Low Platelets and Treatment Update/Bloodwork Details

Blood Tests and Treatment Update #36 (TDM-1 #19) 

One of the problems with being treated for cancer over an extended period of time is the threat of injury/damage to a person’s body by the drugs given. To help lessen this, blood tests are done before each infusion to determine treatment decisions. Many times immediately after treatment, certain bodily functions decline but recover by the time the next treatment is due. For me, a CBC (Complete Blood Count) is done every time I am scheduled for another treatment. Other times a CMP (Comprehensive Metabolic Panel) is also done. See the bottom of this post for a description of these tests.

May 6th was my two year anniversary of my first treatment for stage IV breast cancer. From that day to the day of my most recent treatment, I have seen a small yet steady decline in the function of my blood cells and liver. My lab print-out always shows a number result of each test performed and then provides the standard range that the numbers should fall. Numbers too high or too low, of course, are never good. Thankfully, there is room for increases or decreases outside the normal range before the numbers are deemed dangerous.

This past Monday, I had treatment #36 (TDM-1 #19). My internet fun was interrupted by a nurse who reported a concern about one of my blood tests.  As I already stated, many of my numbers have been decreasing or increasing slightly each time I have received treatment. This time my platelet count had taken a significant drop possibly so low that treatment may have to be delayed. Dr. R had been contacted to determine if I could receive treatment.

Platelets impact the blood's ability to clot. Their counts are supposed to fall within a range of 150,000 to 450,000. My counts have been as high as 317,000 and as low 114,000 over the course of my treatment. On Monday, though, my platelet count dipped to an all-time low of 77,000.  YIKES!! I believe if the count is below 20,000, the patient may have to have a platelet infusion. I am not there yet, but still it is in the YIKES category.

In the end, my doctor decided that my current drug, TDM-1, could be reduced by 20%. That allowed me to receive treatment without putting my blood clotting ability at significant risk. At full-dose, my drug was 3.6 mg/kilogram. The reduction put my dose to be 2.88 mg/kilogram.

Scans are due the first week of June. Hopefully all will be fine, and I can continue being treated with TDM-1 (Kadcyla). No matter what happens, my blood will be tested to see if there are any changes. If my platelets have improved then my drug can be increased to full-dose again. It could also remain at its current reduced dose if my blood test numbers do not improve.

On top of being terribly tired lately, I feel like this is the downhill descent I have so vehemently feared. I hope it is not. 

Below describes the blood tests used to determine if treatments can be given.

(Some information came from Lab Test On-line )

CBC– (Complete Blood Count) and Differential (counts different types of blood cells) 
– looks at all the parts of the blood - It shows size and number of red blood cells and looks at important proteins as well as the different types of white blood cells. 

White Blood Cells- fight infections
White Blood Cell Tests – determine numbers of each
*Neutrophils Absolute                                                
*Lymphocytes Absolute                                                             
*Monocytes Absolute
*Eosinophils
*Basophils

Red Blood Cells- transport oxygen through the body
Red Blood Cell Count – number of cells in a sample of blood
*Hemoglobin – a protein in red blood cells, carries oxygen to cells
*Hematocrit – measures what percent of blood made-up of red blood cells                                                      
 
Red Blood Cells Tests 
*MCV- (mean corpuscular volume) measures average size of individual blood cells        
*MCH – (mean corpuscular hemoglobin) calculates percentage of hemoglobin inside a red blood cells, high number indicates large red blood cells, may have macrocytic anemia—not enough folic acid or B12          
*Platelet (vital to blood clotting) Counts – low number indicates lower ability of blood to clot      

Comprehensive Metabolic Panel— test are done to determine the condition of a patient’s kidneys, liver, levels of blood glucose and blood proteins along with electrolytes and acid/base balance.

Kidney Tests
*BUN (blood urea nitrogen – waste product) this product is filtered from blood through the kidneys. If not filtered efficiently, could indicate liver damage
*Creatinine – a waste product made in the muscles filtered out of blood by kidneys. If not filtered enough, kidneys may be compromised.

Blood Proteins
*Albumin – protein made in liver, carries medicine through blood
*Total Protein- measures albumin and serum blood proteins

Liver Tests
*AST – (enzyme in cells of heart and liver)-  high number means liver is being damaged,
*ALT – (enzyme in cells of liver and kidneys)- high numbers indicate liver damage
*ALP – (enzyme found in liver, bone)- high levels indicate liver problems
*Total Bilirubin (waste product) – found in bile, produced when liver breaks down old red blood cells

Electrolytes
*Potassium- needed by all cells metabolism and for muscles to function
*CO2 – needed to maintain acid/base balance in body
*Sodium- necessary for normal bodily functions such as nerve and muscle
*Calcium- needed for muscle, nerve, heart function, required in blood clotting and development of bones
*Chloride- necessary to maintain fluid balance in body and acid/base balance
*Glucose- body needs this for energy

