Nadir is the term used to describe the time between rounds of chemo. It's when a chemotherapy patient is at his or her lowest. I never really heard anyone use it until recently but now I hear it all the time. I have been wallowing in my nadir all week. For me that has meant very low blood cell counts and with that comes very intense fatigue. My counts have been as bad this week as they were good last week.
How low is low? My white blood cells reached a low of 1.0 K/uL (reference range 4.1-10.9). My hematocrit, which indicates the amount of red blood cells, dropped to a low of 23.3% (reference range 37-51%). My platelets hit a new personal record dropping to 12 K/uL (reference range 140-440 K/uL).
This was a sudden and deeper than expected dive which has required Neupogen shots every day this week, a transfusion of two units of red blood cells on Thursday, then a transfusion of platelets on Friday. It is now Saturday and I am back in the hospital (as the clinic is closed on the weekend) to have my blood checked again and to get another Neupogen shot. This is all in an effort to assist my bone marrow (which is still recovering from the two autologous transplants) in bringing me back up to snuff so that I can receive more chemo as scheduled on Wednesday. Then the process starts all over ... .
When my red blood cells are low that means that the oxygen I need is not being efficiently carried around my body. When my platelets are low this means that my blood cannot properly clot nor heal cuts or bruises. The combination leaves me very weak, very tired and very mentally flighty. I can't handle more than one task at a time and I forget things just moments after I heard them. After a slow walk up the stairs my heart is racing and my breath is short as my body has to work extra hard to perform such a daunting task. I get so tired it hurts and I can do nothing else but lay there like a blob. Oddly though, sleep is hard to come by, I think because I'm so beyond exhausted. I'm haunted by nightmares and can't sleep through the night without having to go to the bathroom as my body is doing so much purging. My new plan is to try and choose one thing every day that I really want to do and save my energy up for that. i.e. if I know I want to take a walk then I can't expend all my energy doing laundry and dishes that morning. Otherwise, by 2 p.m. I'm spent. Dishes and laundry have yet to be the day's choice activity.
Getting out of this nadar requires a lot of time and a lot of waiting. It is a beautiful summer day out and here I am waiting for blood work results. It's been two-and-a-half hours. It's very likely that I won't need a transfusion but regardless I still have to wait and see that for certain.
It's frustrating at times because when time is so precious and I know I'm going to be trapped in a hospital for at least a month very soon, the cancer center or hospital is the last place that I want to spend my time. I want to be out in my new (used) kayak or sitting in a beach chair by the river with Craig and Sammy. Even for the quick CBC finger prick appointments you still have to drive in, drive out, register, wait, see the nurse, see the doctor, wait, wait, wait ... . It gets old.
It's also hard to keep or make any plans with anyone as every day something new seems to crop up and I can never count on anything taking the anticipated amount of time. Plus, with my white count so low I again have to be very cautious about crowds, sick people, what I eat, etc. This also gets very old. I haven't been able to go to the yoga studio all week; we couldn't see a friend in New York because her baby had just received live vaccines and I could easily catch the viruses; I couldn't sit in on the Stupid Cancer radio show broadcast as planned; I missed a planned breakfast at my favorite place with a friend this morning; I missed a get together with friends last night and will miss a birthday party tonight. Being a cancer patient truly does command my schedule right now, but I do my best to make the most of the free time that I do have and try to remember the fact that all these appointments, port pokes, blood draws, quarantine and the incessant waiting are all just part of the process that is saving my life.
It is a full-time job and the most important position I have ever held. It seems it's time for a promotion?