Wednesday, March 10, 2004

How Low Can Your White Count Go?

Dave’s Great Adventure, Book Two
Chapter 2, Verse 9
March 10, 2004
It’s Limbo Time...again!

About sixteen months ago I used this phrase to describe the fact that my white counts were extremely low. You remember, don’t you? “How low can you go?“ At that time my white counts, after four rounds of chemotherapy, with the previously noted Rituxan Fludara and Cytoxan (FCR for short), were down to 1,100 (normal is about 6,000 to 12,000 for most folks). Some of you may actually recall that event. Well, it turns out I hadn’t seen anything. My white counts are now so low, the lab would call the numbers “panic” values, meaning they would hurriedly call the doctor who was treating the patient with the news that he/she was in critical danger as indicated by the numbers.

But more about that in a moment.

I’m going to send this letter out to the whole mail-list again, as I know at least a few of my correspondents are out of town, and others may have not checked their e-mail from recent days yet, and so don‘t know about my request for a response. Our friends in Castle Rock are in fact in Mexico at this moment, a buddy from here in town is, I know, in San Francisco (what's that town's nickname...?) teaching computer stuff, and I suspect others may be on spring break, etc. So that’s why all of you are still getting this communication, for the moment. But I won’t keep pestering all of you too much longer.

I got a number of comments on the “pop test” that I sent out recently. If anyone out there didn’t look at it because they thought I was seriously sending out a test, look again. I hope you would get a giggle out of it. My wonderful colleague Joan, whose fault it is that there was a test at all (damn, gave away an answer!) wrote “Are you sure somebody didn’t put some LSD in your tubes? I laughed so hard I had tears in my eyes...I’m to blame for all this?”

Atlanta Kathy, who works in a real estate office said, ”I laughed so hard some of the brokers here wanted to read the test. Anyway keep me on the list. I sometimes forget you’re fighting a disease. You make things so funny... only YOU, Dave, could come up with a Pop Test.”

Our friend Cindy in El Paso said she was “worried” about me. Regarding the pop quiz she said: “You know you haven't been going through this round too long yet. I was really worried about you before, but, I'm really worried. This stuff is really getting to you this time. You thought the throwing up was bad; I'm concerned that this side effect might even be worse!! :) And hey, how did you find out about my hooking job??? That's confidential information! :) You still make me laugh!” Actually, Cindy really isn’t a hooker, not that I know of for sure....

My cousin/step-brother Tom, also out in the Hotlanta area, said, “Someone has way too much time on his hands.” Well, that’s true. I’m not working, and I can’t get out of the house much. Hey, what else can I do except dream up pop tests? By the way, Tom didn’t report his score. Could it be that he didn’t do well? What about it, Tom?

Our brother-in-law, the Hay Man Ray (he’s an agronomist at Montana State, in Bozeman, specializing in feed grasses[is that right, Ray?]) said, “I enjoyed your quiz. A different way to keep folks up to date, but a lot of work, I suspect.” Actually it wasn’t a lot of work, just a lot of fun. I didn’t really have to try to make the test tricky like HE does to his students!

Now, my sister, Deb, out in Sacramento (which is near “The City,” hint, hint), hasn’t even taken the test yet. She’ll have to get docked a few points for tardiness. And former colleague, patient and great friend Marcia, from the lovely city of Heidelberg, Germany, said “I loved your pop test and think I did well, only missing three (you caught me on the Mensa thing; wasn’t reading it right, as I know you did that on purpose.” What, me try to trick you guys, my gentle readers, on a pop quiz?

Now, curiously, almost all the folks who wrote back about the “quiz” and actually admitted taking it, reported that they passed with flying colors. I wonder if they really checked their answers against the key. The only honest folks in the bunch were Kathy's sister Carol and husband Frank, down in “Duke City” (hey, that could be another test question...”Where is Duke City, and what is it’s legal name?”). They reported “failing miserably.” But really, how many of you REALLY knew that “The City” on the quiz wasn’t here in Colorado. Probably just my li’l sis who lives in nearby Sacramento (which is “Sacto” in Calspeak).

And my good buddy, former colleague and former boss, Cesar, out in Florida, wrote, “Frankly, I do not know whether - when and if faced with the challenges you are facing- I will be able to keep the even keel and humor that you impart on your notes.”

Well you know, you just can’t take yourself too seriously.

The night before I was to get the Cytoxan, and expecting to become very ill soon after, I lay awake in bed. But what was going through my mind? Worries about the risks, the side effects, the possible fatal outcome (unlikely, but possible)? Not at all. I was thinking about jokes about my therapy. (See, I really am a manic-depressive.) You know, I never heard of hypergraphia before that article from the paper that I recently mentioned (oops, there goes another test answer), but I’m beginning to believe in it!

The next morning the first two hours of the treatment were just hydration through my chest tubes, without any drugs to make me feel goofy. So I spent that time writing down the things I had been thinking about the night before. We’re all going to go through something like this, unless we’re (un)lucky (take your pick) enough to have a sudden massive fatal heart attack, car wreck, or something. Hey, you have to roll with it. You can only do what you can do. Don’t worry about the rest, the things beyond your control.

