featured image: a Macrophage (red) engulfing tuberculosis bacteria (yellow), taken with ZEISS FE-SEM (Scanning Electron Microscope. ) Courtesy of Dr. Volker Brinkmann, Max Planck Institute for Infection Biology – Berlin, Germany. http://www.zeiss.com/sem
I had my blood tested, and nutritionally I’m doing fairly well, but my immune system is still very weak.
My most important immune cells were decimated by the chemotherapy, and are still not back to strength. In the graphic above, the levels on 8/20 (before any treatment) were fairly normal, but by the morning before my second chemotherapy infusion, they were alarmingly low – especially the hunter-killer lymphocytes which target enemies and generate antibodies to kill them, and also to point them out to the monocytes, which kill and eat the bad guys. When stimulated by antigens from alarmed lymphocytes, monocytes grow to become large and highly mobile macrophages which engulf and destroy invading organisms and irritants.
The chemotherapy on 10/7 even further diminished my immune system, and by 10/14, the day of the feeding-tube scare, it was at a dangerously low point. A very slight improvement can be seen on 10/21, and a smidgen more by 12/23, but I have a long way to go.
Nutritionally, things are a bit better:
…so I am continuing to use the weight builder shake, and trying to eat a little more solid food every day.
Hopefully by March 21st, these statistics will have changed significantly.
Time for an update on the weight builder shake I use to keep my calorie count up, hoping to gain – or at least not lose – weight. After some exhaustive online research, I have concluded that the best product for my purposes is Serious Mass, from Optimum Nutrition. I have no connection with the company, save liking their products, but theirs is the ONLY line of protein powders I found which don’t contain appreciable amounts of heavy metals. Most others have one or several heavy metals barely below the FDA limits, so I find this to be significant. In addition, the balance and quality of their ingredients is better than most, and they come highly recommended even by GNC, who sell their own competing product. If buying it at GNC, be sure to mention their price matching program, because it will save you a LOT of money. In addition to other food, I drink half a serving (16 oz.) of the shake with an oz. of wheat dextrin, and an ounce of coconut oil, twice a day. That gives me 2300 calories, which is my maintenance level. With a little other food, that assures me of having enough calories that if my body is willing, it can bulk up. The NIH has a handy calculator at http://fnic.nal.usda.gov/fnic/interactiveDRI/ so you can find out how many calories you need.
I have streamlined my method for mixing the weight builder shake. I learned how to avoid entraining air into the mix, so it does not need foam removed, and I learned that crushing the pills was a bad idea both labor-wise and nutritionally. Now I use just three pieces of kitchenware, vs the dozen or so I used to use. This slide show gives my new procedure:
010 - IMPLEMENTS
Now all I need is the 16-oz soup bowl/cup, the measure for the milk, and the whisk. I also use a 1-ounce measuring spout like is used for whiskey, for the coconut oil, and a Tupperware dispenser for the fiber, but not everyone will need those. Since the mix is a lot like cake batter, a kitchen mixer would probably be useful, but extra cleanup, even if I had one.
020 FIRST THIRD OF LIQUID
I use one scoop of the mix (½ a serving according to the package!) and 12 oz. of whole milk, since I want extra calories any way I can get them. I begin by measuring one third of the milk (4 ounces) into the bowl, so the slurry does not stick to the bottom of the bowl as badly as it might. I have learned not to just eyeball the first part of the milk, because it is too easy to get it wrong, and the mixing doesn’t go well.
030 - MIX AND FIBER
I dump in the shake mix on top of the first 4 ounces of milk, and then add 6 tsp of wheat dextrin for fiber. If I were eating more regular solid food, I might not need the fiber, but believe me, you do NOT want to fail to have plenty of fiber in your diet, and some probiotics as well.
040 - REALLY STICKY STUFF
The first stage of mixing wets the powder by forcing it and the milk through the whisk. If there is too much liquid, there is not enough viscosity in the mix to break up the small lumps. If it’s too dry, then it just clumps EVEN WORSE into a big ball of glue on the whisk.
