On again off again

I'm starting to feel like my relationship with cancer is on again, off again. It was here and then it was gone, then it comes back, and now I'm saying "good-bye. We are through. I mean it this time. I am done."

Over these past few weeks I have continued to feel great. I am eating, sleeping, playing with my kids, working, etc. I have had a few days in the last week where it seems that some of my activities have finally caught up with me and I have needed to just sleep, but I'm still amazed.

Today I was scheduled to start round 2 of chemo. Everything seemed pretty straight-forward. I had my labs drawn and an IV placed and then we headed downstairs for an oncology appointment. I met one of the physician assistants (Geoff has met her before). She was very nice and she asked the usual questions and did a quick physical. Then she pulled up my labs from this morning. I was looking over her shoulder and the first thing I saw was that my RBC (red blood cells) and my H & H (hemoglobin & hematocrit) all went up. This is good. These are indicators of anemia. Then I saw my WBC (white blood cells) and my neutrophils (a more specific type of WBC) and I groaned. Both of these are indicators of immune function and I'm not doing so well in that category right now.

I find it hard to decide how to explain any of this here in my blog because so many of my friends are nurses or in healthcare professions and yet, so many are not. The normal plan after chemo is on day 10 I have labs drawn because this "should" correlate with my peak lows. I did have low numbers on day 10, but the numbers today were even lower. As an example, the normal range for WBC is supposed to be about 3.5-10.5 billion cells/L. Today mine was 1 something. Not awesome.

I was curious why they might be so much lower today. As it turns out, previous pelvic radiation can influence the rebound of WBC/neutrophil production. WBC's are produced in bone marrow and an important site of bone marrow production is the hip bones. Since I have had pelvic radiation including my hip bones, it can be a slower process for the regeneration of WBC's.

Well, that sucks.

A lot.

So I didn't qualify for chemo today. I never expected or planned for that.

It's funny how you think you don't want something until you can't have it. Suddenly I really wanted chemo today, but I know holding off is the right decision. Of course, this led to many more questions. 

The hardest part is that I was supposed to be in Kentucky next Thursday for Clinical Bound (my clinical intensive training for school). There was discussion of moving my chemo schedule from Tues, Wed, Thurs to Mon, Tues, Wed, but then there was more discussion about whether that would work with a neupogen injection. Neupogen is medication that I will most likely get after chemo treatments in the future to help stimulate WBC production/help against neutropenia.

An oncologist came in and sat down with us and the PA (physician assistant) and all of us talked and in the end it was decided that the best and least stressful option would be for me to see if I could reschedule my trip to Kentucky to April 30th. I hadn't bought tickets yet just in case something like this happened, so as soon as I got home I contacted the dean, the program director, my adviser, and my clinical adviser, and let them know about my current situation (all of them know me too well and are in constant contact with me). In less than a minute the dean wrote me back that the schedule change was taken care of.

So now my job is to take it easy and get those numbers back up so I can have chemo next week as planned. Then I will follow my three days with a neupogen injection and I will have my day 10 labs checked right before I go to Kentucky.

I'm not going to deny that I am enjoying a little break, but since I am pretty set on being done with cancer and living, I need to be "back on" with my chemo treatments.