Now, hold that thought while I go back to the report on my labs, technical stuff in which I’m sure you all will be very interested. I went in for the first of my daily complete blood counts (CBC) Monday. Now that we’re done with all the chemotherapy we need to see how my counts do, and when/if they rebound enough to start the stem cell collection. Man, I’m really anxious to get on with that process, if only to get the tube taken out of my chest. It’s really hard to sleep on the thing, always worrying about pulling on it, feeling the plastic hubs against my skin when I try to sleep on my chest, and just generally being aware of the foreign structure attached to my body.

As an “insider,” I had arranged to sneak in the lab before it opened, avoiding the early morning wait, but more importantly, avoiding the crowds of sick folks, as I expected my white count, the infection fighting cells, to be low. I really don’t want to pick up any infections now, after what I just went through with the RSV (...and what’s that stand for...and how do you spell it? Just checking up on you guys). So we got there at about a quarter ‘til eight, snuck in, got the blood drawn and then left just as the sick hoards were arriving. Then we waited for the call with the results.

Our friend, Christine, who works in the OB clinic and has access to the computer information, was looking for the results for us. They finally showed up by about two in the afternoon. I was amazed! The test showed that my red cells were normal, and my clotting cells, the platelets, were down to about a third normal, but still adequate to make me clot okay, but my white counts! Normal white counts vary from about 3,000 to about 12,000 for most folks, with an average number bring probably 6,000-10,000 white cells per CC of blood. But my white count was 300. That’s not missing a zero. And the count of my bacterial fighting white cells was zero. It was reported as 0.0. There were no detectable “neutrophils” in my blood.

Now, I’ve never, in my medical career, seen numbers that low. Of course, I have rarely worked with leukemic patients on chemotherapy. I would have thought that numbers that low would be incompatible with life. Those numbers are, to be quite frank, scary to a gynecologist! We all have bacteria all over and inside our bodies, and all that’s keeping them from killing us are the white cells, and the antibodies our lymphocytes produce. Right now I know I have deadly bacteria in my sinuses, my gut, my lungs, and on my skin. What I don’t quite understand is why I feel so (relatively) normal. Why am I not sick?

I guess my transplanter doc, Jeff, expected these numbers. I didn’t even get a call advising me of how low they were. He has me on antibiotics, which, in the short term, will help keep many of the bacteria at bay. Meanwhile, I’m washing my hands compulsively, keeping my hands away from my eyes and mouth and hoping that these numbers rebound rapidly before something bad happens. I’m not even brushing my teeth or flossing too vigorously, because each time each of us brushes, we introduce bacteria into our bloodstreams. Normally it’s not a problem; now it could be, for me.

So I snuck into the lab again Tuesday morning, to get another CBC done. Then we went home to be shut-ins again for the rest of the day. We got another call from Christine about mid-afternoon. My numbers hadn’t improved at all. That worried me a bit, so I called the folks at the RMCC and talked to them a bit. It turns out that they expect such numbers on a regular basis after the kind of treatment I’ve gotten. But, they thought I might have rebounded at least a bit. However, since there was no rebound, we won’t start the collection yet. I’ll keep getting my blood counts at my clinic for now and when they finally start up, I’ll be going downtown to the RMCC for labs and, eventually, the big procedure.

In old news, I was talking to our daughter in Dallas. She asked why I was so excited about the new monitor screen, the 17” one that I bought quite by surprise while chemo-brained. She couldn’t understand my enthusiasm. It turns out that she, as a computer geek of sorts at Sprint (don’t call her with any complaints, she just does software applications) has nineteen and twenty-one inch monitors!! She obviously doesn't understand what it’s like to be an amateur on the PC at home!

And through all this, my hair continues to “gently” fall out. It’s noticeably thin now, and I expect a massive fallout soon. And there is no longer any hair on my chest. No, wait...there never was any hair on my chest, sorry. Meanwhile, my beard has essentially stopped growing. Ah, yes, THERE’S the silver lining...I don’t have to expend time and resources on shaving for a while.

And to close, let me go back to not taking one's self too seriously. There’s a little song I’d like to share with you. It’s the ending theme from that wondrously irreverent movie, “The Life of Brian,” done by the Monty Python troupe a number of years ago, as they hung on crosses awaiting execution at the hands of the Romans. If you’d like to listen to it, and see the complete lyrics, you can go to:

“...always look on the bright side of life
Always look on the light side of life.

For life is quite absurd
and death’s the final word
You must always face the curtain with a bow
Forget about your sin--give the audience a grin
Enjoy it--it’s your last chance anyhow.

So… always look on the bright side of death
Just before you draw your terminal breath.

Life’s a piece of sh*t
When you look at it
Life’s a laugh and death’s a joke it’s true
You’ll see it’s all a show
Keep ‘em laughing as you go
Just remember that the last laugh is on you.

And, always look on the bright side of life
Always look on the right side of life...
...I mean, what have you got to lose? You know, you
come from nothing-- you’re going back to nothing. What have you lost--

And with that, I’ll ask again, if you haven’t responded, letting me know that you’d like to be kept on this list, just send me a quick “Reply” and I’ll add you to the updated list. My brother, Dan, down Texas way jokes that this is just a cheap way to troll for e-mail. But like I said in the last letter, I truly don’t want to be continually spamming folks who have grown weary of this tale. I suspect most of them will never see the message anyway and will sort of be dropped off without any hurt feelings on either side. I must admit, though, that my request has generated a number of very nice e-mails from friends, just as Dan suspected. I always appreciate hearing from you guys. So, until the inevitable next verse....


“Life’s a laugh and death’s a joke it’s true
Just remember that the last laugh is on you”