It's baaaack

This is it! It's upon us! What the heck is it?? It's the nadir week!! This is the week, usually beginning on Friday of the week I come home from the Club, when things begin to tank. Hemoglobin, platelets, neutrophils; you name it, it tanks. 

For example, today my hemoglobin level is at 7.1gm/dL, whereas just four days ago, it was at 8.3. Now just looking at those numbers, you might find yourself feeling like the proverbial deer in the headlights. Well, look at them from my perspective. That change represents a 15% drop in the amount of hemoglobin in my blood stream. So what, I hear you asking. Well, simply speaking, hemoglobin is a protein that carries oxygen to the tissues. It is found in red blood cells. The less of it you have, the less oxygen gets to your tissues, especially the brain. 

Did you ever try to do some exercise at high altitude? Did you notice how you seemed to be short of breath, compared to how you might have felt at home, assuming that your home is at lower altitude. Well, there you go. That's why hemoglobin is important. Now consider that 8.3 gm/dL is only 64% of the bottom end of the normal range for hemoglobin content in the blood. At 7.1 what you end up with, mon frère, is 54% of the minimum "normal" ability of the blood to keep oxygen flowing to the brain. Now that will mess with your head. 

I'm sure you all passed the quiz after reading "Did you ever have a nosebleed?", so you are intimately familiar with the clotting mechanism of human blood, right? OK! Let's move on to platelets. The day after I last checked in at Club Sunnyside, my platelet count was 251 (that's times 10(9)/Liter, if you care about such things).  The normal range is 140-375; so far so good. When I checked out, four days later, the count was 186. Still good, but six days later, i.e., Sunday we were at 29, and yesterday they dropped to 13. That's less than 10% of the bottom end of the normal range. And what is it, class, that platelets do for us? That's right, they initiate the process of clotting blood, when we have an injury. 

I have promised before not to terrorize you with icky photos; and thank your lucky stars, because I could show you a really discouraging photo of the blood blisters all over my face and scalp caused by, you guessed it, a low platelet count that doesn't allow for proper clotting of my blood! 

Finally, let's talk about neutrophils. What are neutrophils, you ask? 

Neutrophil: a phagocytic white blood cell having a lobulate nucleus and neutrophil granules in the cytoplasm.

You had to ask, didn't you! Let me translate, neutrophils are white blood cells that are the backbone of the immune system. Without 'em you could get soooo sick. The normal range for absolute neutrophil count (ANC) is 1800-8300 (just trust me). When I left the Club, eight days ago, my ANC was 4880. On Friday, four days later, it was 2070, still in the normal range. Today it was 290, or 16% of the low end of the normal range. And if past results can't guarantee future performance (as stock brokers are so fond of saying) they can at least give us a clue. After every round of chemotherapy, my ANC has dropped to ZERO!! Usually around ten days post Club Sunnyside, I hit zero and hover there for a few days. Can you understand why we have been quarantining? 

The amazing thing is not that the chemotherapy does all these terrible things to my body. No! The amazing thing is that my body keeps on coming back for more. Typically from an ANC of zero, my neutrophils return to normal counts within two weeks. Platelets do the same, although I usually need some platelet transfusions to carry me through the nadir. Hemoglobin is the outlier. It moves more slowly in both directions, but frankly, I have been anemic (lacking in hemoglobin) for so long that I can hardly remember what it was like not to be short of breath and a bit dizzy. That will go away after some more recovery time.

Our creator has designed a miraculous machine that can take a licking and keep on ticking, as the folks at Timex used to say. (Ten bonus points if you remember John Cameron Swayzie!) So, even though this is nadir week, and my counts are down (transfusion number three for this week is scheduled for tomorrow), don't count me out just yet. I happen to be the proud owner of a 1946 model that is still operational!!

So God created man in his own image,
    in the image of God he created him;
    male and female he created them. 

And God saw everything that he had made, and behold, it was very good. And there was evening and there was morning, the sixth day. (Genesis 1:27, 31 emphasis added)