After getting a few extra days off from radiation, I still tested with very low blood counts on Monday. I had my radiation treatments, but with the counts still low on Tuesday my oncologist decided to postpone my chemotherapy. The problem is that the radiation and chemotherapy both affect my bone marrow, so that it doesn't produce the right blood cells - but the cancer itself is also having the same effect. Some new painful areas, and the evidence of the blood count, indicate that the cancer is working on my bone marrow too.
Oddly, I don't feel that much worse than I have been for the last month. I still have to take painkillers around the clock, and I've had terrible digestive tract problems; but my appetite and energy have been reasonably consistent. But on Monday they asked me to report in immediately if I experienced any fevers (because I have few white blood cells to fight infections) or bleeding (because I have few platelets to coagulate my blood). Well, lo and behold Tuesday morning I developed a spontaneous nosebleed, and Gail took me in early to Dr. A's office. He discussed the predicament that we're in; do we press harder with chemotherapy and radiation, which may leave me bedridden, or back off and risk further damage from the cancer? It's a balancing act between quality of life and quantity, only now with a narrower margin than we have had so far.
So the plan for the coming week is to continue my radiation treatments Wednesday, since I am almost done with the neck-shoulder series, and there is little marrow in those bones anyway. We will delay the next chemotherapy until Tuesday, when we will go back to another medication, one that may be more effective and be less traumatic for the bone marrow. Plus we may be able to use some of the newer drugs to offset the effects of the chemo. Today I had an X-ray on my right leg, which has been a major source of new pain.
The immediate problem of the anemia was addressed with a blood transfusion today, platelets and hemoglobin, to protect me for the short-term. I still feel OK; I ate a full lunch and dinner, and got some sleep while in the oncology lab at Moses Taylor Hospital. (I've been going to Mercy, but they couldn't accommodate me today, so Gail and I got to visit the third major hospital in town.) The verdict: Moses Taylor's food is better than Mercy, not as good as CMC. But it's a big hospital, and parts of it are very impressive; obviously some major renovations were done, but some of the working spaces are still unreconstructed. The staff were all quite friendly, though.
Hopefully my blood count will rally a little this week, and I will get to cook and enjoy my traditional maple-brine turkey for Thanksgiving. As I've written, I've been able to enjoy a reasonable quality of life for the past month or so; I hate the idea of getting sicker and ending up in bed, and/or back in the hospital. All good thoughts are welcome; have a good holiday weekend!