Yesterday provided a reminder that I really shouldn't take things for granted with this disease. I was due for my seventh cycle of treatment with Trabectedin but it had to be postponed because my neutrophil (white blood cell) count was too low. The same problem delayed the start of my second, third and fourth cycles of treatment. However, since changing from a three to four week interval between cycles, I had assumed that my blood count wouldn't be an issue going forward. The oncology ward doesn't have a bed available on Monday so my treatment is now scheduled for Tuesday next week.
In most people the drug causes their neutrophil level to drop just a few days after they receive the Trabectedin, however in my case the delay between the drug entering my system and my neutrophil count dropping is much longer. I've spoken to the oncologist about this and there are three ways to manage it. The first is to increase the delay between treatments, the second is to reduce the dose and the third is to use drugs to try and boost my immune system. We've tried the first of these so it will be interesting to see if the oncologist wants to look at options two or three. The problem with options one and two is that they reduce the total amount of Trabectedin received, something that is likely to reduce how effective the drug is.
Assuming that my next scan shows that Trabectedin is still working then my main concern is that I might eventually be forced to stop taking it because my blood count issues mean I can't get a high enough dose to sustain an impact on the cancer. On the bright side I've been quite lucky not to have picked up any infections so far despite spending considerable periods of time with an impaired immune system.
Something a little different from me on the photographic front for this post. Recently Katie and I went to a US civil war re-enactment that was held at the American Museum in Bath, I don't usually take pictures of people but I decided to give it a go and here are a couple of the results.