Blood

My experience with leukemia taught me many things. I'm not referring here to self-awareness, or deep, meaningful life-changing revelations - though it did provide some insight in these areas - I'm referring to knowledge. Specifically, blood knowledge.

For example, before I got sick I did not know my blood type. Now, I will never forget that I am B+. I did not know what was in blood, or how transfusions work, or what an implantable port was, or that such a thing even existed. And not only do I know this stuff now, but I know it all in Spanish. You have to appreciate the extra challenge, folks.

I am contemplating all of this because tomorrow is blood test day. I'm not going to explain how frightening this is for me, you can use your imagination, but if I were to try I suspect I might make use of the word 'paralytic', and perhaps 'unbearable', and 'overwhelming anxiety' might make an appearance as well...you get the idea.

But no matter how much it scares me, this is my lot in life just now - Cancer Part II: Follow-Up Tests. It is stressful, but far less so that 'Cancer Part III: Relapse' would be so I must remind myself not to complain.

Now, I don't know how often patients with different types of cancer have their blood tested, but in my case they drew blood almost daily throughout my treatment, except during the last two months, when they tested it every three days or so. Follow-up tests are only three months, which is excellent in terms of diminishing needle-pokings, but carries with it a huge rise in worrying-in-between-tests.

Regular needle stabbing does have its effects...

I still have faint bruising and soreness... I will have to ask my doctor later this month when I see him if this is going to go away or if I am likely to look like a junkie forever.

Anyway, I am told that tomorrow's tests are fairly routine. One is a standard blood count test, and the other four are all to check liver function, which I'm told is standard after any heavy medication. The spectacular thing about tests in Colombia is that they hand over the results directly to the patient. So tomorrow afternoon I can access them online and hopefully do a little victory dance and then carry on with my day. (I can also forward them to my doctor this way, and I don't have to worry about losing the paper before I got to see him in two weeks - very handy indeed!)

This is what the results look like, for the blood-count test, anyway. The liver tests are totally new to me and I have no idea what they are supposed to look like. If it is a question of normal or not normal it will probably say so in the results but reading these in any meaningful way will have to wait for my visit to the doctor.

The report shows my blood results, what unit they are measured in, and the normal range for my age and gender. Quite user-friendly, wouldn't you say? I circled the numbers that are most important.

The red circle is the hemoglobin, these are the cells that carry the oxygen around the body. Low hemoglobin = anemia, and makes you too tired to walk up the street or get out of bed! If this number goes below 8.0 it is transfusion time. I think my record was 6.9...

The orange circle refers to platelets. Platelets are the cells in your blood that allow it to clot. Low platelet count is called thrombocytopenia, and it means that if you happen to pass out on the bathroom floor and bump your head just a little bit on the toilet they are going to make you sit through a CAT scan and an MRI to check for internal bleeding.

It also means random outbreaks of petechia - these look like little red freckles which are actually superficial bleeding into the skin. I catch myself examining my skin for these little dots on a regular basis.

A count less than 10,000 means transfusion time, I think I made it as low as 2,000 at one point. Platelet transfusions are interesting because platelets are not red - they are an almost transparent yellowy colour so it looks like they are putting a bag of snot into you. And as an extra bonus, I tend to be allergic to them, so these transfusions come accompanied by some heavy anti-histamines of the knock-you-on-your-ass-in-less-than-three-minutes variety. Basically, platelet transfusion = immediate and extended drug-induced nap.)

The blue circle is the white blood cell count. White blood cells fight disease. When you don't have enough of these - a condition called leukopenia - you are not allowed to go outside or interact with other people, and anyone that comes near you has to disinfect their hands first and wear a medical mask.

Leukemia (or at least my type, I don't know much about the others) is basically blood cell production gone awry. Certain cells don't develop properly and the blood becomes full of these immature and useless cells called myeloblasts, which crowd out fully developed and functioning cells. So, it is very important that tomorrow's tests show normal levels of healthy cells, and no blast cells. Positive vibes, people!

For your enjoyment, some 'transfusion highlights' below... over the course of my treatment I was given 15 units of whole blood and 96 units of platelets. The nurses joked with me that I am now at least half Colombian :-)

Transfusions take a looooong time...up to 5 hours per bag of whole blood, and they usually do two consecutively. So the nurses have developed a number of strategies to speed the process up. Below observe the blood pressure cuff trick, followed by the tape-the-bag-to-the-ceiling tactic.