Red Cells and White Cells and Platelets, Oh My!

If only I could remember things from one day to the next. In my previous post, I shared that my ANC has been plummeting over the course of the last three weeks. This is a great concern to me, because just as we were beginning to emerge from quarantine, I learned that my immunity is dropping again. The fact that I couldn't seem to connect with the oncology office didn't help to allay my anxiety.  Yesterday, I was finally able to make contact with the oncology office. I spoke with one of the nurses about my concerns, and what she had to say was, well, helpful if not comforting. She reminded me that recovery from chemotherapy takes a long time...several months to a year. One of the things that happens as my body seeks the point of equilibrium between my bone marrow being beaten down by the chemo and returning to its normal function of making new blood cells is that there are periods when new cell production goes kind of wild and may overshoot the target.  There are also times whe...

Life is full of little surprises and little mysteries. For example, white Christmases are somewhat unusual in Dallas, OR. And although the snow didn't start falling in earnest until Christmas evening, we did have an accumulation of maybe an inch of the white stuff by the time we went to bed. The next day we awoke to about 4" on the ground, and the storm brought us another three or four inches during the day. And then, yesterday, we awoke to about three additional inches of snow.  Mondays I have a standing appointment for my blood draws and PIIC line dressing change. We debated about pursuing the 23 mile drive to the clinic in Salem and back, given the road conditions. Then it occurred to me that to miss my appointment would mean having to go later in the week. Since the forecast doesn't sound encouraging for the weather conditions to improve before the weekend, "later in the week" would effectively mean next Monday. In other words, I would go two weeks without la...

I just shared the following with some of my ministry partners, and I decided I would like to share it with all my dear readers.   

Today is a red letter day! We will have a visit from our son Patrick and his wife Katie and their two beautiful daughters Ryanne and Megan. With the exception of medical personnel and neighbors we have encountered while walking, with whom we maintain distances on the order of 20 feet and conversations on the order of 5 minutes or less, this will be our first in person visit with anyone since we began our quarantine in June. This will be our perfect Christmas present.  We are discovering that "un-quarantining" is something of a challenge. We do not want to remain in quarantine forever, but we also don't want to take foolish chances with being exposed to illness, given that my immunity is, at best, compromised. So, we are going about it in baby steps. We will see our son and his family today. They are all vaccinated against Covid19, as are we. They have not had any known exposures, nor do they have any symptoms of illness. The same is true for us. This seems like a pretty s...

One hundred six years ago today, my mom was born in Tacoma, WA. Seven years ago, as of the 10th of this month, she passed away in Portland, OR, just eight days short of her 99th birthday. She might have made 100, had she not fallen and broken her back in three places. She was bright and alert and healthy up until that time, although her body was wearing out.  I guess the point of this reminiscence is that none of us ever knows what is coming or how long we will be around to find out. As I reflect on my journey through the land of leukemia, I realize how important it is to live everyday to the fullest. The author of the Book of Hebrews wrote, "...let us run with endurance the race that is set before us." (Hebrews 12:1) In other words, we are given so many days on this earth, and we need to continue moving forward as long as the Lord gives us breath. You are no doubt familiar with Aesop's fable of the tortoise and the hare: The Hare was once boasting of his speed before t...

You know something?  It feels good to feel good! I had more lab work yesterday. All of my blood parameters are in the normal range, except for my red blood cells (RBC). But, and this is big, my RBCs are rebounding at an amazing rate. Two weeks ago, my hemoglobin was at 7.7 gm/dL (grams per deciliter of blood), whereas the normal range is 13-17 (let's drop the gm/dL). Last Monday, it had risen to 8.8, and yesterday it was up to 10.7. Now, at the risk of pointing out the obvious, my hemoglobin rose a little over one point the first week and almost two points the second week.  Hemoglobin, as you will know if you have been following the blog, is a protein contained in RBCs that carries oxygen to the tissues in the body. When there is not enough hemoglobin, the tissues starve for oxygen, including the brain. I think I have also previously used the analogy of exerting oneself at a considerably higher altitude than one is accustomed to and feeling short of breath and light-headed. Th...

It's amazing how much having a decision made and behind you frees you up to move forward. When I went off to college at age 17, I was admitted to Yale University in New Haven, CT.  I was a graduate of a public high school in Portland, OR. To say that I suffered some culture shock would be a gross understatement.  Most of the people I met at Yale were nice enough, but most of them also were graduates of private preparatory schools, mainly on the east coast, but also including one of my roommates who attended Punahou school in Honolulu, the same school Barak Obama later attended. These "preppies" had a completely different worldview than I had. They were, well, more worldly. They were self assured and seemed to have the notion that they were somehow a cut above those of us who had attended public schools.  During the one semester I spent at Yale, I was miserable. I was accustomed to being a straight A student, but now I found myself struggling to pull down Cs. In addition, ...

