Iron Man Will Glow in the Dark

Hemoglobin Treatment

I’m not inclined to display pictures of myself but I’m feeling really good so it just seemed the right thing to do. Yesterday I had a chance to get some flying time in. I’m not sure who snapped this picture but that’s a pretty good side of me.

If you read my post titled What Goes Around Comes Around, you already know that my hemoglobin tanked earlier this week. A normal count for a man my age is between 120 and 140. Mine was 55 so even finding the energy to sit up was a challenge. I also passed out in the wee hours of the morning and dented my wall when I collapsed. For the first time in my life, I needed to have a blood transfusion.

Original: A single unit of blood is about 450 ml. Correction (See end of post for an explanation): A single unit of blood is about 250 ml. It takes between three to four hours to empty a unit. After seven hours I had taken two units and my hemoglobin count increased to 62. After a third unit, my count was up to 69. After a fourth unit, I was at 85. According to the protocol, four is the maximum I could have.

I went into the Emergency Department at Dartmouth General around 1:00 pm on Monday and completed the transfusion of the fourth unit around noon on Tuesday. My colour had returned to normal and my sense of humour was back. I felt normal. I was back. Crisis averted.

So why did my hemoglobin tank? There is no definitive answer. Blood loss is the most common cause. So that begs the question of how would I know if I was losing blood? Here are common symptoms:

  • Obviously getting cut or an accident with an associated blood loss but that didn’t apply to me.
  • A nose bleed results in a loss of blood but that’s typically only a small amount and that didn’t apply to me.
  • Coughing up blood or vomiting blood but that didn’t apply to me.
  • Blood in your urine but that didn’t apply to me.
  • Blood in the stool (poop) which might show as reddish ting in the toilet bowl but is more likely to show as a black stool and may be tar-like in appearance. I didn’t think that applied to me but since Monday, I’ve been paying closer attention and my stool was on the blackish side of the colour spectrum but that doesn’t seem to be the case now. It looks pretty normal … too much information eh?

As I write, I feel full of energy and ready to take on the world. I asked Dr. O’Brien if I could get a little more active and he said walking would be okay but only in moderation. It is too important to build my strength for the radiation and chemo ahead.

Dr. O’Brien plans to put me on an iron IV once a week starting in a few days. This should restore my hemoglobin level faster than possible through diet or supplemental pills. Many people find that taking iron supplements is hard on their stomachs. Given the drop in my hemoglobin was likely a gastrointestinal blood loss (stomach or intestines), anything that might aggravate my stomach is not under consideration. Throughout life, I’ve not been prone to nausea but these days I have mild nausea a lot of the time. The cancer clinic nurses suspect its a result of the secretions from my tumor which is stimulating my esophagus to secret more fluids. Who knew that the esophagus has secretions. I guess I should have been paying closer attention in health class.

Should you not understand the connection between hemoglobin and iron, here’s what I can tell you in human-speak … at least how I understand it.

Hemoglobin is protein in the red blood cells. Its role is to transport oxygen throughout the body. Iron is used as a building block in the production of hemoglobin so increasing my iron will result in restoring my hemoglobin numbers.

So starting next week, I will be iron man! Tony Stark stand aside … new guy on the block.

Getting Ready to Get a Glow On

Friday afternoon Janet and I were back at the Cancer Clinic. Our mission is for me to get my Radiation Markers Tattoo. This is the first time I’ve been to the radiation area of the clinic. It is bright and inviting, the reception staff are welcoming and informative, the clinicians are knowledgeable and proud of their work, and I look forward to starting treatment.

The treatment plan for every cancer patient is custom-tailored and unique for each individual. Although not yet finalized, on day 1, I will get radiation and chemotherapy, on days 2 to 5, I will get radiation only. On days 6 and 7 I will rest and recover. After week one, there will be four additional weeks of his model for a total of five treatment weeks. If I am still strong and fit in week 5, the odds are an additional week will be added. After that, I will rest for 4 to 6 weeks to recover and prepare my body for surgery. In the 8-hour surgery, most of my esophagus will be removed and my stomach will be stretched up and reattached to what remains of my esophagus just above the level of my nipples. So swallowing as I know it today will never be the same but I will learn a new way to pass food and drink through my mouth to my newly positioned stomach. I bet I’ll be able to chug better than I can now. ha ha

For every radiation treatment, the goal is to blast my tumor with powerful x-rays in exactly the same way. Over the five treatment weeks, I will have 25 radiation session and 5 chemo sessions. In the picture to the right, clearly that woman is not me and during a session, patients do not move. That machine does rotate around the table so that the x-rays blasts my tumor from all sides. I will feel like I’m in a science fiction shoot.

