Blood work, blemishes, and a better me

I am currently awaiting word as to whether chemotherapy will be administered today. I am eager for it despite the uncomfortable side-effects, including my first ever major case of facial blemishes. Cancer takes from us both the big and small things we appreciate or value. Its most recent victim is my skin. Now, my eyesight, teeth and hair have always required correction…But, for some reason my siblings and I were blessed with basically good skin. And I’ve been vigilant about maintaining it with a comprehensive skincare regimen. While the rest of me ages in haste due to cancer and harsh chemotherapy treatment, my current skin condition is downright pubescent. As Neal might say, “You’ve got that Benjamin Button thing going on.” Oh well, my skin will clear up when this cancer does. In the meantime, the mirror’s reflection both surprises and intrigues me. I feel as if I look very different from my former self. Not my 20 years ago self, of course, but rather my one month ago self. My seemingly altered appearance emanates from a much deeper place than pimples, or uncolored, drastically thinning hair. Cancer’s plot for my premature death has changed me internally; the story, it seems to me, is written on my face.

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This one week delay due to a low white blood count has had its benefits, though. Most notably, a reprieve from the constant dyspepsia that plagued me for the past several weeks. Free of stomach upset, I used the time to prepare, consume and freeze for future use plenty of protein-rich foods. Sister, Sally Jo, also delivered to me several delicious meals she prepared on her days off. I am now very well stocked. Eating, or should I say a lack of eating, has been an issue. And while I’m advised I can’t eat my way into a higher white blood count, proper nutrition during treatment is very important. OncologyNutrition.org states: “White blood counts (wbc) and all other blood cells are made in the bone marrow…No specific foods or diet changes are proven to increase production of white blood cells…Good quality protein is important for cancer patients to include in their diet, because our bodies need the building blocks (amino acids) from the protein we eat to make the new WBCs.”

But the delay was also stressful in some ways. A low level of neutrophils (neutropenia), a type of white blood cell that fights infection, put me at a higher risk of developing an illness. If I developed an infection, my body couldn’t protect itself. I would have to miss more chemotherapy treatments. So I spent most of the last week avoiding any possible exposure to viruses, bacterias, and germs. It was a little isolating to be sure, but it also forced me to surrender to rest and stillness. I needed that. I also experienced a brief and intermittent return of some of my prior symptoms. That was scary! I worried the cancer could be regrouping and regenerating. I also had a low platelet count, the consequence of which was spontaneous and rather frequent nose bleeds. A sustained fever of 100+ degrees, or moderate-heavy bleeding that lasts for 15-25 minutes can necessitate an emergency room visit.

A couple of hours after my blood draw this morning, I was called to infusion therapy for a check of my vitals, then placed in a large, cushioned, reclining chair just off the hallway, where I was to sit and receive chemo. A television hung overhead, and a curtain was drawn around me. It was perfectly comfortable and accommodating, but somehow I felt as if I’d been kicked out of first class and sent to the back of the airplane! The suites are so nice, and so much more private. Relieved to finally be seated for chemo, though, I raised the foot rest, covered myself with warm blankets, pulled out my iPad, and awaited the arrival of my cancer exterminators.

No sooner had I settled in did the nurse arrive to inform me that chemo had once again been cancelled. I was disappointed, mildly annoyed and concerned, to say the least. It was, however, a bad news/good news report. She said my ANC (absolute neutrophil count) was still low, but that I was very close to the magic number. The number of neutrophils in the blood is expressed as absolute neutrophil count (ANC) and it measures the percentage of neutrophils in the differential white blood count. The magic number, or ANC threshold, is 1.0 for receiving chemo, and today I was at .93. I asked the nurse to page Charla, the trial study nurse following me, so I could ask a few questions. When Charla called me back a few minutes later I inquired about the possibility of receiving the drug Neupogen, which helps boost the production of neutrophils. She informed me that it isn’t an option right now because the doctors need to see how well and how efficiently my white blood count rebounds on its own. And the fact is, it is rebounding on its own. Last Thursday, my regularly scheduled chemo day, my ANC was .68. When they retested me on Monday, I was .47. Today it was .93. While I forgot to ask today for my platelet count, a lack of nosebleeds over the past several days suggests to me that my platelets are on the rise, as well. I also asked Charla whether delays in treatment affect prognosis and outcomes. She said the doctors tell her, “no,” and that they have patients who’ve experienced longer, frequent treatment delays with no adverse effect. So I sucked up my disappointment, gathered all my belongings and texted sweet Carl to pick me up.

This cancer and treatment ordeal forces me to reflect on both my character attributes and flaws. I feel impatient, at times, with those who are trying to help me. I feel ashamed of that, but I have to give myself a break about it, too. My impatience is both chemically-induced and fear-based. I’m worried about infection, so “missing” the port with the needle requires an extra puncture, which I fear. Steroids produce in me an inescapable, chronic irritability. And I’m somewhat resentful about my health challenges. I’ve taken pretty good care of myself over the past 30+ years. How do those who habitually abuse their bodies for decades escape cancer? It’s nonsense to think that way, but what can I say? I’m flawed. On the positive side, I recognize negativity very quickly right now, as it has no place in my recovery. And I have learned that I adjust to new, challenging situations better than I imagined. I say “I love you” like I mean it, because I truly do, and I’ve stopped stifling the urge to say it frequently.

Friends and family tell me I’m “strong,” and “courageous.” I so appreciate the reinforcement, especially when the seeds of fear and doubt threaten to take root. Crises, I think, effectuates in most everyone a certain and individual level of previously unexposed resolve and fortitude. We tend to conceptualize how we’d personally cope with another’s adversity, usually diminishing our ability to “handle it.” But the truth is, we have no choice but to “handle” crises. I don’t think anyone, myself included, feels as if they possess extraordinary bravery at these times. Retrospect may be our best and only affirmation that we did, indeed, prevail and overcome even as our world came crashing down around us.

I return to MDA again tomorrow to have my blood drawn and, hopefully, receive chemo. The infusion nurse expressed confidence that my wbc will be in range within 24 hours. The port needle was left in place, so all I have to do is show up for blood work, then practice patience and gratitude while I await the verdict. I’ll use the opportunity to do better while I get better.

I just hope I get to better myself in an upgraded first class suite!
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