platelet

Day -20: Campath Poster-Baby

/ Evan / 4 Comments

The evening went well, Zoe slept very fitfully through the night. We saw a little bit of rash again this morning just as she was getting her Hydrocortisone pre-med, which may have been coincidence since Hydrocortisone usually treats rashes, not causes them.

We’re told Zoe is looking more and more like a “Poster-baby” for

Lucky the fish

Campath, her reactions so far are the mildest most of the staff have seen. I’ll take it.

Today is expected to go just the same as yesterday, no changes to treatment. If we finish out the week tomorrow without anything else eventful, we can breath a big sigh of relief for our first successful week.

Morning Counts:

  • Creatinine: .2 (down from yesterday, which is good)
  • Bilirubin: .3 (unchanged)
  • AST: 78
  • ALT: 36
  • Sodium: 141
  • WBC: 11.5
  • RBC: 3.38
  • Hemo: 10.2
  • Platelets: 111 (down from the campath, we may hold her hydroyurea if they get too low)
  • Lymphocytes: 0

Very quiet today so far. Our appointed mascot, Lucky the fish, highly approves.

Afternoon Update:

Once again, we made it all the way to the end of the day before seeing any reactions. Zoe is having a bit of a flush this time, in what you might call an unusual pattern. Her entire left side of her face is red, with a line right down the middle where it ends.

A couple of NP’s came in to take a look, and they hadn’t seen a rash quite like this before. But, it doesn’t appear to be bothering Zoe much, she’s a little squirmy but vitals are fine.

This reaction is definitely curious. I promise we didn’t leave her in a tanning bed on one side too long, but that sure is what it looks like.

Still, one of the NP’s said he’d never seen such a happy Campath baby, so I guess all things considered we’re doing ok.

Late update: It’s called Harlequin Phenomenon, and we’re told it’s harmless.

Day -21: Campath Full Dose

/ Evan / 3 Comments

Our second day of conditioning brings the first full dose of Campath, and a much higher chance of a reaction. So far this morning we’ve done her pre-meds with the addition of Dexamethasone as the steroid, and begun her Campath. The chemo is still administered on a stepped schedule, a small dose, then a slightly higher dose, then the full amount for the remainder of the day.

Zoe’s counts look good:

  • WBC: 18.2 (higher)
  • Hemo: 9.9
  • Lymphocytes: 1 (her partial dose almost completely wiped them out — this is intended)
  • Sodium: 138
  • Creatinine: .3 (up from yesterday, we’re told it will go up and down with the conditioning)
  • Platelet: 331
  • Bilirubin: .4 (still fine)
  • AST: 44
  • ALT: 21

So, no major changes other than a drop in platelets and lymphocytes, both expected. I’ll update later with any reactions and changes, she has only just begun the Campath so it’s calm at the moment.

Afternoon Update:

Everything has gone really smoothly again today.

Minor Campath Rash

Around 3pm, Zoe started some minor rashes on her face and head, no where else. She’s been very sleepy and calm all day and we were beginning to think she would plow on through day 2 without any side effects. So far, things have gone much better than we expected.

We finished the Campath and her rashes showed up just as we began the saline flush, exactly the same as yesterday’s slight fever. Nothing to be concerned about, Zoe is doing great with her treatment at this point.

Blood pressure has held steady around 100/65 most of the day, temperature averaging about 98 degrees.

So far, so good.

2 O’clock and All is (mostly) Well

/ Evan / 3 Comments

So far it’s been an uneventful day medically. Zoe has near constant visitors in the form of nurses with medications for her IV, but we have finally reached a point where it is routine and there is no immediate danger.

Zoe’s platelet count is up from 90 to 150 on her own, so that’s a very positive sign. Dr. B came by and we discussed some of our ongoing concerns, one of which is how much should we expect her counts to go back down as a result of the chemo, even as we are watching them rise with enthusiasm. He says that it will take as much as a week to see her counts take a toll from the Etoposide, and in the meantime good news is good news, so we can continue to be pleased by improvements we see. We’ll be watching for news of her inflammation to continue to decrease, watch for ferritin counts to start to drop, and hope that her temperature starts to stay at 98º instead of 97º.

Zoe continues to gain weight from the Dexamethasone, which we’re told will continue for awhile and then level out as her dosage is reduced in coming weeks. I spoke to Dr. B about potential complications from weight, but at this point developmentally she’s really only expected to be working on keeping her head up and perfecting her wiggle. There should be no problems there, and by the time we’re ready to see her trying to roll or lift up, she should be at a more moderate weight. She makes a cute butterball though, I’ll give her that.