In the Friday session, I swallowed a chalk-like substance with the consistency of a pudding. It coated the inside of my esophagus and then I was run through a machine that looked like a cat scan. The clinicians were able to see the location of my tumor and use this to figure out where to mark my skin with permanent marks. I now have four small tattoos. No, they are not renderings of Janet in a bikini. They are tiny dots the size of a freckle. Two are on my chest, one at the top of my breastbone and the other on my belly. The other two are on my sides. These four marks are used to line up that massive machine in the picture to ensure the x-rays hit my tumor in the same way every session.

The role of the x-rays is to destroy cancer cells. Nearby cells will be damaged but they can grow back. cancer cells cannot grow back. Because of the proximity of my lungs to the location of my tumor, odds are the bottom of my lungs will be irritated and I’ll develop a cough, but this will pass once the radiation stops. I can also expect my skin to get red and sore like it does with a sunburn. I’ll treat this with a topical cream.

Since my tumor is localized to the 8 cm of my esophagus just above my stomach and three lymph nodes in the wall of my esophagus close to the tumor, my chemotherapy will be moderate. There are multiple mixes of chemo drugs with varying potency. When someone has cancer throughout their body, they get high dosages. In my case, the chemo will support the radiation treatment. My understanding is the chemo targets cells that duplicate at a high rate and prevent the duplication so they die off. There are several good cells in the body that duplicate at a high rate like those of the skin, hair, intestines, and bone marrow. Chemotherapy cannot discriminate between good cells and cancer cells which is why people lose their hair and have other side effects. At this time it is unknown whether I will lose my hair. If I don’t, I plan to shave anyway. I mean it as a gesture of gratitude for Alexis Gravel who shaved his head as a sign of support shortly after I told him about my diagnosis.

I am in a holding pattern waiting for my expert cancer team to finalize my treatment plan. I expect that will happen this week and I may start around February 3rd. Is there an opportunity here to get a betting pool going? Winner take all!

As always, thanks for being at my side as I take on this challenge. The overwhelming words of support are humbling. If there is any aspect of my experience you’d like me to chat about, please let me know and I’ll make sure it gets included.

Peace, Love and Laughter

Phil
Future cancer Survivor

Correction – January 28, 2020

What follows is a comment from my brother Mike. He was much more in the moment than I when the conversation he mentions took place.

Great update! One factual correction. I believe we were told by the nurse in your emerg room that a unit of blood is typically 220-280ml. Here’s what Google says (Basically, they start with 500ml and then centrifuge it and it ends up between 200 and 285ml):

“Typically the bag of packed red blood cells will say on the label “From 500 ml CPD (or CPDA) whole blood.” CPD stands for citrate/phosphate/dextrose, an anticoagulant and preservative, and the extra A is for adenine, which extends the shelf life. Whole blood is not what is transfused, though. The original 500 ml is centrifuged, and the cells are removed. The cell portion, which is what most people think of when they see a transfusion, has a hematocrit of about 70 to 75%, meaning it is 70% red cells and 30% liquid, mostly plasma. Given that a typical hematocrit in an adult is about 40%, the original bag of blood will have something like 200 ml of packed red blood cells (40% of 500). If the unit has a final hematocrit, after processing, of 70%, then the total volume in the unit is 285 ml (200/0.7). But this is an average, and there is NO WAY to give an exact number to how much blood is actually in a unit.

4 Replies to “Iron Man Will Glow in the Dark”

  1. Good update. If I may, I have one suggested correction. I thought the nurse in your emerg room had told us a unit of blood was typically in the 240-280 ml range or thereabouts. I will Google it….now back from Google land. See below, which I think is telling us they start with 500 ml, centrifuge it and end up with between 200 and 285.

    Mike

    “Typically the bag of packed red blood cells will say on the label “From 500 ml CPD (or CPDA) whole blood.” CPD stands for citrate/phosphate/dextrose, an anticoagulant and preservative, and the extra A is for adenine, which extends the shelf life. Whole blood is not what is transfused, though. The original 500 ml is centrifuged, and the cells are removed. The cell portion, which is what most people think of when they see a transfusion, has a hematocrit of about 70 to 75%, meaning it is 70% red cells and 30% liquid, mostly plasma. Given that a typical hematocrit in an adult is about 40%, the original bag of blood will have something like 200 ml of packed red blood cells (40% of 500). If the unit has a final hematocrit, after processing, of 70%, then the total volume in the unit is 285 ml (200/0.7). But this is an average, and there is NO WAY to give an exact number to how much blood is actually in a unit.”

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