In previous posts, I have anguished over the fact that I would soon need to make a huge, potentially life altering decision: to wit, will I proceed with a bone marrow transplant (BMT) or not? This decision is not like deciding whether I will wear a plain shirt or a striped shirt; it is not even like deciding whether I will pay my taxes or not. In my mind this decision is on the order of Russian roulette, you know the "game" where you put one cartridge in the cylinder of a revolver, spin the cylinder, and without looking, put the revolver to your temple and pull the trigger.  In the strictly theoretical sense, Russian roulette gives you a one in six chance of blowing your brains out.  (This, of course, is why I always use my NINE shot .22 caliber pistol when I play Russian roulette!) Even if you factor in the weight of that one bullet in the cylinder, which might make it more likely that the spinning cylinder will stop with the bullet laden chamber at the bottom, away from the...

One of the comforts I enjoy is reading the Psalms. When I don't know where else to go in the Bible, I turn to the Psalms. This one has been on my heart and in my prayers:   Your word is a lamp to my feet      and a light to my path. 106  I have sworn an oath and confirmed it,      to keep your righteous rules. 107  I am severely afflicted;      give me life, O Lord , according to your word! 108  Accept my freewill offerings of praise, O Lord ,      and teach me your rules. 109  I hold my life in my hand continually,      but I do not forget your law. 110  The wicked have laid a snare for me,      but I do not stray from your precepts. 111  Your testimonies are my heritage forever,      for they are the joy of my heart. 112  I incline my heart to perform your statutes      forever, to the e...

When life's circumstances change, what are you going to do? You have some choices here. You can moan and weep and curse your fate. You can give up and sink into depression, or you can embrace the change as an opportunity to experience life in a new way, one that you may have never thought you would consider.  My diagnosis has certainly changed things in our household. One of the little things entails Saturday morning breakfast time. Before the diagnosis, Jill had a tradition of meeting daughter Tara for breakfast halfway between our homes which are about an hour apart. After breakfast at a favorite restaurant, the two would do grocery shopping at Walmart. They got so much joy from these times together.  In the meantime, I would prepare my own breakfast, often choosing to have something that I especially enjoy that Jill, perhaps, does not. Then it was off to men's Bible study at our church. I grew very attached to the men in that group; men who seek the truth and wisdom that Go...

Welcome to the day! Today is one of my favorite days of the year, the day before Thanksgiving Day. When I was working, my schedule was ten hour days on Monday, Tuesday, Thursday and Friday. So, every Wednesday was a day off for me. When Thanksgiving rolled around, I would take Friday as a vacation day, giving me a five day vacation. That was nice, but what makes Thanksgiving Eve special for me is the memory of spending the whole day in the kitchen prepping for the big feast day.  The smell of pies baking, the blending of bread cubes, spices, diced onions and celery and turkey giblets and sausage to make the stuffing, the calculation of cook times in order to have everything ready at the same time for the big feast; the memory of these fills me with nostalgia. I guess maybe it was the one day of the year when I could be fully immersed in kitchen tasks. Son Patrick was in school and I had the house to myself. My family of origin, Mom, Dad and brother Charlie celebrated Thanksgiving a...

Nadir week seems to be over. I had six transfusions, but it was all well coordinated by Sara in the oncology office. So, I didn't have to go to the ER; I didn't have to agonize over finding an appointment at the infusion center. I have been feeling pretty good since Thursday, when I had my final transfusions followed by a blood draw for stat labs. The results showed my platelets and hemoglobin not up to normal, but in much better ranges for keeping me out of the ER.  Jill and I have had a couple of spirited walks since then, and we should be able to get another one in today, although it is pretty chilly outside. I have another blood draw tomorrow, which I expect will show my hemoglobin and platelets up a bit and my absolute neutrophil count (ANC) beginning to climb. ANC was at zero on Thursday afternoon. That's when my immunity is at it's worst, so I look forward to seeing that number rising.  I mentioned in my last post the blood blisters on my face and scalp. They ha...

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 ...

