The Chemo Nadir

Tonight, I am due to hit what is called “the nadir” of my first chemo treatment.


Get it?

First of all, did you know they use chemo to treat things besides cancer? I had no idea. I received a chemo treatment because it was the most expedient way to “turn off” my immune system. We think my immune system is sending confusing messages to my kidneys and gumming up the works, so it was important to hit reset and start damage control.

The thing about chemo is, it shuts down A LOT of shit. A significant amount of the treatments I’ve had to go through the past week had little to do with my kidneys and everything to do with combating the negative effects of the chemo. My white and red blood counts started dropping dramatically, making it basically impossible for my body to produce red blood cells when combined with my extreme anemia, making me fatigued and shaky. I had to undergo two very painful iron infusions to get my levels high enough to support a few days of hormone injections so my body can hopefully start making red blood cells on its own again. (I’m literally doping like a professional athlete right now — steroids + hormone injections.)

My white blood count — the immune system part — is also tanked, which is intended but not without consequences. I’m taking antibiotics everyday and they’re constantly taking my temperature to make sure I don’t have signs of an infection. (So far, so good!)

The nadir is the point at which all your levels are at their lowest after receiving a chemo treatment. For me, this was estimated to occur a week after treatment. I don’t know if this is true for people on different doses, or what, but I’m due to hit mine tonight.

As of this morning, my hemoglobin (red blood count) is no longer in free fall — it’s holding steady at 5.8, which is dangerously low. Anything that dips under about 10 is usually an automatic blood transfusion. We’re trying to avoid that, as receiving a blood transfusion now could make it more complicated for me to find a donor match down the road, should I need one. I’ve also shown a tendency towards allergic reactions recently and the blood transfusion is unlikely to be pleasant for me. Because I’m slated to spend the next week in the hospital resting and I’m not reporting dizziness, shortness of breath, or fainting we’re holding off until a blood transfusion becomes an emergency and hoping the other interventions we’ve made to boost my red blood count work in the mean time.

This is making my nurses exceptionally nervous and causing a bit of friction between some of my doctors. Luckily, my two doctors who are mostly in charge — Josh, my nephrologist, and my attending are in agreement with me that until I need the transfusion to live, I can suffer through a few days of fatigue since I’m mostly just laying around anyway.

It’s encouraging that my hemoglobin is stable today. Hopefully this means I’ve reached the nadir and I’ll start getting better from here.

As of right now, the plan is for me to receive a chemo treatment once a month for six months — assuming my kidneys start regaining function and we consider the treatment successful. I don’t really know what that means for me long-term. I guess we’ll find out next week when we formulate our long-term treatment plan, but I’m super not looking forward to doing this on a monthly basis. From what I understand, I’m receiving a relatively small dosage compared to someone receiving chemo for cancer, for instance. It’s unlikely I’ll even see any hair loss and might even keep my fertility. We shall see. Fingers crossed I don’t faint today!


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