** Remember I am a patient and not a doctor. If you see anything wrong with my descriptions, please let me know.

Spring Break-- from cancer

Johnny Jump-Ups on my front porch

Two years ago, on April 1st, my former oncologist called me with horrific news. My cancer had revealed itself for a third time. A month later I began having infusions every three weeks. One year later I had progression of my disease, so a new treatment with a drug called TDM-1 (Kadcyla) was started. My first scan after four infusions of this new drug showed it was working against my cancer. I had no evidence of active disease! It doesn't get any better than that. I still get infusions every three weeks with my 17th treatment of TDM-1 and my 34th treatment overall occurring almost two weeks ago.

Living with metastatic breast cancer is difficult. I probably think about my disease several times during every hour of the day. Every strange bump, every pain under my ribs, any chest tightness, and every headache immediately causes me to think about what this disease could be doing to me. I don’t want this disease to define me, but it does. It is no different than how motherhood, being married, loving learning, and attending to the needs and wants of my family defines me. Or, the way I love sunshine because of how it makes me feel, and how I love the way horses look when they run defines me. My opinions about the world define me and unfortunately so does my cancer.

I have learned to adjust to cancer's role in my life. Physically, I feel so good on some days it is hard to believe I have a terminal disease. On days I don’t get enough sleep, though, I am left with not enough energy to attend to my very long to-do list. Those are rough days.

Then there is the CAT scan that my timeline races toward. I can’t stop it. My days of grocery shopping, cleaning, picking-up my kids from college, driving them back, watching my youngest in dance and tennis class, and going to a party with my husband all leads me to that sleek white machine where I am told “Hold your Breath” and then “Breathe”. That machine will give evidence of continued treatment success or . . . not. I fear that machine. It is the source of my present anxiety. While my life ticks away that machine awaits my visit.

I had my last scan January 29th. Since I am accustomed to every three month scans my internal time clock has sparked anxiety. This time my scans are not until the first week of June because my oncologist agreed with me that we could have scans every four months instead of the usual three. So, I must somehow temper my anxiety while I wait for the first week of June. Then I will know whether life will continue as it has or whether a new path will be taken.

Azalea Festival Garden Party

Of course I cannot completely remove the knowledge of my condition from my mind, but there are moments where I notice I wasn't aware I had any thoughts of it at all. Last Friday was one of those times. My thoughts were focused on a garden full of vivid spring colors not adorned by real flowers, but by people. I went to an outdoor party and people watched for hours.

Azaleas in my yard

Wilmington North Carolina hosts a festival every spring. The name Azalea is attached to this festival. Every year the planners try to guess when the azalea flowers will be at their peak blooming time so the festival is surrounded by the beauty that these flowers bring. This year for the week of the festival, the flowers were just beginning to show their beauty. I don't think most people cared though, as long as the days of the festival did not include rain.

Party goers waiting for the celebrities to appear.

For those desiring it, the week of the festival is a time for parties--one party after another.

My husband’s employer donated money to the event this year. With that donation, he received tickets to an outdoor party. Tickets to the party we attended were $150 A PIECE!--crazy, I know.  Never could I part with that kind of money for plenty of liquor, a few celebrity sightings or to see the lovely landscape of Wilmington’s Airlie Garden. I was glad my husband’s company did or I would never have seen the spectacle of The Azalea Festival's Garden Party.

There were probably other celebrities, local and otherwise at this party, but the only two I recognized were the three-time beach volley ball Olympic Gold Medalist, Kerri Walsh Jennings (yes, she is super tall), and the US Congressman from NC, David Rouzer.

Summerall Guards

After the celebrities made their appearance, everyone was entertained by the Summerall Guards. They performed their well-rehearsed choreographed military movements. I later learned that being a part of this group is a high achievement for these military cadets. The only unusual part, was the humming of a drone  hovering over our heads. I hope it took some good pictures of these guards or perhaps the crowd if that was what it was there to do.

Before I arrived, I expected to see a lot of people around my age attempting to make business connections. They were there, but it was clear they were not in the mood for business conversations. As I people watched I was surprised at the many young people that were there. It seemed to me this party probably was more about seeing and being seen especially since everyone had preened their feathers and now were doing their mating dances. I saw people in short, short dresses and shoes with very high heels. Some of it was tasteful and some not.

I am not a fan of these shoes.

Nor, do I like these.

Men adorned 100% cotton light-blue striped Seersucker suits and suit jackets of solid blues and pinks. Several young men were brave enough to wear shorts instead of slacks. There were a few women in one piece pant outfits, too. The colors were wonderful with lots of corals, reds, blues and pinks. I truly appreciate how some people can wear giant decorated hats and not look ridiculous. This was Wilmington's mini Kentucky Derby without the horses.

