A Blood Transfusion?

I got a surprise when I went in for my treatment appointment yesterday: Dr. Lee told me I needed a blood transfusion.

I was surprised because I've been feeling pretty well. I even went to water aerobics on Thursday and did an hour of moderately strenuous exercise. Granted, I spent most of the rest of the day on the couch, but that's life with cancer. 

Anyway, the reason Dr. Lee thought I needed a transfusion was that my hematocrit was below 30, it was 29 actually, and 30 is the cutoff for giving a blood transfusion. Now, I've never received a transfusion in the whole 11 years that I've been living with cancer, so I had a lot of questions. 

In case you are wondering exactly what hematocrit is, well, I didn't really know either, other than that it has something to do with the red blood cells, and it's one of the things we check every time I go in for treatment. But here's a definition:

Hematocrit

According to that definition, mine should be between 38 and 46, so 29 is pretty low. OK. 

Dr. Lee said I would have to come in on another day, either today or Monday, to get the transfusion, and that between waiting for the blood typing and cross-check to come back and actually getting the transfusion, I would be there most of the day. Ugh. I like to spend as little time as possible at the cancer center. 

Then we discussed the risks of a blood transfusion. The AIDS risk is pretty close to zero these days, which is good to know, but there is some risk of catching hepatitis B or C, something like one in 25,000. 

We also discussed my getting a shot of Aranesp instead, a drug that boosts production of red blood cells, and one that I've had in the past. That's not without risks either, including the possibility that it could cause a cancer relapse, but since I already have active disease, I'm not too worried about that. It has other side effects as well, including stroke and even death ...

In the end, I chose the Aranesp, solely for convenience. I didn't feel like I have a day to spend in a chair watching blood drip into my arm. 

Is It Working?

I went in with just a couple of questions for Dr. Lee, the most important of which was how we would determine if my current treatment regimen was doing any good. One thing about starting a new regimen is that you have to wait a couple of months, at least, before doing tests and scans to see if it is working. 

Right now I'm on Herceptin and irinotecan, but a greatly reduced dose of the irinotecan, because I couldn't tolerate the larger dose. 

Dr. Lee ordered a tumor marker test from the blood I had drawn yesterday, and we agreed that next time I'm in for treatment--in two weeks--we would schedule a CT of my abdomen to check on my tumors. 

Neratinib

I also gave Dr. Lee a copy of the research I've done so far on Neratinib, which I think will be my next treatment, and I told him I would contact the company about getting it for free. That's going to take some work, and I can't tackle it until I get my taxes done (I had filed for an extension, so now I have to do them. Argh). 

This is what I gave Dr. Lee: Researching Neratinib

A Flu Shot?

Dr. Lee also raised the issue of me getting a flu shot or two, but I told him I thought that I couldn't get it with the irinotecan. I remembered that from the drug handout I'd read before I started on this one. He went away and checked that, and sure enough, no flu shot with irinotecan. 

The info we both had didn't say WHY, so don't e-mail and ask me, because I don't know. 

I'm actually fine with this, because I never get a flu shot. I prefer that my own immunity--no matter how battered--fight off things like the flu.

Of course, Dr. Lee pointed out that I am immunosuppressed, but I replied that I use hand sanitizer, don't see a lot of people during my daily life, and avoid people who are coughing and sneezing. 

And I wash my hands a lot. Oh, here's something on hand-washing: 

Yuck! Wash Those Hands!

Yuck! Wash Those Hands! Take 2

Three Hours in the Chair

After my appointment with my doctor, I went to the treatment room, which is right next door, and spent three hours or more in the chair getting my premeds and my Herceptin and irinotecan. Dr. Lee increased the dose slightly on the irinotecan, so we'll see how I do with that. 

This drug takes forever to infuse: 90 minutes once it's up and running. 

I also got the shot of Aranesp, which goes in the muscle of the arm. 

I was tired when I was done, and it was almost 6 p.m., so I came home, ate some lentil soup (homemade with my garden vegetables), ordered a pizza and called it a night. I watched a couple of old movies online before bed. Had a bit of trouble sleeping, despite being tired and taking a sleeping pill, but that was the steroids I get before the chemo. 

Now, Saturday morning, I feel pretty good. I have a couple of pieces of jewelry to finish and Younger Son is coming home from campus today. 

Read about Aranesp: Aranesp: More Bad News

@ Jeanne Sather 2009. 

Comments

[amy]

Marshall had a lot of blood transfusions and he always felt better after. I thought of it too late, but when people asked me "What can I do?" I should have said, Give blood.

[jeanne Sather]

Donating blood is good. We should probably all ask our friends and families to donate.

The Aranesp seems to be working already. I feel great today!

[carrie s]

After 9-11 I started giving blood every 58 days (when my iron was high enough that they didn't send me away.) When Jeff got sick I felt too depleted to be able to continue, and kind of that I was giving everything I could give already. But I guess I should go back to it. Thanks for the reminder. Hope you are feeling well.

[jeanne Sather]

Hi Carrie--I'm really good.