We dit it! We finally hit rock bottom! And no, before you ask, this isn’t a terrible pun about (the amazing) Dwayne ‘The Rock’ Johnson, or something else more farcical. I’m being literal. We hit rock bottom, and I’m very, very happy. Why? Keep reading, it’s going to take a bit of explaining.
‘What’s chemo like?’
I hear this question quite frequently. Since I haven’t had a chance to talk to everyone, and since it can take quite a bit of explaining, I decided to write about it in this Medium post. So, what is chemo like? The answer, of course, is that it depends when you ask me.
In addition to the obvious loss of hair, chemo is a deluge of bodily symptoms that range from mildly droll to calamitous, with a heavy skew towards the latter end.
That’s the TLDR version.
To explain it further, I have to break down each round of chemo into its three parts, which are: Infusion, The Pit of Despair, and Recovery. The total round is three weeks long, with each part taking one week. Infusion is the only exception since it technically only lasts 5 days, but let’s round up for charity.
During the Infusion period, in addition to oral medications, cancer-fighting chemicals are pumped into my body continuously for the 5-day treatment. The hospital gives me a portable, battery-powered pump and hooks me up to a bag containing a chemical cocktail, primarily doxorubicin. The bag is swapped out for a new one every 24 hours back at the hospital.
The oral medications during this period will make you jittery and irritable, and you have to time them right so that they don’t keep you up late into the night.
The infused chemo fluids are an entirely different matter. Over the 5-day period you feel yourself being filled, as if your body were an empty vessel. It starts at your feet, working it’s way up your legs, towards your hips and chest. The hot, sticky, toxic molasses then rises above your shoulders and up your neck. It finishes, deviously, right at your adam’s apple. Hovering there, never rising and never falling, it tickles your throat whenever it fancies. This of course has the effect of making you feel nauseous and causing you to gag if you, for example, decide to brush the back-side of your teeth.
At the end of the Infusion, the final send-off is a literal shot to the abdomen of a chemical called Neulasta. This has the beneficial effect of helping your body produce white blood cells, but of course it has side-effects that rollover into the next period of chemo.
The Pit of Despair
Here we are, the Pit of Despair. Welcome! Every day may feel like getting body slammed by The Rock (see above). So stay a while and enjoy the attractions.
That Neulasta shot you just got is now causing you pain in your joints and muscles, almost as if you are recovering from a hard workout. But of course, you haven’t been working out because you have cancer, so thank you for that reminder. Every time you open your mouth for the first bite of a meal, it feels as if your jaw is a set of ancient gears that are being forced to move for the first time in a thousand years. But this, at least, will only last a few days.
Your taste buds slowly mutate. Water becomes metallic, and most foods just become more bland. I once turned away my mother’s chicken soup, believing for a second it must have been made with putrid sewer water. My fiancée later informed me it was actually quite delicious. During this time, I tend to prefer cheesier foods like lasagna and pizza.
You may develop sores on the inside of your mouth. You’ll be unable to chew solid food without experiencing excruciating pain, and you may begin to talk like a high-schooler that just got braces.
Your digestive system is thrown into total chaos. If you haven’t seen the movie Spy (94% RT), stop reading and go watch it right now because this part of chemo makes all too real the following hilarious exchange:
Susan Cooper: What happened?
Rayna Boyanov: I’ve never seen somebody dive for stool softener before. That’s one thing that happened.
But, wait! There’s more waiting for you in the Pit of Despair. Fatigue. Terrible, terrible fatigue. Some days the journey from the bed to the couch and back will sap all the energy your body can muster. Answering the front door causes you to breathe heavily, like you just ran full speed around the block. Showering is the equivalent of the ‘I’m sprinting at a 10 incline’ Barry’s Bootcamp class.
While we’re on the topic of showering, in the ‘mildly droll’ category of symptoms, your fingers will wrinkle almost instantly after getting wet. I don’t know why, they just do. At least it adds a little amusement. Also on the milder side of the symptom spectrum, I developed a bit of numbness in the tips of my thumb, index, and middle fingers. I’d be interested to find out whether the cause of these two symptoms is at all related.
Finally, you’ve made it to Recovery. You start to feel a bit more like your old self. Some effects like the fatigue linger, though not at full intensity. This is a great time to make plans with friends. They’ll see you in relatively good health and think that chemo isn’t as bad as some people say. Enjoy these seven days, because you’ll start all over again soon and recover less each round.
Whew! Glad we got that out of the way. I’m sure that novel-length descriptions of various chemo symptoms aren’t what anyone is searching for in the Kindle store, so let’s get back to the good news…
Hitting Rock Bottom
Throughout chemo, you get your blood drawn twice a week, and the doctors monitor you closely to see how you’re responding to treatments. One metric extracted from your blood sample that is particularly important is your ANC, or Absolute Neutrophil Count. Neutrophils, for those of us who don’t have medical degrees, are a type of white blood cell, the ones that protect your body from infectious diseases.
While you are enjoying your visit to The Pit of Despair, your ANCs are supposed to drop to precipitous levels. To give you an idea, ANCs in a healthy human body will typically be in the range of 1,800 to 6,800 (x 10E6 per liter of blood). The target for each round of chemo is to drop below 500 ANC. Failure to reach this level, as my doctor informed me, would result in an increase in the intensity of my chemo infusions. The doctor’s goal is quite literally to pump as much chemo into you as your body will tolerate, with the 500 ANC level being the threshold indicator.
I never managed to drop below 500 ANC during my first three rounds. As a result, each subsequent round was increased in intensity by 20% — Round 4 was 73% stronger than the Round 1. This is (beautifully, if I may praise myself) depicted in the following bar chart I put together.
As the rounds became harder and harder, you’ll understand my HUGE relief when I finally plummeted to neutropenia. My ANCs as of last Friday were 210! Rock bottom! There will officially be no more increases in chemo intensity. Of course, this also means that my ANCs are 89.3% below the minimum normal level, and I’m at enormous risk of infection and hospitalization, but now you know why hitting rock bottom never felt so good.