Clotting Challenges - Health Update

The night before last, I groomed my dog, Tucker. He is a poodle mix so it is necessary to groom and clip him especially when he turns into a puff ball of fur that can no longer see. As I brushed him, I saw a scratch on my arm. No big deal, just a little scratch, not sure how it happened. What was unusual about this little scratch was the bubble of blood it produced. I thought to myself, hummm, I wonder if that means my platelets are really low; little scratches usually clot quickly. I applied some pressure; the bleeding stopped. I found my dog inside that puff ball and didn’t give it another thought.

Yesterday morning I drove to my infusion appointment, went through the maneuvers of checking in, getting my port accessed, and then sitting while waiting to see the Physician’s Assistant I have been seeing a lot of these days. She came in, greeted me and said, “Well, you’re not going to be happy with your platelet count.”

She was right. When a normal number is between 150,000 to 450,000 platelets per microliter of blood then my current number of 67,000 is not a good level.

For a while, my platelets have been bouncing between 80,000 and 90,000. In November, they were 70,000. By early December, the number was 75,000. On January 3rd my blood work revealed a small increase to 80,000. These numbers can bounce around even if my blood counts were redone an hour later. Would it bounce up to 90,000? Probably not.

I have had platelet troubles before. In order to improve them, we tried increasing the time between treatments. It worked sometimes, but in the end dose reduction to 80% of full-dose of my current drug treatment--TDM-1-- was the most effective change. When my platelets started to fall again, it was decided that as long as my numbers didn’t drop below 50,000, I could receive treatment.

Yesterday's platelet count was above 50,000 which is within the treatment range, but since there is no protocol to follow for people like me--on this drug almost three years--it was decided in an effort to do no more harm than necessary, it would be better to wait another week before treating. While disappointing, I am okay with the decision. I have been feeling more tired than usual, so maybe one more week might help that too. Next week, I get to do this all over again hopefully leaving with infusion #61 overall and #44 for TDM-1 completed.

In February-- the 20th –scans will be done. Oh the anxiety . . . my nesting instinct has been in full swing, organizing this and moving that just in case my life changes dramatically. The thought of it leaves my stomach tight and internally I feel I might explode.

Until next time . . .

Thanks for checking on me.

Thrombocytopenia--a big word for a HUGE problem

Good Grief. 66,000! That is the number I was given by phone yesterday concerning my platelet counts.  This is the lowest my platelets have ever been. There is no drug that can be given to increase them--at least that is what my doctor said.

Human blood has several components—white blood cells, red blood cells and platelets all surrounded by plasma. Platelets are responsible for the clotting of blood which is crucial to our survival. Without them, I could die of excessive blood loss instead of cancer.

Platelet image from Bing

Platelet counts are considered normal when there are 150,000 to 400,000 of these saucer-shaped parts of our blood in one cubic millimeter.

Interesting fact:  Some platelets line our blood vessels. If platelets are low, that lining diminishes which allows some blood to seep into surrounding tissues. This can produce little red spots on the skin. Several months ago I asked my doctor about the red spots I have. She had no idea what they were. Thankfully, they were not skin metastases. That eliminated the worst possible cause at least. Perhaps, I have stumbled upon a possible cause--low platelets.

Almost three weeks ago before my last treatment on June 22, my platelet count was 78,000 in a cubic millimeter of blood. I was allowed to continue treatment with the same drug I have had for 1 year and 2 months, but only at a reduced dose.

In order to be treated again with TDM-1 (Kadcyla), my platelets need to be 75,000 or greater.

My next infusion is scheduled for this Monday. I will know more about what the plan will be for treatment by the end of today. (Friday, July 9, 2015) Hopefully, it will be to wait another week and hope for improvement. Or, treatment may have to change. That is my greatest fear.

Now, not only do I have to worry about my cancer progressing, I have to worry about my body not being able to handle the treatments. Oh, woe is me.

Interesting fact: TDM-1 ( Kadcyla) has a very long half-life which means it stays in your body a long time. That is good concerning the cancer cells, but when your platelets are suffering, it is not so good.  

My first treatment in May of 2013 included the drugs Taxotere, Perjeta and Herceptin. That was 2 years and 2 months ago. At that time my platelets were 208,000.  At one point my platelets increased to 317,000. By August, I began to see a trend that my platelet counts were decreasing with each treatment. A year later, I started TDM-1 (Kadcyla). Platelets at that time were 188,000. Another year later and they crashed at 77,000. There was a slight increase and then the count dropped to the present total of 66,000.

Not too long ago, I was told by my PA that platelet counts can fluctuate daily. The trend I am seeing is that my platelets do not fluctuate significantly enough to reach the normal range again any time soon.

Below is information that categorizes the degrees of severity in platelet numbers.

http://www.chemocare.com/chemotherapy/drug-info/kadcyla.aspx 

Normal Platelet Count
150,000 - 400,000 cells/mm3

Risk of Bleeding is based on the Platelet Count
100,000 - 149,000 cells/mm3
   
Little to no risk of bleeding
50,000 - 99,000 cells/mm3

Increased risk of bleeding with injury
20,000 - 49,000 cells/mm3

Risk of bleeding increased without injury
10,000 - 19,000 cells/mm3
   
Risk of bleeding greatly increased
Less than 10,000
Spontaneous bleeding likely

As of today, I have seen no bleeding. I have had a few bruises on my legs but nothing that has scared me. I believe my platelet count is in the grade 2 range. When it gets into the grade 3 range—below 50,000—there can be bleeding of the gums, nose and intestines. 

I am so thankful for the internet. It has given me far more information than I have received from the people I see for treatment. I was reminded via the internet that there are certain drugs that should not be taken with low platelets. Those are Ibuprofen, aspirin, or Aleeve. Those medications can interfere with the clotting ability of my platelets. My medicine cabinet holds some dangerous chemicals for someone like me. I learned I should stay away from rectal suppositories. Good thing I know this now for I almost bought some the other day because I have been experiencing some intestinal discomfort not related to diarrhea.

This condition threatening my current treatment is one I knew could happen, but one I did not expect. Stupid me. Anything is possible.

Up-date:  Doctor recommended attending scheduled appointment and having platelets checked at that time or having them checked locally next week. If platelets have risen, I can have treatment on Thursday. I decided to have blood work checked locally next week instead of driving two hours with the possibility of not being treated. Platelets need to be 75,000 or above for treatment to occur.

Up-date #2. Platelets checked. 64,000. Delay treatment.  Check platelet count in another few days.

And, the saga continues . . .

Keep your fingers crossed for me!