Wednesday, January 13, 2010

Chemo working a little too good, she's neutropenic again

The increased dosage of chemo has finally shown itself in Emily's labs. Her ANC was around 350, which is pretty low, defintely moderate neupenia. To remind some of you, that means she doesn't have enough neutrophils in her white blood cell count to fight common colds and viruses effectively. It means we have to really consider her exposure to the public, weighing risks and benefits. School may be worth the risk, but the Sharks game we had tickets to tomorrow night is a definite no no. Malls and movie theaters are strongly discouraged as well. This is data we all can consider during flu season. So this week her chemo is reduced to zero, nothing for the whole week. Next week we will start building up to full dose again. I did the math and by the time she is back on full dose, she will only have two weeks of therapy left.

Some of you may be wondering, "is it a concern that Emily is having these issues so late in therapy, is this a bad sign?" The quick answer is no, in fact it's completely possible that on her last week, she could be neutropenic, and that therapy would be considered a complete success, neutropenia is just a side effect of strong chemotherapy.

In immuno-suppresion you seem to be doing a "dance" with the combination of drugs, viruses, the disease, and the environment. With a child who really doesn't understand how viruses are passed, and who has to go to school, this is just part of the road to recovery. They have done the studies and it's much more beneficial in the long run for Emily to be in society, rather than locked in a sterile hospital. (In the 1970's you literally dropped your child off at diagnosis and hopfully picked them up when they were "done" current oncologists at Packard remember this, that's how recently treatment was done that way.)

Emily's Doctor, Dr. Link received a special honor this week. Dr. Link was voted to be President and lead the American Society of Clinical Oncologists. He was voted in by his peers, the organization consists of 27,000 clinical oncologists. He also has the honor of being the first pediatric oncologist to ever be named President of the society. We are really excited for him and the whole program he leads at Packard, this really shows how great they are. He will continue to see his current patients so there is no worry there.

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