050 - MIX AND MIX MORE
It will take 50 to 100 strokes, all the way around the edge of the bowl, to get the stuff thoroughly mixed. As you begin mixing, the gooey stuff will clog the whisk, but keep on around and around the rim of the bowl, with a will. Occasionally shake the clumps that form inside the whisk into the bowl, so you can break them up.
060 - At some point before getting to the final proportions, the mix will have a consistency much like cake batter. That is when you can get the last dry patches or unmixed bits entrained into it, before adding the last of the liquid and mixing thoroughly, without splashing the gooey mess around.
070 - DRINKABLE AT LAST
The final result is a large volume of mixed goo, with few if any lumps, and little or no foam. Immediately after mixing, wash the whisk thoroughly, because this stuff is a hard-setting, egg- and casein-based adhesive. Do the same for the bowl and the sink. I drink it right from the mixing bowl, but it keeps well in the fridge if covered. You can make more in a large batch and save it, if that works better for you.
If you want to learn about my early struggle with weight loss, and see what I did for the first several months of using the weight builder shake,
This tube feeding is a VERY frustrating business. The tube sticks out of my upper abdomen about a foot and a half. It has a plastic clamp to seal it off, and an adapter at the end, which will receive the business end of either a regular syringe, or a big 60mL syringe with a big nozzle. Neither of them has any provision to lock the syringe to the tube. Friction only. Are they that stupid? Really?? To add insult to injury, they automatically included with my liquid food, a box of hang bags like IV bags, with LOCKING CONNECTORS! In order to fit the joke I have hanging from my side, it requires an adaptor (see photo) and it tightens my jaw every time I use it. I have had several very messy and stressful malfunctions, getting not only food, but stomach acid, all over myself. There is an entire system designed, built, and sold and used, to connect the bag to a tiny button on the abdomen, locking it in place during the feeding, and then toss the dirty stuff, leaving just the button on the surface of the abdomen. https://youtu.be/8WKgKJ66mk8 Why the HELL don’t I have THAT instead of THIS kludge? This business hanging off my side and hurting and flopping around is nothing but a hasty lash-up. We’ve had the technology to do it right for decades. I’m disgusted and angry. www.safeenteralconnections.com
Now that I have the tube I have, I am not eager to go back in for anesthesia and endoscopy and such, but I am really upset about the impracticality of what they installed.
The system they sent with the bags has a locking connector and – believe it or not – an adapter, to fit my outdated tube. Turns out that I got my tube just a little too soon. The old system is supposed to have been phased out and unavailable as of January, 2016, but of course, things are running behind. http://www.medline.com/pages/enfit Instead I get the kludge.
At least I have discovered products that will flow through the narrow tubing, yet give me lots of calories. I now put a cup of whole milk into a shaker, with an ounce of fiber, and add a cup of Jevity 1.5, to make the main mix. First I pour two ounces of coconut oil down the tube, and then follow it with the mix. No more gagging and choking on the thick stuff I used to mix up. That is a definite improvement. I have managed to obtain many of my meds in liquid form, allowing me to add them to the mix, but then there are the pills. I was using a plastic pill crusher I bought at the pharmacy, but it was not much use. I bought a coffee mill (a real grinder, with ceramic mill parts) and it does an admirable job. Now I strain out the shards of enteric coatings with a tea strainer, and down it all goes.
Another item of very encouraging news: no more Cetuximab or the other two chemo drugs I was getting… because they didn’t work. Instead now I will get a new drug beginning Tuesday (2016/07/05) which works differently. It is considered an immunotherapy, because it aids the immune system instead of suppressing it. Hallelujah! The new drug is called Pembrolizumab (Brand name Keytruda) and it binds to a site on cancer cells that triggers them to self-destruct (apoptose) as they should have done the moment they became zombies. I have a lot of hope for this one, especially since it is not poison. Maybe this brand-new drug (only barely approved by the FDA) will be the key. Goodness knows I could use a key.