A Path Through

For those of you who are not familiar with the chemotherapy process, blood work is done prior to chemo session to assure that your body is able to manage the poison, or shall I say the medication to come.  

Actually to be honest, poison is a pretty good descriptor for what a chemo patient is given as every session you get a concoction of medications designed to kill cancer while carefully avoiding doing the same to you. It is also a safe bet that it can be fairly challenging to put this toxic milkshake into your system without affecting the body’s normal operations.  This is where the pre-chemo blood work gives the Oncologist an up to the moment picture as to what is going on in the body. 

As I have walked the path through my chemo journey, my level of knowledge has grown as to how to understand my blood work and what it is saying about how my body is making it through this challenging portion of the journey.  Additionally, as I am the kind of patient that walks into each appointment with a list of questions, my Oncologist has spent time supporting  my growing understanding on what we are doing, the impacts, and the challenges. She has also helped my understand the role of the mighty neutrophil on this path through.

Now, before cancer I would have thought neutrophils were something you put on your flowers to make them bloom larger and longer.  However, in my new world I can assure you that this lovely word is not associated with flowers, or gardening, or blossoms.

What is a Neutrophil? Well let me share a bit of my learning with you.

Neutrophils are a type of white blood cell that represents the largest number of white blood cells in the body and they are uber important to the immune system.  Neutrophils could be described as the “first responders” of the white blood cells, with a sprinkling of aggression.  Their job is to seek out infections within the body and when they find it, they figure out what is causing the issue, and then well…they ingest the problem, and kill it with power fighting enzymes.  These little cells are critical to the body’s ability to fight infections and when there are not enough of them, the body is at risk.

Why are neutrophils so important when it comes to cancer patients? Again, another excellent question!  As you will remember from a few paragraphs above, chemotherapy is focused on killing the cancer and to do this, the body takes a beating including your immunity.  Reducing immunity means increasing the risk of infection and this is something that a person dealing with cancer simply does not have on their bucket list.

With neutrophils, for your blood work there is a “reference range” which is a fancy way of saying the goal to be within. This range is between 2.0 and 8.0. The higher the number, the more your neutrophils move from first responders to an elite Navy Seal team that will seek and destroy infections before they even have a chance to set up camp! Prior to starting chemo, my neutrophils were a comfortable fighting force of 4.4, so well within the normal reference range and my body was a happy infection free zone. The issues start when the number starts to fall. Neutrophil rates below 1.5 is considered a “danger zone” with heightened risk of infection and complications, and going below 1.0 could result in hospitalization. When the number falls under 1.5, your ability to stay on your chemo schedule or treatment can also be put into question. This is referred to as Neutropenia.

As of this week, I have now completed my 12 weeks of weekly chemotherapy in 13 weeks.  Now, my husband will tell you I suck at math (and I do), however he will also agree that the above is correct.  Let me explain further.

On March 28, 2022, as I got set up in my little chemo chair and ready for my treatment, I was advised by my chemo nurse that my neutrophils had dropped to 1.4 (remember that 1.5 is the bar of safety).  This was a shock to me as I had not looked at my bloodwork and also did not have any idea that there was a marker I needed to hit.  The positive was that in looking at the remaining blood work, the Oncologist has agreed to move forward with the treatment that day.  This decision also came with a list of things to do and watch for which included; taking my temperature several times a day, avoiding crowds, increased hand washing, etc. Basically, I needed to focus on removing the risks for infection and finding it quickly if it happened. 

The reality is that with the first part of my chemo treatment I was on weekly sessions which made it a bit more of a challenge for my body to bounce back and build up the fighting forces before the next session.  Additionally, every four weeks I was scheduled to receive Carboplatin (a drug known to impact white blood cells) which added to the challenges being experienced by my little neutrophils. By March 28 (5 sessions in), my body was starting to show the impacts.

With my chemo schedule, my blood work is always done on Sundays so it is available for Monday morning which is “chemo day”. So on April 3^rd I headed to the lab in the morning and when I reviewed my online results, my heart sunk a little.  My neutrophils had gone from 1.4 to 1.1 in 6 days.  Yup, my little neutrophils were waiving the white flag saying that they could not fight that week and as expected I got the call from the chemo team Monday morning confirming it was not safe to move forward with my treatment.  My chemo session was officially being “delayed” by a week to allow my body to bounce back. 

