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Postcards From Lebanon: Part 5 in a Series of Cancer-Related Commentary

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Looking for adventure...

Well, I found it, in a manner of speaking.

I felt like a piece of lead on day three after chemo -- sleeping fitfully throughout the day and night. I'd been advised to take the nausea meds before feeling nauseous, and I'm glad I did. Mentally, I felt as if a zillion chemicals were floating in my head (they're going to create a new periodic table element dedicated to me -- Js -- Jamesium), while physically feeling as if I had no form, oozing through a new space and time continuum. After all, I did elect the harshest chemotherapy to put me into remission and my leukemia hopefully to sleep.

What ended up being put to sleep were my neutrophils -- the good white blood cells that fight infection. On Monday, one week to the day after my chemo began, I had a slight headache, my eyes felt like there were weights pulling them back into my skull, and flu-like symptoms continued. And then I spiked a fever over 101. I had been told to go to the nearest hospital if my fever was over 100.4 (it had been running on average around 99.8), so I went to the closest hospital for blood work. My ANC (absolute neutrophil count) was zero -- yes: zip, zilch, nada, nil, and as my momma used to say, diddly-squat.

You might be asking yourself, "So what does it mean when a chemo patient has zero neutrophils?" It means you have severe neutropenia; and when there is a fever associated with it, you have severe neutropenic fever. Basically, you have no infection-fighting white blood cells in your system, and you could die. The blood analysis the hospital performs can also tell if there are presently any infections causing the fever, or if the fever is simply from the absence of neutrophils. There is also a slight risk that the bacteria in your mouth and intestines can cross over the body's natural barriers and cause infections. Sounds rather daunting, I know. Yet in my debilitated state, instead of "neutropenia," I kept hearing the emergency room personnel saying, "neutro-penis," and when I used that word and said there was nothing wrong down there, we all had a good laugh.

Given the "state of James," I needed to be put in a "quarantined" environment so that I would be protected from any outside virus or bacteria until my ANC was back above 500, and I had not had a fever for over 24 hours. Any medical personnel or guests who visited had to wear masks, gowns and gloves -- sounds like a masquerade party in room 106, BYOB.

As a precautionary measure to protect me against internal bacteria, I was given 2 gm of liquid antibiotics -- ceftazidime (Fortaz) -- every eight hours since Monday night, and on Tuesday morning I began daily injections of of neupogen (Filgrastim) to help boost the production of my neutrophils, which have progressed as follows:

Monday: 0
Tuesday: 18
Wednesday: 80
Thursday: 345
Friday: 435

As I write this I am still in the hospital with only 65 neutrophils to go from being released, which I'm hoping will be Saturday -- fingers, toes and eyes crossed.

This is actually a common side effect when receiving chemotherapy, and it had been highly likely that it would happen based on my past medical history and drug responses. As it is, I have now qualified for a shot of neulasta (Pegfilgrastim) the day after my chemotherapy (you may remember that I am being treated on a three-day cycle -- this adds a fourth day to the cycle, but it is only a shot and not given intravenously). Some hospitals include the use of neulasta as part of their cancer treatment protocol, but then there is also the theory of why introduce an additional drug into the body and its potential side effects (mainly bone aches) that may not be needed. I'd rather not have gone through this chemotherapy side effect experience, but then if I had my druthers, I'd rather not have cancer! Druthers I don't got...

Although my fingers continue tingling and have gotten slightly worse, I have to admit that I am feeling much better. I have lost about 20 pounds since beginning chemo -- both from the chemo and the neutropenic diet. However, being in an artificial environment I'm not sure how I actually feel. I'll know more once I'm released from the quarantined hospital room. The good news is that I have not gotten sick, my disorientation and confusion have subsided, and the minor flu-like symptoms from a low-grade fever have disappeared. Also, my stomach seems to have calmed down, and Dove soap had been helping with my slightly dryer skin, and I'm sure will again once I can shower -- no, I haven't showered since Monday (you don't want to know).

I would be remiss if I did not include the following: There is so much so many of us take for granted regarding health care (sure, we pay out the nose); yet, without the community who day in and day out provide the care we so desperately need, and their humanness, we would be a less-civilized society. I can't imagine having to go through this without the aid of the brilliant, dedicated, immensely professional people who come and go each day. While they may appear like the rest of us, they are far better people for what they do: Handling the needy and sick, providing help, guidance, reassurance and knowledge -- they are the reason for the word "care" in health care. I can't praise these extraordinary individuals enough.

Timing: Aug. 26 -- Aug blood work check up to see how low on the Nadir my blood counts have fallen (which we mostly know) and to meet with my oncologist to discuss ongoing treatments.

Oh, and Stuart and Karina Warshaw, Matt Partalis and Lee Wighting have been added to my list of angels here on earth. The medical personnel who angelically came through for me brilliantly this past week (in alphabetical order) are the following:

  • Lorri Amato, RN
  • Ted Cody, MD
  • Katie Cooper, LNA
  • Amanda Donnelly, RN
  • Gary Farnsworth, RN
  • Zoey Grabowski, LNA
  • Katrina Harris, MD
  • Will Hoser, PA
  • Mary (Tyler -- not really) Moore, RN
  • Lucinda Zamir, RN

Looking for adventure...

Postcards From Lebanon: Part 1
Postcards From Lebanon: Part 2
Postcards From Lebanon: Part 3
Postcards From Lebanon: Part 4