This isn't "oh my gosh, that's terrible news", since the protocol has been designed to account for it (it allows for either 21 or 28 day cycles), but it's not what I wanted to hear, either, since (1) the optimal cycle is 21 days and not 28 and (2) this means I'm at an elevated risk for serious infection, so I'll need to be extra careful. This will also extend the time in which I'll be in treatment, obviously. It doesn't necessarily mean that the next cycle will be 28 days as well, but this is certainly a possibility. In any case, my white blood cell counts should start to rebound by next Monday, since the usual nadir for these counts is around the middle of the 21-day cycle (with today being day 15). If my counts haven't bounced back up by next week, they can also give me some (very expensive, but covered by insurance) shots to boost them, but the oncologist didn't seem to think that this was called for in my case.
He also didn't give me special advice about diet or exercise (I asked), but said to try and avoid sick people. This sort of advice seems to be the way things are moving--apparently the special "neutropenic diets" that used to be an absolute rule (no fast food, no raw vegetables, no yogurt, etc.) have recently come under attack as being ill supported by the evidence. Everything I've read suggests that it is important to make sure I'm extra careful to follow all food safety guidelines, though (clean cooking surfaces, properly cook food, throw out old leftovers, and don't eat any place sketchy).
In other news, I still have most of my hair, though my beard has begun shedding, and I will probably have to shave it off within the next day or two. The only other reminder to me that I have cancer (beyond the port sticking out of my chest, and the scar on my lower abdomen) are my nipples, which continue to be a bit tender on the account of the betaHCG my tumors are producing.
Recap of Week 2
The week started off a bit rough, and I was really wiped out (and bit nauseous) for the first few days after my bleomycin dose on Monday, but I've felt progressively better all week. By Thursday and Friday, I could almost pass for normal, except for the occasional odd ringing in my ears and the fact that every half hour or so I'll have a moment when I feel a bit off-kilter, and am reminded that I'm still pretty beat up physically. The steroids from last week are finally out of my system, and on Thursday I slept a full eight hours for the first time since chemo started.
On the Monday after week 1 (day 8), my blood counts were basically fine in all the important ways--both white and red cell counts were normal, hemoglobin and blood sugar were OK, and there weren't any signs of worrisome infections (though I've started coughing stuff up again after my immunosuppressing steroids wore off). The only exception were my potassium levels, which were a bit lower than what they should have been. The oncologist told me that this was probably from the cisplatin, though my bet would be the huge amounts of fluid that I'd been drinking for the previous week had probably exacerbated this as well (though I've been instructed to keep it up, which is what I plan on doing).
I've also learned to manage my nausea medicine a bit better, and have been relying almost exclusively on the ondansetron, which I take every morning and occasional evenings. Both subjective experience and internet research have told me that this drug is more effective, and less likely to cause unpleasant side effects, than the prochlorperazine. The nausea got progressively better throughout the week, and Sunday morning was the first day I could get through without any pills whatsoever.
I felt pretty well the last few days, especially when compared to the week and a half that preceded them. Restaurants no longer sound disgusting, my run on Sunday felt almost normal, and I managed to write a 4,000-word article (though I'm not sure how confident I am that what I wrote makes sense). I thought I would devote this week's post to my cancer diet, since this week has been pretty good for eating, and I'm not sure how long I can expect this to continue, especially given the white blood cell counts. So, without further ado, here are some of the food-related highlights from week so far:
Beans, Beans, Beans!
The staple of my diet think week has been beans, as it is in almost every week. For those who don't know (though I'm guessing most of you do), I'm a vegan-except-for-hunted-and-fished-things-who-sometimes-cheats-by-eating-cookies-and-pancakes. My reasons are moral ones, but I'm very nonevangelical (so, it's perfectly OK if you eat a large steak with a side of bacon in front of me; I used to love both steak and bacon.). In any case, since I think most animals raised on factory farms probably live unhappy lives and I don't think there any health benefits to eating animal products, I usually don't. I've got no problem with using animal products I do need (my running shoes have leather uppers) or with using medicine tested on animals (I sincerely hope they did some sort of testing on all of these drugs they are feeding me...). The doctors seemed fine with me continuing to eat more or less as I always have.
In any case, I've had lots of good bean dishes this week, and especially on Sunday and Monday. For lunch Sunday, I had some leftover black-bean-and-pumpkin soup my mom and Anne had made on Saturday. On Sunday evening, Kate and Graham had I Anne and I over for dinner. We had some excellent pinto beans and vegan cornbread, and then some Hershey's dark chocolate for desert. Then, on Monday, we had some excellent bean-and-vegetable soup that Tara had brought over for us, together with some leftover bread (from Mom) and cornbread (from Kate). And, of course, some cookies, since I have now taken to having deserts after every meal, including breakfast.
On Monday night, Anne made vegetable stuffed tofu with mushrooms, cabbage, tofu, and onion, which we had over brown rice.The food was great, but I was so zonked out from the benadryl they'd administered with bleomycin that I think I barely noticed the fact I was eating supper (the leftovers were tasty, though!). We also had some good baked beans and chili later in the week, though I won't bore you with the details.
Favorite bean dish: The misir wot (spicy lentils) at the Red Sea restaurant in Minneapolis, MN (it's on Cedar, across the street from Midwest Mountaineering). They are served (together with a bunch of other dishes) on a huge, spongy pancake called injera. On occasion, I've driven over an hour just to eat there.
