come back to the RCC on my non-chemo weeks for iron infusions. It also means I’m sitting in the chair an extra two hours today, which makes for a long day. What can you do. Hopefully the kids are behaving for my mother-in-law today!

Changing my diet

Before I get chemo, Doctor Li wants to check my blood to make sure I’m healthy enough to handle the chemo. I got a chance to see the results from my blood tests before my second round of chemo. Most things were good, including the counts of my red and white blood cells and my platelets. I had two problematic areas, though – my hemoglobin and hemocrit levels were low and my liver enzymes were high. None of it was bad enough to cancel chemo, but it was something to watch. In fact, Dr. Li ordered a blood test of my iron levels that day. Blood tests after chemo are great – since the needle is still in the port I don’t need another hole put into my veins.

My iron levels must have come back low, because Dr. Li ordered iron infusions on the weeks I’m not doing chemo. Now, I would like to avoid any more drugs put into my system, but at the same time I need enough iron for my red blood cells to function correctly. Therefore, I’ve tried to add more iron rich foods to my diet in the hopes of avoiding the infusions. This has involved a couple of changes. I’ve been trying to eat more greens (Swiss chard in particular, this time of year), and I’ve been eating eggs more often. The eggs are easy since my mom’s chickens have started laying. Nothing better than fresh eggs from a known flock of chickens! I’ve also looked for more iron-rich snacks to eat, like nuts and sesame-based crunchies.

The other trick to adding iron is to make sure I get some vitamin C at the same time I’m consuming the iron. The vitamin C helps the body to absorb the iron more effectively. At lunch, it’s not a problem since any fruit I’m going to eat is full of vitamin C (it’s blueberry/peach/watermelon season around here). At snack, I might add some dried fruit to the nuts I’m eating. I also am sure to drink juice when I take my daily vitamin.

My liver is a little trickier to help. StatsGuy heard from a colleague who went through chemo last year (for stomach cancer) that avocado can be beneficial to the liver, so he went out a bought a couple. Too bad I eat them so slowly, since the second one went bad before I could eat it. The other thing I’m doing is cutting out alcohol completely. It’s not something I should have often on chemo (since it’s a blood thinner), but I had a couple of beers on vacation. I figure my liver doesn’t need any more work to do, and alcohol is an easy one to cut out. We’ll see how I’ve done when I go back on Thursday for the next round of chemo. I’m hoping the problematic numbers at least held steady, but I won’t know for a few days.