I will be honest, the delay hit me hard as your head goes places you do not want it to go and when you are on this path, any delay makes the goal that much farther away. 

A few days later, I met with my Oncologist and the delay in treatment was a topic of discussion.   As much as I understood why, my focus was on not delaying again.  She was pretty frank with me and for the first time the removal of the Carboplatin was brought up.  This drug was an additional “nice to have” drug that we added to my treatment plan, but the side effects were now starting to outweigh the benefits.  Now, I think I MAY have referenced I am stubborn, and that MAY also spill over to my desire to follow through on things, so I was not up for the removal of anything.  If it was killing the cancer, we kept it.  However, my doctor was clear that both she (and her colleagues) would recommend the removal of the drug if my blood work continued to be an issue.  Additionally, she reminded me that with every session with my counts under 1.5, the big gun, Paclitaxel would be given in a reduced dose as my body could not manage the full impacts.  I walked away from this appointment feeling as if I had failed a bit as my body was giving up on me before we had even completed this portion of the journey. 

After the April 4^th delay, the impacts of my low neutrophil numbers started to become evident as fatigue, nausea, and other issues started to creep in to my day-to-day life.  The two weeks that followed were the worst of this chemo path I am on as the side effects defeated every effort I made at managing them and sadly my little fighting neutrophils struggled along with me.

Unfortunately, as I continued down my chemo path, the reality of the chemo impacts have become clear and my final session with Carboplatin (scheduled for May 2) was removed from my treatment plan.  My Oncologist congratulated me on making it through three of the four sessions, but I was still disappointed I could not do what we had planned.  Additionally, as I have yet to get back above the baseline of 1.5 my chemo dose of Paclitaxel has been reduced in order to assure that we could move forward safely. In the back of my head I will always have the lingering question as to whether I did all I could and will this impact my success it beating this. 

So this brings us to two days ago, and as referenced above, my last chemo session with my arch nemesis Paclitaxel and my last weekly chemo session (YES!).  This was a day that has been circled on my calendar for weeks as the impacts of weekly chemo have started to finally get the best of me. I was also on edge as I knew on Sunday that my beaten and battered neutrophils were sitting at 1.1 yet again.  My appointment was scheduled for 10:40 am and as we got in the car I was starting to feel more confident that all would be fine and there would be no call to delay.  Then my cell phone rang and it was the nurse from the chemo room advising that the on-call Oncologist was not comfortable with moving forward. 

Now, I need to put on the table that for the past 12 weeks (well 13 weeks) I have been welcoming a drug into my body that hates me (and I will admit I am not a fan of it as well).  In order to make it through each session my body must be prepped with steroids 12 and 6 hours prior to the session.  I have had a count down calendar in my office for weeks that urges me on every Monday with the mindset that this is just about over….and now, I was being told I needed to wait another week.  At that point we were halfway to the hospital and I am not to proud to say….I started to beg.  I promised to live in a bubble for a week in order to avoid any chance of an issue, I would bathe in sanitizer, take my temperature every 30 minutes, I would do ANYTHING not to delay.  I bargained with every ounce of my being not to go another week and with me understanding and accepting the risks, the Oncologist agreed to move forward with the final session.  That is right ladies and gentlemen, at 2:46 pm Monday afternoon I completed my first leg of my chemo therapy journey with my neutrophils limping along with me. 

So what does this mean now?  Well, on May 30 I will start my second leg of my chemo path with a new cocktail of medication.  Instead of weekly treatments, I will have 3 weeks in between each session to allow for my body to bounce back (as this is how long it will need).   My neutrophils will continue to be a topic of conversation and this week is all about encouraging them to build their resources and get back into fighting mode.

I have no idea what to expect with the new mediations, however that is a worry for next week. Right now, I am content sitting in my bubble wearing a big “Hug a Neutrophil” button as I prepare to take the next steps on the path through.