Watching the Bloodwork in Here Be Dust

This past Thursday was my fourth Taxol infusion. Eight more to go!

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At least, that's the plan. We'll see what my body says.

I've been feeling relatively fine, all things considered. Certainly I'm not up to pre-chemo snuff, but my side effects have been mild thus far.

My bloodwork, however, begs to differ. Here are a few examples:

My other iron levels test out fine, but as I understand it the iron is not being transported in my body very well, hence the dip in iron saturation percent.

My WBC (white blood cell count) experienced peaks and valleys under Adriamycin/Cytoxan; those peaks came from the Neulasta shots I received to rebuild immunity. Following my first Taxol infusion (and without Neulasta), my immunity began a steady decline and is now trending toward neutropenia.

My RBC (red blood cell count) also experienced peaks and valleys under A/C but still showed a steady drop, which increased after my switch to Taxol. Among other blood test results, this prompted my oncologist to order an anemia panel, which is where all the iron levels come in.

According to the American Cancer Society's "Anemia in People With Cancer", "Doctors often define anemia as a hemoglobin (Hb) level of less than 12 g/dL (grams per deciliter). But many people do not feel much different until their hemoglobin level falls below 11 g/dL, or sometimes even lower." My Hb fell below 11 g/dL after my first two Taxol infusions and currently clocks in at 10.8 g/dL.

My ARNP had mentioned Procrit as a way to treat anemia, but my oncologist told me this past Thursday that Procrit is not recommended in my case. As the ACS drug guide says, "It should not be used in people whose treatment is expected to cure their cancer.... some patients getting this or similar drugs have had tumor growth or shorter survival."

I'll get to the semantics of "cure" in a minute. The bottom line is that the aim of my treatment is to eradicate cancer from my body entirely, as opposed to managing cancer as a chronic illness. The aim of chemotherapy for me is to cut my risk of recurrence. The best scenario is that the aggressive treatment I'm getting wipes out any and all cancer cells for good.

"Cure" is something of a misnomer. Here's what the National Cancer Institute says:

"A cure means that treatment has successfully eradicated all traces of a person’s cancer, and the cancer will never recur (return). A cure does not mean, however, that the person will never have cancer again. It is possible that another cancer, even the same type of cancer, will develop in the person’s body at some point in the future.

"A remission means that the signs and symptoms of a person’s cancer are reduced. Remissions can be partial or complete. In a complete remission, all signs and symptoms of cancer have disappeared.

"If a patient remains in complete remission for 5 years or more, some doctors may say that the patient is cured. However, some cancer cells can remain undetected in a person’s body for years or even decades after apparently successful treatment, and these cells may eventually cause a recurrence. Although most types of cancer usually recur within the first 5 years after diagnosis and treatment, later recurrences always remain a possibility. Therefore, doctors cannot say with any certainty that an individual cancer patient is cured. The most they can say is that there are no signs of cancer at this time."

Ideally, my breast cancer is a one-shot-only. But there are no guarantees. My job is to fight the good fight and to keep my fingers crossed.

The final graph is for total protein. I make sure I get plenty of dietary protein (which is also recommended during chemo), but blood protein refers mainly to two classes of proteins: albumin, which helps prevent fluid from leaking out of blood vessels; and globulins, which relate to the immune system. According to the NIH, total blood protein readings can also relate to liver and kidney functions.

So far, my albumin, globulin, and A/G ratio are within normal range. From what I can tell, my liver and kidneys are working fine (according to a gaggle of tests). It's just that my total blood protein has been taking a dive. That goes on my list of things to discuss next week.

Another item on my list relates to the neutropenia. Despite my anemia I continue to exercise, which energizes me. The endorphins do wonders for my mood. And exercise has been shown to improve survival for breast cancer patients.

That said, it is possible to overtrain. I've done it in the past, although I don't feel as though I've been currently overtraining. Overtraining induces fatigue and lowers immunity -- in the past I have overtrained myself into a cold.

These days my immunity is compromised by chemo. Exercise boosts immunity, which is a good thing, but is it possible to exercise too much in this instance even without overtraining? Should I dial my workouts down a notch? Would that make a difference as far as my neutropenia is concerned? Again, that goes on my list of questions for next week's appointment.

It's a little surreal to feel as good (and, yes, energized) as I do while watching some of these numbers skew (and the skewing is typical for chemo). Talk about an out-of-body experience. But the fact remains that my body undergoes a controlled poisoning, and chemotherapy strives for that delicate balance of killing the cancer without killing the patient in the process. That's why my blood gets tested weekly on dozens of parameters. Whether and what interventions occur will depend on where those numbers go.

Meanwhile, we keep watching.