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Postcards From Lebanon: Part 11 in a Series of Cancer-Related Commentary (Cycle 4)

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"Long may you run." (Neil Young)

The weather had turned bitter on the first day of cycle 4. With a low in the teens, and it only being early November, the prospect of having to get up before the sun, even though it was now daylight saving time, in frigid temperature, and driving to Lebanon for chemotherapy, didn't offer warm predictions. Since the first three cycles had progressed so well, I was convinced that cycle 4 would have a delay. After all, my platelets had been dropping, and for cycle 3 had been at 101 (below 100 they don't administer chemotherapy; normal range is 150-400). My platelets came in at 104 for cycle 4 -- good to go. (Note: Each of the platelet numbers should be followed by "x10(3)/mcL" as they are actually measured in thousands per microliter, i.e., 100 would be 100,000 per microliter.)

In my pre-infusion meeting with my doctor, I peppered him with questions, one of which had to do with how to improve the counts of my various blood components. Using my platelets as an example, should my platelets have come in below 100 x10(3)/mcL, they would have offered up one of two options: 1) a transfusion to boost my platelets, or 2) wait a week and hope the number comes in at an acceptable level (platelets have a life span of 10 days).

I have been craving cheese, and asked if cheese helped boost one or more of my blood components. There was no medical reason that my doctor knew of as to why I would be craving cheese. But he did ask me if there was any specific type of cheese I was craving, not that it mattered. I then asked about red meat as I understood it helped with the creation of red blood cells.

Instead of having me play 20 questions, the good doctor pointed out that there were three things that helped boost blood component counts: iron, vitamin B12 and folate (synthetic form is known as folic acid). Iron helps the body produce red blood cells; vitamin B12 is important for normal blood, cells, and nerves; and folic acid is essential for blood cell growth and reproduction.

I made a note to buy supplements containing the mineral (iron) and the two vitamins (B12 and folic acid) so I would be assured of not having to postpone/delay one of my cycles. Knowing that I was most likely going to take that path, and that taking supplements wouldn't help, the good doctor brilliantly offered an analogy (upon which I have embellished).

Say you are the manager of an auto assembly plant, and every day, without fail, 100 cars drive out of the workroom just as night becomes day. And then suddenly only 60 cars are seen coming off of the assembly line. You think that it must be that there isn't enough steel (for the body, chassis, etc.). So you order more steel. But the number of cars being assembled is still 60 a day. So you think it must be that they are out of a rubber product (tires, wiper blades, hoses, belts, etc.). Again, after the rubber products arrive, you count only 60 cars a day being made. Then, you assume, it must be that they need glass products (windows, mirrors, etc.). Still only 60 cars are being made daily.

Scratching your head, you decide to check inside the assembly plant (yes, a good manager would have done this first, but play along with me). Going inside you notice that there is an overabundance of parts made from steel, rubber and glass. What strikes you is the missing employees because the vast majority of them are out sick. Without the requisite number of employees the maximum number of 100 cars being made can't be reached.

If we think in terms of the steel being iron, the rubber being vitamin B12, and the glass being folic acid, while the chemotherapy is the sick employees, you can see that adding supplements to you body of iron, vitamin B12 and folic acid above and beyond what the body is capable of utilizing won't make more platelets or red and white blood cells that the chemotherapy has suppressed.

With that said, I thought I'd check into what types of food offer these vitamins and mineral to be sure I was eating the appropriate diet so I at least have the minimum daily requirement of each. A partial list of those foods follows:

Iron-Rich Foods: Dark green leafy vegetables (spinach), dried fruit, eggs, iron-fortified cereals/breads/pastas, legumes, peas, pork, poultry, red meat, and seafood.
  • Note: The body can more easily absorb iron if eaten at the same time as foods rich in vitamin C.
Vitamin B12-Rich Foods: Dairy products, eggs, fish, meat and shellfish.
  • Note: The body stores this water-soluble vitamin in the liver, deficiency is extremely rare.
Folic Acid-Rich Foods: Asparagus, baked goods, cereals, fruits (bananas, melons, lemons), leafy vegetables (spinach, broccoli), legumes, okra, mushrooms, orange juice, organ meat (beef liver, kidney), tomato juice and yeast.

I have been taking baby aspirin on a daily basis for the last couple of years, which I have now stopped until I have completed chemotherapy as aspirin is a blood thinner and lowers the platelet count. You never know...

The good news: The chemotherapy is working, as my Lymphocytes are well under a single digit at 0.4 (x10(3)/mcL). Also, my spleen, which had grown to the size of Detroit prior to the great recession, is now hidden under my left ribcage where it should be.

The bad news: After three days of chemo and then the Neulasta shot, I was blended to a puree. Unable to get out of bed with ripping aches and pains, racked with fever, monster waves of nausea, strewn with dizziness, ravaged fatigue, pounding headache, and a pillow littered with thinning hair, I felt slashed to hash. I was barely able to climb out of this malaise with the help of medical marijuana. I then developed a sore throat which has caused me to lose sleep, and my urine became dark and got me out of bed every two hours at night. As for cognitive therapy and my ongoing issues with chemo brain, it unfortunately continues. This has been by far the worst cycle to date.

On both days one and two of cycle 4 I was given a foot massage. To have ones feet caressed and manipulated while receiving chemo was a joy. The Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center in Lebanon, N.H. is a phenomenal place. I'm so pleased to have chosen to have my treatments there, even having to get up at the crack of dawn in the freezing cold.

Timing: 2-Dec thru 5-Dec cycle five (5) of chemotherapy.

Oh, and Marilyn Mason, Leigh Dakin, Jacey Cobb, and Beth Hazlett have been added to my list of angels here on earth.

Long may you run.

Postcards From Lebanon: Part 1 History
Postcards From Lebanon: Part 2 Vincristine Study
Postcards From Lebanon: Part 3 Prep for Chemo
Postcards From Lebanon: Part 4 Cycle 1
Postcards From Lebanon: Part 5 Neutroponic Fever
Postcards From Lebanon: Part 6 Nadir Charts
Postcards From Lebanon: Part 7 Cycle 2
Postcards From Lebanon: Part 8 How People Respond
Postcards From Lebanon: Part 9 Cycle 3
Postcards From Lebanon: Part 10 Medical Marijuana

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