Potassium-Loading at 6:00 AM
The big thing the oncologist told during my meeting with him on day 8 was to try and get some potassium. He mentioned bananas, vegetables, and Gatorade as possible sources. I bought some bananas and vegetables, but not the Gatorade, on the grounds that sports drinks are actually pretty poor sources of potassium (you'd have to drink about 50 servings to get a normal daily dose, and I needed to get *more* than an average daily dose). When I was working with developmentally disabled adults, I noticed that prescribing these sorts of drinks remains the standard practice for low potassium diagnoses,which I think is a pretty disappointing failure for evidence-based practice (but a success for Gatorade marketing, I guess). In any case, I chose tomato juice as my liquid potassium source (it has 10 times as much as Gatorade!), and made a concerned effort to drink more soy milk. This worked well enough to get my potassium levels backed to normal, apparently, so I'll keep it up.
In any case, my breakfast this week was (almost without exception) a bowl of Grapenuts with soy milk, a banana, some tomato juice and, if I was still hungry, some bread and peanut butter. Soy milk aside, this reminds me a bit of breakfasts I had growing up, when Grapenuts and bananas were always a popular combo with me dad. Today (Monday), I had second breakfast at the Carle Cafeteria, which consisted a bagel with peanut butter and some fried potatoes. I remember that this was the same breakfast I'd had every day during the spring semester of 2001, which was when Anne and I had just started dating. This time, though, I didn't have to share my potatoes :).
Favorite breakfast: I love breakfast restaurants, so it's tough to choose just one. Some highlights from my childhood include Mickey's Dairy Bar in Madison, where I've had some great (and very large) pancakes over the years, and the now-defunct Heckel's in Eau Claire, where my Mom would often go before school on Thursdays.
Brendan Cooking Italian
I tried cooking Italian-ish foods twice this week, with mixed success. On Tuesday, with potassium on my mind, I made baked flounder over tomato sauce with olives, which I served with smashed garlic potatoes. I thought the basic idea was OK, but the fish took longer than I expected to cook (we had to microwave it even after it had been in the oven for 20 minutes) and was still a touch fishy tasting even through the sauce (though neither Anne nor I thought it tasted at all spoiled).
Whenever I make a mistake cooking, I think of my sophomore year of college, which was the first year I'd really had to cook for myself. From the start, I was a pretty excited, passionate cook, but I distinctly recall some moments of questionable kitchen decision making, such as Lolo telling me "No, Brendan, the recipe said to add two cloves of garlic, not two bulbs" or my lighting the garlic bread on fire on Anne's and my second date (if I remember right, we ate it anyways).
On Saturday, we had Eric and Todd over for pizza and a game of Risk. I made a vegan pizza with seasoned vegetable protein (using sausage spices like onions, garlic, fennel, pepper, and vinegar), mushrooms, tomato sauce, and hummus. I then put cheese on half of it for Anne and Todd. I usually use a french bread recipe for the dough, and I thought everything turned out fairly well. In any case, it felt oddly reassuring to be able to accomplish the sort of ordinary task that has eluded me the last few weeks.
My greatest cooking success this week was probably a loaf of oatmeal raisin bread that I pieced together out of what was laying around the house:
3 cups flour
1 cup quick oats (I actually used instant, but I normally use quick)
1/2 cup maple syrup
1/3 cup raisins
1 1/2 cup warm water
2 tablespoons oil
3 teaspoons cinnamon
1 teaspoon salt
Bread yeast
Best pizza: Since I'm not a cheese eater, I rarely go out for pizza any more, though I have had some pretty decent cheese-less pizzas in the last few months. When I was young, I think every group I belonged to (soccer and boy scouts, in particular) met at Pizza del Re about once a month, and I've always had an affection for their (perhaps objectively somewhat mediocre) version of midwestern flat crusted pizza.
Fish and Chips
With my white blood cell counts being what they are, I'll probably minimize my takeout eating for at least a few weeks, regardless of whether or not it is technically "permissible" for me to eat this sort of stuff. And really, this isn't really a terrible thing, as it's easier to cook healthy, high-protein, high-potassium foods at home than it is to order them.
I did get to have some of my favorite takeout this week, though, in the form of Seaboat fish and french fries, which Rachel and Scott came over to eat with Anne and me on Wednesday. The Seaboat, which is more-or-less a South Chicago style neighborhood fish and chicken restaurant that has become of a C-U institution. When Anne I first came to town, it was located in one of the poorer neighborhood in north Urbana, but this didn't stop all sorts of people (students and professionals, especially) from driving to get food there. A few years ago, it moved to a new location near Hessell park, which works well for Anne and I (we often pick up food and go eat it in the park).
I have a number of good memories of fish-and-potatoes from over the years: fried bluegill at the Feck trailer, fish boils when visiting Door County, and countless fish-and-chips diners ordered at bars where this was closest thing to a "vegetable" on the menu.
Favorite Fish and Chips: I'd never really been a fan of fish and chips until I moved to Dublin. So, let's say Burdock's Fish and Chips (the Rathmines location, not the original one in City Centre). I think Seaboat could probably give them a run for their money, except for the whole not-being-next-to-the-ocean thing.
The Future
The next week will basically be one of waiting--making sure I eat well, exercise enough to get the bone marrow going (but not intensely enough to set me back), and avoid anything that looks likely to give me an infection (sick children, expired food). I'm going to try and go back to work on Wednesday through Friday, which will at least give me something to do. I have a feeling this week will probably be a long one, subjectively speaking, and it also means that I'll have to wait an additional week before finding out about my tumor markers, which is when I'll finally find out if the cisplatin has made an impact.
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