silver nitrate and white blood cells

It’s Always Something

I spent much of this afternoon in various rooms of the IU Simon Cancer Center in Indianapolis. I was there to meet with my “Indiana oncologist” Dr. Einhorn, and the surgeon who removed nearly twenty of my abdominal lymph nodes exactly one month ago, known here as Dr. [name withheld]. I arrived early, and stayed much later than expected.

First, it was the oncology clinic to have blood drawn and wait to see Dr. Einhorn. And wait we did (my father-in-law, Hartmut, was there with me). When I finally did see Dr. Einhorn and his nurse Jackie there was (as usual, it seems) one surprise: although my tumor markers were all normal, my white blood count (WBC) was unexpectedly low at 2500 or 2.5. Although a low WBC is not abnormal for someone who has recently undergone high dose chemo, it did seem odd to everyone that my WBC had recovered before my surgery — it was about 7000 then — and now had taken a nosedive.

“It may just be an aberration,” Dr. Einhorn said.

The trouble with this low WBC is this: they will not start me on the oral VP-16 (aka Etoposide) if my WBC remains at this level because, of course, the chemo’s main side effect is a lowering of the WBC. Because the VP-16 is a “maintenance” measure, rather than treating an existing cancer, Dr. Einhorn told me that he would not want to risk the dangers when the benefits are not wholly known and may not be worth it.

So, next week, I will have my WBC checked again. It is entirely possible — and very likely according to Jackie — that my WBC will come back normal at that time. If it does, I will begin the VP-16; if not, we will have another discussion and make a decision about further treatment.

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Proud Flesh

Two weeks ago when my local GP removed fifty-two staples from the incision running down my middle, he placed about eight large Steri-Strips across the wound to hold it all together. Today, Dr. [name withheld] tore off the remaing six (along with much of my hair). There were a couple of spots in the lower third of the wound that didn’t fare too well during the staple removal, and they were dealt with today with something called silver nitrate.

“Ah,” the doctor said after removing the final two Steri-Strips, “I see what we have here.” He stepped over to a cabinet and as he began pulling out little sterile packages said, “it’s called proud flesh.”

“Proud flesh?” I said.

“Yes,” he said, “so what I need to do is cauterize it with silver nitrate.”

Cauterize? Cauterize? I didn’t like the sound of that and winced a little when he said it. When I think of cauterization, I think of burning. And I also think of it as a means of coagulating. But, in this case, it was a means of destroying damaged tissue to let the affected area heal. And so, he pulled out what looked like a very long Q-tip and set about cauterizing an area of my incision that is about an inch and a half long. It stung a bit, but was not overly painful. The area is now sort of grotesque looking, almost completely blackened by the process.

My body looks very strange to me now, a long still healing scar slicing through the center of my body — my belly button misshapen, seemingly forever. It will make it very hard to forget this cancer experience of mine. Maybe that’s a good thing.

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