Tuesday, June 2, 2009

Transplant B, Day +6: Platelets and other news...

So...another uneventful day, for the most part. Whites are at 0.02, which was where they bottomed out before. Hemoglobin still north of 11. Platelets fell to 8, so I got a bag today, and I'll probably need more tomorrow based on last time. Electrolytes are all in good shape, CRP is down to just over 10. All good.

Shared the room with the same guy from yesterday and a different daughter (presumably not one getting married in a feed store although I bet she's no stranger to such events) and I'm not sure the guy stopped talking at any point in the intermitting 24 hours between visits. Nice enough fellow (or fella, or even feller) though, and I hope the treatment works for him. He's on the standard branch and is three weeks after his first transplant, and his whites are still not high enough for him to be discharged. He's also got (per a variety of stories he told) nausea, colitis, the shakes, voices in his head, "the boo-hoos" and panic attacks. Okay, I made up the voices part. But not the rest.

I'm fortunate to be weathering this as well as I have been.

I learned two new things to look for clinically. The first is Immature Reticulocytes. These are, I guess, baby white blood cells. The count there will double approximately four days before white blood cells rebound. As of now, they are stable and low, so I'm probably at least four days out from the end of neutropenia. No problem, so long as I don't get sick!

The second thing, and the ultimate goal, is now a little more specific. Once the M-spike has fallen to zero and cannot be observed in the normal blood analysis, it is then subject to a more sensitive test called immunofixation. It's possible for the normal protein electrophoresis to show a zero M-spike, and still have M-protein under immunofixation analysis. So what we are looking for is technically called "Immunofixation-Negative Complete Remission." I will obviously keep the blog updated on that!

Having said this, I couldn't resist a peek at my tumor markers. The most recent ones were drawn last Thursday (I had more drawn yesterday but the results are still in the lab). Now mind you, the purpose of the chemo/transplant process is to kill my blood off and replace it with new blood. The old blood is now dead (the white blood cell count is a good proxy for the overall blood system) but as of last Thursday, a lot of the blood was kicking around. So as an indication of the effectiveness of the therapy, anything drawn before this upcoming Thursday is probably not worth a whole lot.

Nonetheless, I checked out the data from five days ago. M-spike at 0.5 (dammit I know it won't have bottomed out yet but I really wanted it to be zero!) and IgG at 890. IgG is now well within normal range (700-1400) so that is a good sign. Obviously, we want that M-spike to be 0.0 and we want negative results from immunifixation analysis. A watched M-spike never drops, as they say. But mine will, and you'll be updated every step of the way.

Feeling good, albeit exhausted still. The horrible rash from the Dex appears to be subsiding and with any luck it will be gone in the next few days.



  1. Great, Nick! Sounds good. But sorry you're so tired!
    Every day is closer to this being done.
    Can't wait to see you and for you to meet Sammie! :)

  2. Hey Nick .. Glad to see you're doing well. My fun starts next week. ciao.. Chuck

  3. Great job, Nick! Quiet days on the 7th floor are good things!!! We know what you mean about the "new" level of remission... Jon is still at <0.1 and we are striving for the "stringent remission" now.... Keep up the good work - you will be home before you know it!