Holding Pattern

After undergoing another EUA last Wednesday, Edward had a CBC drawn on Thursday to morning to check his counts.  His chemotherapy suppresses his immune system, most notably his neutrophil count.  He needs his neutrophils to be over 750 to receive each cycle to avoid unnecessarily prolonged periods of immunosuppression and the associated risk of infection.

Two weeks prior to his EUA, his neutrophil count was surprisingly 880, well over the required 750 - his neutrophil count has always been a little sluggish in its recovery from the previous cycle, but we were glad to see such a robust number.  The following week it was a little lower at 680, but these levels naturally bounce around a little bit, so we were not too worried as we had another week to go before having to make it to 750.

So we found ourselves on Thursday in the oncology clinic with our bags packed anticipating a two day admission for chemotherapy.  Per usual, they drew his blood on arrival and started IV fluids as his urine output has to reach a certain threshold before starting chemo.  But unfortunately, his labs came back and his neutrophils were only 730.  A mere twenty cells away!  Katie tried to gently cajole our oncology team, but of course, as they should, they stuck to the preset protocol.  In fact, UVA's typical protocol requires a neutrophil count over 1000, but CHOP uses 750 and UVA felt comfortable using this lower level.  

We were definitely disappointed as we are anxious to cross each cycle off of our list.  We seem so close to wrapping up these six cycles, yet so far away at the same time.  However, we knew that it was best for Edward to wait and to allow his immune system to be as strong as it could be before delivering the next cycle.  We were given an appointment for this morning to recheck his counts and hopefully start chemo today.

Then on Sunday, Edward was 'clingy' and a little irritable, grabbing at his right ear.  This was quickly followed by a low grade fever which we watch like a hawk.  His temperature eventually climbed above a certain threshold requiring us to call our oncologist, but fortunately was not high enough to necessitate a trip to the ER or direct admission.  Edward actually seemed to perk up a little bit this morning and did not have a fever through the night.

His labs were drawn again this morning.  We waited patiently for the results, alternating cheerios + corn pops with blueberries + cheerios to keep Edward happy.  190.  Yep, 190 measly neutrophils.  The viral illness that he likely has has driven down his immune system even further (a natural response unfortunately).  So again, we wait.....and wait.....and wait.  In fact, we are not going to have blood work drawn for another week to allow him to convalesce from his current illness and then allow his immune system to adequately recover.  I think we are ready to be done with chemotherapy.