#12 Eat when the mood strikes

I have always carried a cooler with me pretty much wherever I am going.  It’s just something I’ve picked up from years of being an athlete, bodybuilder, and personal trainer.  I never want to be stuck making a bad decision so I try to make my decisions ahead of time.  I found that cancer robbed me of my appetite.  Or rather the nausea that accompanied many of the medications tended to rob me of my appetite.  In dealing with the constant nausea I found that I had slipped from my habit of carrying my cooler simply because I was never hungry.  What I did find though was the mistake that if I were to get hungry, I did not have anything with me.  

This became obviously clear one day in the clinic.  I had every intention of it just being a short visit.  Short for me being four hours or less.  I had eaten before leaving the house and had mixed and drank a protein shake on the way to the appointment.  I thought that those items would have been enough to tide me over until I got home.  This particular day saw a drop in both my hemoglobin and platelets.  That meant I’d need both blood and platelets.  While ordinarily not a problem, this day was also one of the busiest days and that meant things weren’t running too quickly.  

I had arrived at nine in the morning to get labs done.  This is followed by about an hour wait before the doctors and nurses get the test results back.  Once the results are back, I’m called into the doctor’s office where we discuss the results and what our steps will be or if any changes to our ongoing protocol might be.  This was pre-transplant so I wasn’t on as many meds but the chemo I was on was doing its job.  We didn’t really have any changes that needed to be made so I was sent over to the infusion center for a blood and platelet transfusion.  By this time it’s probably 10:30am.  

Thankfully this was during the time I already had my PICC line installed and didn’t need the nurses to start an IV.  That’s always an anxiety inducing experience.  When I first started going to the clinic to see the doctors and getting transfusions, my veins were still pretty fresh and visible.  By the time I was nearing my transplant, my arms and veins had been so badly abused that they had started using an ultrasound to find a vein to get an IV started.  

The nurses go ahead and hook me up to some fluids and get the process started.  They have to call down to the blood bank to order both the blood and platelets.  Prior to getting the blood products they retake blood pressure and body temperature.  After about thirty minutes my blood shows up and another ten minutes after that my platelets arrive.  They retake vitals again to make sure that there are no adverse reactions to the blood products.  The platelets take about forty to forty five minutes to run while the blood can take about an hour and a half. 

By the time my first bag of platelets are about finished, I’m starting to get hungry.  It’s been nearly four hours since my last meal and almost three hours since I had that protein shake.  My blood should be done shortly and I can get out and go get something to eat.  

After the platelets have run, they wait fifteen minutes and do a post platelet count.  They want to make sure that the platelets I was given would bump my numbers up sufficiently enough for them to let me go home.  Because of my history of nosebleeds and the chemo I was on, they had set my lower limit for platelet transfusion at 20 (for reference normal platelet range is 140-440).  When I had originally had my platelets checked on this day they were at twelve.  While we were waiting for those results to come back, my blood transfusion had finished so we were just waiting on the platelet count.  

When the results of the post platelet count came back, I was at a whopping fifteen (there’s some heavy sarcasm there in case it doesn’t come across).  Just a three point rise and not enough for them to let me go home without at least doing one more bag.  By now it has been just over four and a half hours since my last meal and I’m hungry now.  Thankfully the clinic will supply some crackers and ginger ale.  I did have the foresight to bring myself water.  I refilled my water, ate some crackers, and waited while my next bag of platelets were ordered and brought up.  As I mentioned earlier, this was a particularly busy day so things were running just a bit behind.  The nurses were dutiful enough to check twice to make sure the blood bank had received their request since it was taking so long and they knew I had been there a long time.  

By the time the platelets came, were run, and I was finally allowed to leave, it had been six hours since my last meal.  I was starving.  It was odd because normally I’m dealing with nausea or stomach issues but the fact that I was hungry was great.  The downside was that I didn’t have anything to eat.  I refilled my water bottle before leaving and headed to the car.  I do keep some emergency supplies in the jeep, so as I exiting the parking garage I’m ravishingly devouring a bag of beef jerky.  I still manage to stop at Boxcar Betty’s (a local chicken sandwich shop that’s delicious) and pick up two sandwiches and readily consume them as soon as I get home.  

That was my lesson to always pack some food with me whenever I go anywhere.  There might be days where I miss breakfast, or any meal, because of the nausea.  So I don’t want to get stuck without having something to eat with me.  There might also be those days where my appointments or clinic visits run so long that I have to have my meal at the clinic.  

There’s several ways I’ve started preparing, or recommend, for just such scenarios:

1.  First keep a protein shake handy.  It doesn’t have to be pre-mixed.  Just toss a couple scoops of protein powder in a shaker and keep it in your bag or in your car.  Dry and in a container, it lasts for several days up to a couple weeks depending on the weather.  It makes a great emergency backup.  
2. Second, keep a bag packed with relatively long lasting snacks.  I’m a huge fan of beef jerky, simply because I like the taste.  Nuts and dried fruit work well as do pre-packaged peanut butter and crackers.  I won’t lie, I also keep a candy bar or something sweet handy as well.  Both because I like sweets and on the off chance that if it’s been so long between meals that my blood sugar is low.  A quick pick me up can go a long way.  
3. I plan snacks and/or meals the night before.  Most of my appointments are fairly early (since they have such a tendency to run so long), so I don’t have a lot of time in the morning to prepare what I’m taking.  A couple sandwiches packed in plastic bags, beef and rice tossed in a tupperware container, or some simple soup tossed in an easily accessible thermos.  I like the wide mouth thermos for packing food since that makes them easier to eat out of.  The smaller ones work great for coffee or tea but you need something large enough to get an eating utensil into.  

The overarching point is that food is a necessity.  There were certainly plenty of times where I didn’t feel like eating.  So it became a huge priority to make sure I ate when the mood did strike me.  In the event of being hungry I had to make sure I was prepared.  With nausea causing me to skip meals or to just have to wait longer than usual, my meal timing was all over the place.  I could wake up hungry and not eat for six to eight hours later, or I could wake up nauseous and not end up eating until lunch time.  Playing it by ear saved me from making the nausea worse but it also made meals difficult.  If I couldn’t control when I ate, I could at least control the fact that I had food ready and prepared.