Chemo Round 5 is ON for Tuesday!!!

What a relief! Based on Monday morning bloodwork, my platelets are up to 117. 100 is the cut off for getting chemo. I am having chemo Round 5 on Tuesday!

This weekend was mentally tough, wondering if/when I'd be able to get this next round over with. I felt physically ok, but I only ended up doing about half the things I had planned, just with the stress of the bloodwork weighing heavily on me and not being able to do anything about it. Everything hinged on platelets: When to take the required dose of dexamethasone. My chemo schedule. My work schedule. My surgery date. Radiation. Finishing. Even though I was doing my best to try to accept whatever may come, I still felt adrift not knowing when this next round might happen. Florence & the Machine's "Shake It Out" was a quiet theme song on repeat Saturday and Sunday.

 

 

Since my platelets have only perked up to 117, it's likely that round 6, my final round of the Horrible Cocktail, TCHP, will also be delayed. This site had some useful information: 

How long will it take platelet counts to rise again?

That's the big question, and the answer is: probably within three to four weeks. Doctors can't make an accurate prediction because platelet count depends on many factors, including the type of treatment -- particularly the type and dosage of chemo -- and a patient's general state of health. One thing to keep in mind is that platelet counts generally won't drop immediately after chemo; it usually takes a week or two. This is because chemo doesn't kill off the platelets already in the bloodstream, which are mature and aren't dividing rapidly. It kills off the cells forming in the marrow, and therefore there's a delayed response, with the lowest platelet counts (called the nadir) usually occurring seven to 14 days after chemo. After that, the body begins regenerating platelets at a rate of approximately 10 percent a day. (Platelets have a life span of eight to ten days, so, on any given day, approximately 10 percent are being lost and replaced.) But some types of cancer and some types of treatment suppress the production of platelets, so the rebuilding process can be much slower.

 

 

From round 4 to what should have been 5, I dropped from 140 to 87 by day 21 and to 85 by day 23. By day 26, I was back to 117. During round 4, I only got 60% of the Taxotere, the T in TCHP, due to the liver enzyme AST being elevated. I don't know what the effect of a full dose of Taxotere might be on platelets, but I want the thing to fully kill off those cancer cells! Naively assuming Taxotere does nothing to platelets and that there will be a linear correlation (for which I have no basis to assume and have done no research - just thinking to get an idea), let's assume that my platelet count will drop by an identical amount between round 5 and 6 - that's down 53 to a total of 64, best case scenario. That is still above the platelet infusion range, which is anything below 50. If I waste down to 64, then we are looking at a delay of about 5 days assuming a 10% increase in platelets each day. It may take me a little bit longer to bottom out like it did this round, so maybe a week's delay for round 6? Ugh. I do not want to move all those appointments again. It would put my surgery on the Tuesday before Thanksgiving, and I do not want the hospital to be empty if I have complications. All that said, I'm excited to be one step closer tomorrow to finishing all of it. One foot in front of the other.

 

Tonight at 8:30pm, I'll be on the field as a breast cancer survivor for Monday Night Football, when the Washington Redskins and the Seattle Seahawks take the field! Looking forward to a great game!