Dumpster diving. It almost sounds like a sport or a game of some kind; like those crazy people who jump off the side of a cliff, wearing a suit with fabric sewn between the legs and arms. I think it's called base jumping. The idea is to glide around like a flying squirrel, until you get so close to the ground that you have to open a parachute and land.  But as we all know, dumpster diving really is not a pleasant thing. (Base jumping sounds pretty unpleasant to me, too, but to each his own.) It's about rooting in unpleasantness to find something of value; or at least something one can make use of.  I have arrived at the point in my recovery from round four of consolidation chemotherapy where the treatment has wiped out a number of my blood components, including neutrophils, red blood cells, platelets and who knows what else. I'm dizzy; yesterday, I could barely hold my head up long enough to take a shower; getting up from a chair comes close to making me black out. This is ...

  Oh sing to the Lord a new song;      sing to the Lord , all the earth! 2  Sing to the Lord , bless his name;      tell of his salvation from day to day. 3  Declare his glory among the nations,      his marvelous works among all the peoples! 4  For great is the Lord , and greatly to be praised;      he is to be feared above all gods. 5  For all the gods of the peoples are worthless idols,      but the Lord made the heavens. 6  Splendor and majesty are before him;      strength and beauty are in his sanctuary. (Psalm 96:1-6) Sometimes, I need something to get my motor going again, after I have idled in doubt or tiptoed into the garden of self pity. I think I've been doing a bit of that in the last few days. It's not a good place. But then, as He always does, the Lord will bring me up short by showing me something right under my nose that...

Change is hard. One of the reasons it is hard is because it virtually always involves mourning. Small change probably involves smaller mourning than big change, I suppose. The loss of a loved one is cause for more mourning than when your favorite team loses a game. Nevertheless, we have all experienced that sinking feeling that follows disappointment or deprivation.  Now that my final consolidation chemotherapy round is approaching the end, I find that I am doing a bit of mourning. My path has been pretty clear for the past five months: a round of induction chemotherapy followed by four rounds of consolidation chemotherapy on 28 day cycles. I am now four days into the final cycle, which will include the recovery phase, when I am most likely to feel crummy and probably have another outbreak of my Rosacea, complete with the ugly, painful blood sores I have experienced after the past two rounds.  But it is not the pain and ugliness that I am mourning. Those will pass. I think it ...

Day three of my current round of chemo is coming to a close. That seems weird to write at quarter to six in the morning. Let me explain. I checked in at Club Sunnyside at 7:45AM on Wednesday, November 3rd. During that day there were preliminary record-keeping and preparation activities, as well as significant down time. Then, at 5PM, I had my first dose of chemotherapy. That was the beginning of the process that I came here to accomplish.  The schedule for the chemotherapy doses is two doses of Cytarabine, twelve hours apart on days one, three, and five of my visit. So, day one really begins when the first dose is connected to my PIIC line. So, dose two happened on Thursday morning at 5AM. It's kind of like the Hebrew way of counting days: " And there was evening and there was morning, the first day." So, I am currently receiving dose four, which is the second dose of day three. Now, that wasn't so hard was it? Please be aware you will be required to draw a diagram of...

Lab day is here again. It feels like we've been on vacation, since my last lab work was done Wednesday, five days ago. The prior week, we had eight clinic visits in six days. See where I am coming from?  The labs show that my platelets and ANC are up, which is good. My hemoglobin, on the other hand is down slightly, which is not desirable, but I am still above the threshold for a transfusion. Bottom line: everything is more or less in order.  We had a video conference with Michelle (NP) this afternoon. She was very encouraging about my progress and confirmed that I have a bed reserved at the Club on Wednesday. Jill has our friends' condo available for her accommodations, so we are all set. We will leave Dallas tomorrow afternoon, spend a night together in the condo, and check in to Club Sunnyside Wednesday morning at 7:45.  Something new we learned from Michelle is that she is arranging for a video conference with Dr. Cook (sp? could be Cooke or Koch) from Oregon Health a...

On the day before yesterday I wrote: " I don't know if I was more disappointed that my platelet level is going down, or that, although I was just at the threshold for another platelet transfusion, my HemOnc wanted to wait until tomorrow for a new blood draw to decide on transfusion." Today I am here to say, "Always listen to your HemOnc!"  I had a blood draw yesterday, and my blood counts are rebounding! Hemoglobin is up a bit; platelets are up to the point that I will need to be back on blood thinners because of my deep vein thrombosis (DVT), and my neutrophils are coming back! Neutrophils mean immunity, and their presence is tracked by a datum dubbed Absolute Neutorphil Count (ANC). And mine is on the rise!! And that makes me feel better physically and emotionally. Typically, when my blood counts begin to rebound, the numbers come up pretty quickly. So, I anticipate that platelets and ANC will be into the normal ranges by Monday, just in time for my return...