Down To The Marrow

It had to happen. By the fifth chemotherapy treatment, I came to a point where my white blood cells just weren't bouncing back as enthusiastically as they ought. Neutropenia wasn't exactly a new story for me, but this was the first time my doctor decided that I needed to go one step further than simply wearing a charmingly fashionable surgical mask while out in public. It was time for "the shot".

It's a drug called Neulasta, (pegfilgrastim) and if you watch TV, you've probably seen the ad for it. It features a strikingly attractive African American lady with close cropped gray hair, wielding a paint smeared pallet and a brush. A lady of the arts, perhaps an intellectual, the sort of lady you'd quite like to be friends with. And oh my goodness, she has cancer. The catch phrase is, "Are you ready to start chemotherapy?" She is. Yes indeed. She's got her Neulasta. You just know she's going to make it. I mean, I was inspired when I first saw the ad, and that was long before I was diagnosed.

When you think about it, Neulasta has sort of a nice ring to it. New-last-ah. Good syllables. Solid, reassuring, sort of upbeat. You can dance to it.

In a nutshell, Neulasta gives your immune system a jump-start by helping boost the production of white blood cells–or neutrophils–with which to fight off infections. As with many drugs, there are risks of various icky side effects, (ruptured spleen anyone?) but the most common by far is, "mild to moderate bone pain." The Neulasta website claims 31% of patients experience it. Other medical advice sites claim up to 57%.

Naturally, a need for Neulasta wasn't exactly the news I wanted to hear two days before Thanksgiving, but the doctor quickly reassured me on that point. Side effects usually take several days before they reveal themselves, so I could enjoy my turkey and stuffing in serenity. Well, unless the chemo itself made me sick, of course, but you can't have everything.

So, on November 26th, I dutifully drove myself to the local hospital and presented my arm for puncture. It's a slowly administered shot. It also stings like an irritated nest of hornets. Still, no pain, no gain, right?

On November 27th, I did indeed enjoy my turkey and stuffing. Okay, I popped a few Compazines to keep the chemo effects at bay, but no problem. I even had pie!

Throughout the long holiday weekend, I lived in a state of vague anxiety, waiting to experience my share of "mild to moderate" bone pain. I mean, what is bone pain anyway? Seriously, how bad could it be?

By Monday, I was breathing a smug sigh of relief. Let's hear it for being one of the lucky 69! Or 43! Or whatever! Yippee!

When I woke up on Tuesday morning, my feet hurt. My feet.

Throughout the course of the day, the pain spread. And spread. And spread some more. I mentioned it to a late-morning caller who asked what it felt like. A whole-body migraine, I answered with perfect truth.

It got worse.

If you've ever hit your thumb with a hammer, (or slammed your hand in a car door, or given birth without an epidural,) you might have some reference point from which to understand the intensity of my experience with *cough* moderate *cough* bone pain. You know how it is in those first moments after an intimate encounter between hammer and thumb? You clutch and cradle your hand between your knees. You hiss profanity between your teeth in an uncannily accurate imitation of Yosemite Sam. You might hop up and down or sway side to side or simply stand in a paralytic stupor of pain. It hurts so bad that your teeth sweat. And all the time, your thumb is throbbing. Throbbing. Throbbing in an exquisitely excruciating crescendo of intolerable agony.

Are you with me here?

Okay, now imagine that every bone in your entire body is a hammer-struck thumb.

During the worst of it, as I huddled under my blankets, passing the time by counting my pulse via the thudding in my clavicles, my darling daughter meandered in and gave me a critical once-over.

"Have you considered a body cast?" she asked with raised brow.
"Can't writhe in a body cast," I grated. It was a writhing kind of day.
"Hmm. Then I have to recommend a clinically induced coma," she stated firmly and headed for the kitchen to make me a cup of hot chocolate.

I think she's seen too many episodes of House, but I have to admit, it wasn't a bad suggestion.

I called my best friend at work and pitifully snurfled my tale of woe and presumed osteo-implosion. It's pretty unusual for me to whine about anything cancer related, so she took my clenched-jaw griping with the gravity which it undoubtedly deserved.

"Try a hot bath."
"I honestly don't know if I'd be able to climb back out of the tub," I mourned.
"So just keep adding hot water," she shot straight back, waited a thoughtful beat, then added, "and don't fall asleep."

Your femurs probably aren't supposed to hurt when you laugh.

Over the course of the next twenty-four hours, it did gradually get better. By last night, it was almost a memory, although once in a while I'd experience a full-body cringe when the ribs or vertebrae thumped at me in a reproachful sort of way. This morning, I feel practically normal. For a given value of normal, of course. At least I can sit in a chair without wishing for an out-of-body experience.

I don't want to disparage the makers of Neulasta. By golly, I know they worked really hard on it and it's a dandy little gem of a drug, no doubt! Love that name! Good syllables, like I said.

Nor do I want to discourage anyone from getting it if their doctor recommends it. Thank God, for Neulasta, say I. If it helps, it helps, even if it hurts. Let my white blood cells be fruitful and multiply. Go, you wild little neutrophils, go!

But I have to admit, I'm not sure I want to be friends with that nice artsy lady in the commercial anymore. Although I certainly wish her the best.

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