Finally, I get to have meals that I've ordered on their little menu! I ordered scrambled eggs, with bagels, and a special request for bacon. They gave me pancakes instead of eggs. For anyone who knows me, they will know two things: 1> I loathe pancakes, and 2> My entire breakfast-eating system has effectively been shut down. The egg is a catalyst between the bread and the bacon... a necessary conduit, if you will. My only option: eat the bacon straight and be a little hungry (which is actually OK, because my appetite is waning a bit anyways). I find it remarkable how much I talk about food in this blog...
[10:33am]
Lab work is in! The results are:
WBC (White Blood Count): 1.2 (Normal 4.8 to 10.8)
RBC (Red Blood Count): 3.5 (Normal 4.7 to 6.1)
Hemoglobin: 10.7 (Normal 14 to 18)
Neutrophils: 63 (Normal 35 to 75)
I included neutrophils becuase I recently learned something called a "neutropenia score." If you are below 1000 in this score, you're neutropenic and immunosupressed.
Mild neutropenia (1000 <= ANC < 1500) — minimal risk of infection
Moderate neutropenia (500 <= ANC < 1000) — moderate risk of infection
Severe neutropenia (ANC < 500) — severe risk of infection.
The formula is: (Neutrophils/100) * (WBC*1000) = Neutropenia Score
So, I am: (63/100) * (1.2*1000) = .63*1200 = 756.
This means I have moderate neutropenia. With a WBC of 1.2, this would normally be severe, but my neutrophils are hanging in there at the moment (within normal range!).
As for the hemoglobin. I feel pretty ok right now, but I know from experience that once that number hits 10 or below, then things break down.
In the realm of side-effects, nausea has been more consistent with this cycle. I've asked for ativan so much, I think they're just giving it to me every four hours now. Works for me! Now the nausea hasn't shown up at all. However, food still doesn't seems appetizing. It may be time to take on the approach taught by Liz's mom: chicken noodle soup and popsicles!
As for everything else, I am doing well. Just sitting around playing "Final Fantasy XII: Revenant Wings" on my DS -- it's quite addictive.
Hopefully, I'll get chemo earlier today. I want to be able to go apartment hunting with Liz on Sunday.
[6:03pm]
Woohoo! Chemo has just started with the Cisplatin! So it looks like I'll get out of here in-time. That's good news. Interestingly, I noticed that my dose for ifosfamide was increased from 1750mg to 2200mg. That's quite a big difference if you consider that I've been getting 195mg of Cisplatin. If you've read only of my earlier posts, you'll notice this discrepancy...
The maximum dose for Ifosfamide is 1000mg/m^2. My surface area is 2.2m^2, thus I should achieve 2200mg of Ifosfamide. When I questioned the nurses as to why I was receiving 1750mg, they speculated about maximum dose in such a short time (such as 7000mg). I am skeptical... why, then, am I now able to have 8800mg in four days??
Either: 1: Someone screwed up.
or: 2: They acknowledged my tolerance and decided I could handle a higher dose.
or: 3: They planned to gradually up the dose all along.
I just hope it's not #1. Or maybe Irwin's orders differed from Cecchi's. Who knows? When I looked at the chart, I saw 1750mg crossed out and replaced with 2200mg. Consider what might have happened if I had 2200mg all along? Remember that dose reduction study. Please be #2 or #3, and let all be right in the world.
This also explains why this round of chemo is rougher than the last two -- I'm getting almost 20% more chemo (by volume).
11 comments:
Nonsense! Pancakes are like the deity of breakfast deliciousness.
On a side note, I'm getting an NES!
-TJ
Unbelievable. Pancakes are in no way an acceptable substitute!
Get the NES 2! The top loading feature prevents that pesky flashing red light problem.
They're getting revenge: "Oh, it's the pesky kid who always wants bacon." Heh heh heh, wait until they see an order for 3 chicken noodle soups and 6 popsicles with everything else crossed out!
Enjoy your soup and popsicles :)
Hope ICE 3 is well under way and you're on schedule to getting out on time........nothing like a bit of flat hunting after a round of chemo :}..........exciting times, though - hope Liz finds exactly what she's looking for........Vx
If I recall correctly, eggs are forbidden for you when your wbc is low. Your change of status from "regular patient" to "reverse-isolation protocol immune-compromised patient" might be why they will not give you eggs. The same reasoning might mean that fried foods are actually preferable right now. But I realize that soft, easily swallowed foods which are soothing are what you may want the most since your throat and mouth linings are becoming sore.
Good guess, but I just checked -- my diet is still listed as regular. In addition, even Stanford's BMT guide lists eggs as acceptable, as long as they are well cooked.
Hence, no lemon meringue.
Regarding the dosage of Cisplatin...
Wikipedia has a nice article on it. The "plat" refers to a platinum atom in the center of the molecule. The chemical binds to DNA so strongly that the DNA becomes unusable, and when the cell tries to repair the DNA it fails and has to destroy itself by apoptosis.
However, cisplatin has a fairly high rate of tolerance buildup. That is, it gets less and less effective as it is used. Since it is one of the components of ICE, perhaps it is common for the body to build up a tolerance for it, and that is why your dosage is higher now. Just a 4th possibility. Patients who have received a lot of chemo containing cisplatin will eventually build up resistance to the agent, and it cannot be used anymore. I have a feeling it takes a lot, though, before that happens.
Interesting, but my Cisplatin dose hasn't changed -- I was referring to the Ifosfamide.
I got them confused! Lucky I am not your chemo nurse. 2200mg of cisplatin would definitely be a problem...
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