Like Blood for Chemo

No counts, no glory (2/25/08)

Well, despite having a stellar week in terms of perceived energy, my counts were too low today to go in for chemo. Actually, my red blood cells were so low that I'm anemic and am sitting in the hospital right now getting a blood transfusion. It's not as bad as it sounds - I actually feel fine, despite multiple people having told me that I look pale today. Apparently your counts don't have much to do with how you feel when you're "young" like me.

They're going to give me three units total (I'll probably have to come back tomorrow to finish up) - one unit is about the amount you give when you donate blood. Incidentally, it's also the amount they needed to give me when I had my prostate surgery, though I think that was just the plasma/platelets. The blood they're giving me has been irradiated so that the white blood cells have been killed off. Apparently this is important in case I ever need a bone marrow transplant, as you don't want to have been exposed to anyone else's white blood cells. It's a pretty unlikely scenario, but it's good that they take the precaution.

So why the super low counts? Apparently another hidden symptom of radiation is that it blasts your bone marrow, and in adults the marrow in the pelvis and the sternum produce most of your red blood cells (RBCs). So when you blast the pelvis you really reduce the ability of that bone marrow to produce RBCs. The bone marrow in our adult limbs is all fatty and doesn't really produce RBCs anymore. Supposedly this is why kids are able to take on more radiation/chemotherapy than adults - the marrow in all their extremity bones is still active and working hard, while ours is old, fat, and lazy. Of course, I don't really feel like an adult, but apparently no one told my bone marrow that.

In any case, I'm told that I'll feel really good when I get through all this blood, so I guess that's a plus. It's always a bit of a mixed blessing to have to delay a week - you want to keep the treatment going but you also want to have some more time to feel good. This time around, another positive about delaying a week is that it'll give things a little more time to heal, which will allow us to actually go back to the other set of drugs for chemo. As my doctor puts it, normally this regimen alternates sets of drugs, so you get a "left punch, right punch, left punch..." but so far we've had to do left, left, right, right, because of the radiation therapy (can't give the left set during radiation). By giving things another week, we'll hopefully be able to alternate back to the other set this time instead of giving it a third right punch. Supposedly it doesn't make too much of a difference, but I guess you want to make sure the heavy left is getting its turn. (For those of you keeping track, the aforementioned right punch is Etoposide/Ifosfamide, and the left punch is Vincristine/Adriamycin/Cyclophosphamide. It's really the Adriamycin, also called Doxorubicin, that makes it a heavy left. It's so heavy in fact that it can cause "radiation recall", in which it actually brings back some of the skin symptoms from radiation. I'm not sure how it does that, but I'm hoping I won't have to find out. Stay tuned...)