Posted by Scott in
Chemo Round 5, Counts, on Friday, February 16. 2007 at
Okay, Asher is a little bit irritated after waking up, and he looks pale (because he needs blood!), but his body has made good progress with the neupogen shots.
Asher will be getting blood this morning because his hemoglobin is low. We won't premedicate him for that, and Asher is free to go to the playroom and everything today.
The plan today is to have Asher just be watched, try and eat something, and just play so that tomorrow we can make the decision to go home.
Grandma and Grandpa will be spending the majority of the day with Asher today so I can go to work and attend a meeting, so with Asher in the playroom, it'll keep them busy!
late morning - more from Asher's oncologist:
1. He thinks the reason that Asher came up so fast and won't go back down is no Cisplat this time and Asher had 3+ months off and his bone marrow is very strong right now
2. He's getting blood and trying to Eat today.
TPN will stay at 50% tonight. No TPN tonight cuz he ate sufficiently: half banana, grapes, cheese crackers, half hotdog.
3. He has some concern with the spots that Asher is saying he's having pain (stomach / chest). He thinks it's the body recovering from mucositis in the throat or stomach (like we thought he had) and it'll go away in the next couple of days as his white count comes up. He may give us a med to help in the healing. I don't remember what it was called, but we had it during round 1 I think. Fluconozol maybe?
4. He was currently thinking either Saturday or Sunday home depending on how Asher's doing.
5. Continue Neupogen for a couple of more days.
6. He is talking with the transplant team and the clinic nurse to start scheduling tests and anything that needs to be done prior to going to transplant, for instance, MRI of Brain/Spine, Hearing and psychology (?) testing
7. There's no way we can do the MRI while were here right now. They are backed up in anesthesiology due to a few kids who've had strokes and related things.
Posted by Scott in
Chemo Round 5, Counts, Hospital Stay, on Friday, February 16. 2007 at
Asher had an ANC of 140 today. The one oncologist I talked to wasn't expecting him to be showing progress so soon. In fact, two days ago, he said he'd expect Asher to hit ANC 250 next Wednesday. Not sure why he had thought that.
I'm not saying that we're confident that he'll go up tomorrow, but we expect that he'll not go down. At some point, he was even saying that if Asher was above ANC 250, he could go home on Friday. We're a bit sceptical of that since he's getting platelets today and will get blood sometime in the morning. He also hasn't been eating and the doctors want to see good nutrition and probably good fluid intake prior to going home. So, we're probably realistically looking at Saturday assuming that his counts continue to go up and he can stay above 250 and stay healthy without a fever. The doctors lowered his TPN intake to 50% of his daily calories today so that Asher would be more inclined to eat tomorrow. Until his TPN is completely taken off, he will be very unlikely to eat, we know from past experience.
Counts from 02/15/07
wbc 0.4 (4-12)
rbc 2.81 (4-5.3)
hemoglobin 8.7 (11.5-14.5)
platelet 14 (140-450)
Total Cells counted 20
Today, Asher got Platelets. The doctor had wanted us to get platelets when they were between 10-15 and finally, today about 4:40, the platelets started. As I normally had done (or so I thought), Asher was pre-medicated with Tylenol and Benadryl as recommended by the Doctor in order to ensure that Asher didn't get a fever.
Well, the meds worked, but they caused a minor side-effect. Drug induced anger on the part of Asher. For a while after Asher woke up from the Benadryl sleep he was very angry and loud and was not very easy to control. It took him a while to calm down under the watchful eye of the nurses and Grandma and Grandpa. After what you read below, I feel even worse about this happening, because it likely could have been avoided especially because I was at work during this time!
After I arrived back from work, Asher had calmed down and soon showed that he had a bunch of energy. He saw one of the other girl patients running around in the hallway and he wanted to go out there too. With his counts starting to come up a little bit, I figured if he wore a mask he could run around in the hall a little bit now that there were fewer people out there and mostly nurses and other patients roaming the hallway. Asher had a blast running around with his friend! They chased each other in push cars and then ran and ran and ran and ran. Eventually, Asher got extremely tired and just stopped and said "Daddy, I'm done". So back to the room we went, where Asher is happily and sleepily watching some TV and playing with some new books (and getting Rubber Stamp Ink all over his hands!) that he received from my Boss tonight (Thanks Steve & Jill).
Tonight, Steph asked me why we gave Benadryl and Tylenol (because she never premedicates), and I didn't have a good reason. It's just something that I did, based on what a doctor told me early on in the process after Asher got a fever following one of his platelet transfusions (the first one?). Anyway, I decided to do some research on the issue and here's what I came up with after reading the abstracts of a few research reports.
Often, doctors use premedication with acetaminophen (Tylenol) and/or diphenhydramine (Benadryl) for transfusion with blood products in adults and children. This appears to be common practice in most clinics and hospitals without a lot of major research to back the practice. Well, in all of the research reports that I read, "Febrile and allergic transfusion reactions were rare in pediatric patients transfused with irradiated blood products, whether premedication was used or not". So, it appears there's like a 1% chance he'll get a fever, whether or not he gets Tylenol and Benadryl first.
Research Report 1
Research Report 2
The next time we get platelets, we may choose to give Tylenol to control a fever, but I'm pretty sure we won't give Benadryl which will help us avoid the sleep and possible wake-up anger issues.
Sometime over the next 12-18 hours, Asher will get some blood and then we'll await tomorrow's counts to see if his ANC is above 250. We'll see about going home after.