As my husband and I walked around the garden, we could not help but notice the amount of liquor available--tents, tents and more tents of it with only one tent for food. I am not opposed to serving alcohol. I have enjoyed margaritas, toasted almonds, and wine many times in my life. What I didn’t expect to find was this: We stopped to greet some people that my husband knew, and almost immediately a man asked if we would like a Jello-shooter. “What!” I thought, “But, you must be close to sixty years old.” He then told the story of his wife making the Jello-shooters and how she had used several bottles of Vodka to create them. All I could think was feeling and getting old hurts. Why would anyone over 40 and especially over 50 want to drink shooters?

My husband and several co-workers

The day was a gorgeous day for a party. I now can put names to faces of the men my husband works with. Their wives accompanied them, so that was nice too. A beautiful, sunny day with the man that has given me everything--well almost--I ever wanted is a great day. And it was an even better day with a short but much needed spring break from thinking about cancer.

Greg and I on April 10, 2015

     

My Eyebrow Tattoos

Cancer takes so much . . .

My plastic surgeon who surgically placed the artificial breasts I now bear once said to me when I was stage 0, “I am glad you didn’t have to go through chemotherapy because women look so much older afterwards." Looking back, I think he should have refrained from saying that to me since there was no guarantee I would not have to have chemo one day. Now I know what he meant, unfortunately, about "looking older".

That was 10 years ago. I have had frequent visits from the chemotherapy drug Taxotere since that time. Although I am now 50, I do believe my treatments have made me look older than I would have if I had not had those visits.

Taxotere took my hair. After that treatment ended, my scalp hair returned. For reasons I am not sure of--except for possibly the chemo induced menopause--my eyebrows and eyelashes have been slow to return. As you can see from the picture below my eyebrow and eyelash hair are best described as nonexistent. It has been like this for almost two years.

One of my posts from a few weeks ago told the story of an offer made to me by an extremely nice woman. This woman is the owner of a hair removal business that also specializes in skin care and cosmetic tattooing.

Yesterday, I decided to take the plunge and let her do her magic.

I did it! I got a tattoo.

Well, not exactly.

Eyebrow tattoos, at least the kind I have, are not like body tattoos. The ink is plant-based. Many of the colors used in body tattoos have metals in the ink. Before I received my new brows I would wonder why each MRI technician always asked if I had any tattoos. Now I understand the reason for the question. MRI machines use magnets, so tattoos with metal in the ink don't mix well with those machines. The result, although rare, can be swelling or burning to the tattooed area. The images created can be unclear as well.

Body tattoos have another difference. They are done with a needle(s). Eyebrow tattoos are done with—well, something else.

When the session first began I cringed each time the tattooing instrument went across my skin despite the use of a numbing cream.

I asked, “What are you using--a razor?”

She said, “Yes.”

In which I responded, “It sure feels like a razor.”

I had no idea how the inking was done until she started the procedure. I didn’t ask because I assumed it would be with a needle. Instead, a razor cut very thin lines into my skin while ink filled the slits. Each individually inked-cut-line gives the illusion of hair.

The picture you are about to see is the beginning stages of my new face. These brows will heal and fade a little. It is my job to keep the area moist so the skin pushes out as little of the ink as possible. In 30 days, I will go in to have the final product perfected.

 

This is a lot better than the way it was done not too long ago. Eyebrow tattoos were done by filling in a desired shape with color. The new technique is a tremendous improvement.  

One interesting bit of trivia that I didn’t know I would ever use was used yesterday. I had learned that the left side of a person’s face is more animated than the right. For me, this is indeed fact. It is very hard to get eyebrows to be symmetrical when one eyebrow doesn’t cooperate. If I talked or smiled my left eyebrow would move into a new position. It was especially noticeable when I arrived home, looked in the mirror and tried to adjust to my new look.

Oh symmetry, my symmetry . . . where are you?

I do like having eyebrows again. My right one is my favorite. Can you tell that none of those lines are real hair? I hope that the lines can be tweaked so the left one looks more like the right one.

If my brows look shinny it is due to the Vaseline that must be applied and reapplied for 7 to 10 days so the area does not dry out. Once the skin is healed I will be able to get rid of the shine.

For any of you looking to have this procedure done, I encourage you. Mine are not exactly what I pictured beforehand, but overall it is close.

Now, what can I do about my eyelashes?  


Note:
I was told that the pain varies from person to person. For me, the pain caused me to grasp my hands tightly and scrunch up my toes. As time moved along, the pain lessened some but not completely. At least I wasn’t brought to tears.

** It has almost been a year since I had my eyebrows done. Unfortunately they have faded. Will I do it again? No. It didn't last long enough for me to spend the time it takes to have them done and to feel the that painful razor blade again.