I was guessing 1700 / uL, with a little false bravado, actually just hoping they would be over 1000, so I was shocked to see the smiling nurse with the printout showing 3700, nine times as many as yesterday’s count of 400. Yesterday the doctor and nurses were concerned about neutropenia, asking me how I felt. Based on prior experience, however, I believed that the neutrophils were there all along, just not measurable for some reason. After a good night’s sleep they have to be teased out of hiding, or out of some other phase, or whatever neutrophils do.
Note: I am not a doctor – what happens to neutrophils overnight is WAY above my pay grade – I am making this up! Sort of – here is an article discussing it. Good subject for study, because I’m sure that there are people who DO know.
Anyway the threshold for proceeding with the infusion was 1000 / uL, so here we go full speed ahead. I’m already in the chair, waiting for the prednisone to drain into me – the Darzalex can’t be started for another hour after that.
These things happened between yesterday’s blood draw and today’s:
- Last night I took 20 mg of dexamethasone (DEX), and skipped one dose of Pomalyst. I think this may be the most important factor in improving the neutrophil count. This morning my fasting blood glucose was 143, normally about 90. That is a proven DEX effect, of course, and I wonder if that alone can affect neutrophils.
- This morning I got up well ahead of the blood draw and ate a good breakfast, including two cooked eggs with a scrap of last night’s salmon, plus uncooked strawberries, blueberries, cherries, and blackberries, with low-fat plain yogurt, every item organic of course. In that mix we would find plenty of live bacteria, especially in the yogurt where it is intentional, and perhaps the food can cause the neutrophils to come out and play. I really AM making that up, but it is consistent with the realization that morning blood draws are almost always fasting, and afternoon draws always follow one meal at least, usually two meals.
- I did some short but intense adrenaline-pumping exercises this morning just before checking in for the blood draw: Six flights of stairs, running up as fast as I dared and walking back down carefully, and as many pushups as I could do.
- The blood draw itself was done at about 11:00 am, compared with 7:30 am yesterday. I have always believed (and observed) that neutrophils are at least double at 1:00 pm from what they are at 7:00 or 8:00 am. Now I am wondering if it might be more about the food than the time of day. In almost 13 years of treatment I never thought of that until today.