The White Blood Cells (WBC) have played a significant role in my life for the last two years since my cancer diagnosis. Why did I not write about this earlier? Because sometimes my absent-mindedness takes precedence. I wish I could blame cancer for it too. Anyway, let us get back the focus on WBC and don’t be surprised if this blog turns out to be a science class.
Impact of Chemo
The role of chemotherapy drugs is to kill the fast-growing cancerous cells in the body. Still, because it is dispersed to the entire body, it also kills noncancerous fast-growing cells. Before reading further, can we do a quick science knowledge check – where are the fast-growing cells in our body? Hey, I gave you a fair warning earlier about this becoming a science class.
Well, it’s the cells making the hair follicles, the cells in the lining of the mouth and the lining of the digestive system, and the cells in the bone marrow. So the typical side effects one experiences with the treatment that is why is –
- Hair loss from the damage of the hair follicles (that is why I don’t view it as a huge problem)
- Mouth sores because of the damage in the lining of the mouth (prescription based mouth wash is given called Magic mouthwash)
- Nausea, diarrhea, and vomiting – from the damage to the lining of the digestive system (I get many pre-meds before chemo medication to address these issues)
- A weakened immune system from the damage of the cells in the bone marrow which makes the white blood cells (WBC), red blood cells (RBC), and platelets.
Bone marrow is a fast-growing soft, spongy (like jelly) tissue found in the center of most bones. There are two types of bone marrow: red and yellow. Red marrow contains blood stem cells that can become red blood cells, white blood cells, or platelets. Yellow marrow is mainly fat. In adults, the bone marrow that makes the most blood cells is found in the hip bones, shoulder bones (scapula), bones of the spine (vertebrae), ribs, breast bone (sternum), and skull.
Another critical thing to remember would be Neutrophils – a type of white blood cell (WBC) that are first responders to infections and heal injuries. Yes, you read it right about the type of WBC.
Are you wondering why am I giving all this information? Because very soon, you will be reading about how all this impacts me.
Chemo Cycles and WBC count
The impact of chemo medications on WBC depends on many factors like the chemo drug itself, the dosage, the frequency of chemo, general health, age, type and stage of cancer, etc. With a low WBC count, the neutrophil count goes low too, and the primary line of defense against bacteria and viruses is lost, making me very vulnerable to diseases and infections.
A typical WBC range for women is 4.8-10.8, with the neutrophil range being – 1.5-6.5. By now, if you have been following my blogs, you know I get chemo on Thursdays. So I get chemo on two consecutive Thursdays, followed by a break week. Before every chemo, blood work is done. With continued treatment for the last two years, my WBC averages around 3.5, with the neutrophil at about 2.2 on the first Thursday. Remember the chemo impact? It kills the cells, yep, resulting in my WBC dropping to about 2.5 and neutrophil to about 1.6, barely making the passing number the second Thursday. I get the WBC injections on Friday, Monday, and Tuesday after the second chemo, followed by a break from chemo to recover from the WBC count, only to be beaten again in the 4th week. The cycle continues.
Typically, chemo takes about a week or two to damage the cells; with my week starting at that low a number, I am actually inviting all the viruses and bacteria to come and get me. With the weakened immune system, even though I try to be extremely careful, I still ended up with shingles a few months ago, multiple urinary tract infections, a cough that lingered for a long time, etc. So to maintain the numbers, the WBC injections are a blessing.
If your next question is, what happens to the RBC and Platelet counts? Then, yes, low RBC causes anemia which is common for people with cancer. That is, monitoring your iron count is essential. The platelets are also impacted – many people suffer from bleeding, and there are multiple reasons as to why usually, if you are undergoing chemo, then they recommend not getting hurt – because you could bleed more, and with low immunity, it could take longer to heal or sometimes lead to infecting organs making it difficult to cure.
White Blood Cell (WBC) injections
I am thankful that there are injections that stimulate the bone marrow to make WBCs faster, but the side effects overwhelm me. In these two years of my cancer journey, I have learned that these medications come with many side effects, and if you start with only a few early on, eventually, you catch up to experience many of them together.
With continued treatment, the bone marrow might have weakened, and with the WBC shots, it overworks to produce the WBCs periodically. The side effects from the current chemo medication that I endure are nausea, fatigue, low WBC, dizziness, constipation, and the side effects of the WBC injection include – fatigue, fever, chills, abdominal pain, and bone pain in the back and skull. Although taking Claritin helps reduce the side-effects – yes, Claritin- allergy medicine, it somehow magically works for WBC injections. However, many times the bone pain keeps me awake the entire night. No amount of pressing my legs or back massage by Robin helps because the bone is hurting, not the muscle. It is tough to explain the back pain, which occurs periodically, like cramps. I also experience immense pressure in the skull, almost making me think my head will burst anytime.
A high-protein diet with iron is recommended for healthy bone marrow. I balance my food accordingly on those days. But even with all that, the pain becomes unbearable, and sometimes I end up crying on Friday, Monday, and Tuesday nights. Not that strong after all, and all my resolute to not cry to cancer is tossed out of the window because of the pain. Robin deals with me with the utmost patience and tries to give me all the strength needed. I can confidently say that I have a high capacity to bear the pain, but even with all that, these three days become a testing time. If I miss my exercises, it is mainly one of these days when I feel exhausted, and no sleep at night just makes it even more challenging. I almost feel like a zombie walking to the clinic on Tuesdays for my WBC shot.
What happens in the rest week?
I take 2-3 days to recover from the WBC shot on Tuesday, so usually between Friday to the following Wednesday before the Thursday chemo, I manage to meet friends, travel, write, etc. The likelihood of me doing things I enjoy is higher these 5 days with reduced side effects from chemo and WBC injections. I look forward to the break week, and don’t waste my good days. In fact, as I write this blog today, it is my break week and I plan to meet my girl friends for dinner soon.
While all this is undoubtedly challenging, I know this, too, shall pass. The will to live is way more enormous, and no side effects can pull me down. I find motivation in many things, and music is one of them which also energizes me.
Leaving you all today with this beautiful Tamil (South Indian) song: Idhuvum Kadanthu Pogum (This too shall pass)
Breast Cancer Journey 