Tuesday, July 15, 2008

Bad News in My Blood Test Results

For several months recently my blood test results were quite good.  They showed that I was doing well in many ways, and especially that my immune system was stronger than it had been since before my bone marrow transplant.  My oncologist at Hershey Medical Center was so pleased that he reduced my blood test schedule from once a week to once a month.
Then, about three weeks ago, my lab results showed that my neutrophil count had fallen well below the normal range, which meant my immunities were low, and were actually on the edge of being dangerously low.  I waited a week, all the while wondering if my immunities were getting weaker or stronger.  But after a week, I felt that couldn't wait the remainder of a month to see how I was doing.  Hershey's Post Bone Marrow Transplant Coordinator, the person I call when I have a problem, was away on vacation.  Since I couldn't reach her, I turned to my local oncologist's office for help.  One of the nurses there said that I could have labs done twice a month for a while, since my neutrophil count was low. 
I had to wait another week, but I had the labs done.  The results showed that my neutrophil count was very low, much lower than it had been two weeks before.  This means that I will have to stay in our apartment almost all the time, and when I go out I'll have to wear a surgical mask everywhere.  I'll also have to wash my hands frequently and use hand sanitizer often.  I can't have fresh fruit or vegetables, I can have no fast food, and I must avoid crowds of people. 
My wife Krissy called Hershey to see if I could have a Neulasta shot to raise my neutrophil count.  We learned that not only was the Post Bone Marrow Transplant Coordinator still on vacation, but my oncologist was also on vacation and wouldn't be back for two weeks. 
The doctor and nurse who are filling in for them don't know me.  They said that since my neutrophil count is so low two and a half years after my transplant, it could mean that I'm having a relapse of cancer.  If that's true, a Neulasta shot could further damage my bone marrow.  They said I'll have to wait until my oncologist returns and determines what's wrong with me.  I have an appointment to see my oncologist on July 28.
I'm not too worried about the possibility of a relapse.  The substitute doctor and nurse may not fully appreciate how much of the last two and a half years I've spent with a dangerously low neutrophil count.  Even though I'm not a doctor, I'm reasonably sure that the cancer isn't back.  My oncologist has told me many times that neutropenia (a dangerously low neutrophil count) can be caused by something as simple as a mild viral infection which you may not even be aware that you have except for feeling tired.  I have been tired lately. 
I have a feeling that when I see my oncologist on July 28, he'll tell me that my cancer hasn't come back.  I think he'll say that the substitute doctor doesn't have his personal experience with my condition.  If I'm still neutropenic at that time, I may get that Neulasta shot.
Even though I'm not worried about cancer, I have to be cautious about being neutropenic.  I can't afford to get sick.  With such low immunities, any infection could be very dangerous.  The last time I was neutropenic, I got a blood infection that sent my temperature up to 104.4 degrees and kept me in the hospital for a week.  This time I haven't felt sick -- just tired.  I hope it stays that way until my neutrophil count returns to normal.