In the Blood
It’s good to re-emerge and say hello again. The last month has gone by in a flash as the tortoise might say to the hare. Meanwhile, the trilliums are out in the woods. The poppies are beginning their long growth to their single day of flowering glory. The rose bushes are budding. The frogs are singing in harmony at night and being counted by godchildren by day.
The challenge of the last month was having to have Chemo III rescheduled by a week when blood tests showed that my white blood count had dropped well below the minimum threshold required for chemo to proceed. Because I’ve been so well overall, I was startled to realize that this had been going on behind the scenes. Apparently this is a common side effect of the chemo itself. Fast dividing bone marrow cells supply white cells in blood. Chemo acts by killing fast-dividing cells both cancerous and virtuous. It was sobering to concretely realize the vulnerability of my immune system and hard to be shunted off -track (temporarily) for treatment.
The experience has introduced two new elements into my treatment leading to Chemo IV next Tuesday. First, my oncologist has put me on a drug called Neulasta which helps to generate white blood cells over the 21 days between chemo. I had the first injection after Chemo III. The second element is pasture bone broth. We’d heard from a colleague, who is a fellow traveller, early on that bone broth may help with white blood cell production. Accordingly, Angie brewed up a cauldron of gorgeous, healthy broth with organic beef marrow bones, kelp and vast amounts of various vegetables. It bubbled away over a 24-hour period before being strained through cheesecloth. It’s the sort of broth that wobbles when chilled from all the natural gelatin it contains. I consumed it at a great pace during the ‘waiting week’. In combination with the extra time to recover from the chemo, my white blood count climbed above my starting point. Inadvertently then I’ve become part of a “hot new health trend”. The New York Times reports that “New York City’s latest health trend is a steaming cup of bone broth”, that “bone broth is a trend worth its salt.” Building to the next blood test on Monday, I’m again sculling it down. Fingers crossed. At least I’m getting my vitamins.
There was one silver(ish) lining to the delay. After hearing that the nurses were still having trouble finding a vein for my IV line, Dr Frechette looked me in the eye and said “PICC line or mini-port?” I’d been holding off on either option as they both meant the end of golf for the summer (muscle exertion/repetitive actions can lead to complications, including blood clots). Even knowing that most people end up hating their PICC lines and that it also rules out swimming, I opted for one at this point given that could go in almost immediately, be less complex to insert, be used for blood tests and chemo, and will be quicker to get out on the other side of chemo. Mercifully, it will save me in the order of 30 needles (not counting the extras that the nurses were adding when they missed or blew out my veins). The PICC line (a hollow catheter that goes from a vein in my arm to a central vein near my heart), needs to be flushed each week at the local CLSC (community health centre), adding nurse Chantal to my health team. I’ve had some early irritation from it but hope that will settle down. And, while it places restrictions on the use of my arm, I think I can spin this as an opportunity to work on improving my putting this summer!
After all of that lead up, I did get Chemo III. Happy to report that, as before, I’ve had few of the obvious side effects (no nausea) and my appetite and taste buds remain intact. I’ve also been walking 3-4km most days, along a route that takes me by the Gatineau River along the old railway tracks. There has been a serene stillness on some days. I’ve seen the first spring geese chicks out with their attentive parents. I’ve seen the last snow melt from the shady parts of the trail and the tender green of new leaves emerging. Good for body and soul. It’s also been good to walk with Angie on some days.
And yes indeed, Angie is back in action and in good form. She was out of her sling earlier than we’d anticipated. She began physiotherapy with passive range of motion exercises in mid-April. Last Wednesday she saw her surgeon for a third post-op consult. He confirmed that her bone has healed, muscles are firing and the hardware is solidly in place. He gave her the green light for everything including strengthening exercises. Some days, this is more ‘great news’ in theory than in practice. The exercises are hard and exhausting. Progress is measured in millimeter increments. It can be frustratingly slow. The surgeon has said it will take a year of attention – 2 months done, so 10 to go! Until the most recent visit with the surgeon, there was stress about whether she could reinjure her shoulder. She is proving a most determined patient of the supremely talented Louise Killens at Physiosport Chelsea. She is also finding that being in the hot tub and salt water pool at the health club is a real help. The natural buoyancy of the water lifts her - hydrotherapy. And it is reassuring, even exhilarating, for us to see her gains.
Our pace of life remains slower than normal. Our energy level is lower. After being used to doing a lot, effortlessly, we find that doing a little can be an effort, followed by a nap. But, we are coming to terms with the current reality that we also both have much reduced capacity to do things or to organize things. Between us, we have two good right arms. This can lead to some conundrums – for example how to drain a big pot of boiling pasta water (we abandoned the menu instead). My vaunted concentration level and attention to details is also a shadow of its former self during the first 10 days after chemo. This has created moments of humour however. Not so long ago, I decided to make baked potatoes and a Caesar salad to complete a steak dinner. I duly made my shopping list and headed to the store. I popped the potatoes in to bake and made the Caesar dressing and croutons. About 15 minutes before dinner, Angie cruised through the kitchen and mildly asked me ‘where’s the lettuce’? Oh right. Lettuce. Caesar salad. I repeated this feat when I suggested we have a scallop and pea pasta and offered to go up to the store to get frozen peas. I realized half way home that, while I’d picked up 5 other things, I’d forgotten the peas. A quick U-turn resolved the issue. This too shall pass, as my mother was fond of saying. Thankfully Angie is back anchoring the kitchen.
We’ve also been very thankful of the help that our friends continue to offer. Our garden beds have been raked out. Compost has been delivered and top-dressed onto the garden beds. We’ve appreciated rides to appointments and on errands to provision house and home. I was particularly thrilled to be invited by my fabulous golf teacher, to hang out at an Ottawa Golf Club when Brooke Henderson and her sister became honorary members and hit some balls in front of adoring fans (including me). We’ve had meal drop-offs and good visits, often over food. It’s been wonderful to touch base with people coming from out of town and with those more local. We’ve received poems and cards in the mail which have been cheering and inspiring. One even contained the exciting surprise that our niece is on track to deliver a grandnephew. We love receiving emails and calls even if (especially if) we haven’t been in touch for a while.
This month’s reading included Ottawa’s Tamara Levine, But Hope is Longer: Navigating the Country of Breast Cancer. She recounts her year of treatment and recovery and the various reflections and challenges along the way. Her situation was similar to mine so it was very useful to learn about what may lie ahead. It has also nudged me to read more about causes and treatment approaches. Breast cancer is a loose umbrella term rather than a common definition. There are lots of different kinds and manifestations of breast cancer. Science has tracked various contributing factors to developing cancer including gene mutations linked to environment, genetics and the pace of cell replication. Various biochemical processes that feed cancer (with glucose in particular) are also being studied. But the most honest answer to why I got cancer is ‘we just don’t know’. However, it is cheering to see that there is now a high survival rate and that the treatments available are often pretty effective. As my specialists have said, “there’s no reason not to be optimistic”. Tamara Levine also took a very proactive approach to embrace complementary medicine. I am less sure of some aspects of this but am certainly being proactive to anticipate and manage side effects. And that seems to be working thus far.
I have lots more great reading lined up (as well as some light frippery as I begin to wend my way through Donna Leon’s 25 murder mysteries with Commissario Brunetti). And, of course, weeding the garden awaits at the end of the (short) blackfly season. Country life.
We hope that all is well with you as the Canadian spring unfolds. Thank you for being part of our Village.