October 23, 2008
I found it tough to choose which title to give the entry today, the one you got "Funny, She Doesn't Look Dead" or the runner up, "Don't Expect Me to Eat Food That Sat Next to Pee."
Background on "Doesn't Look Dead":
We went to University Pediatrics to have blood counts done on Tuesday after school. Erin hopped up in her usual seat (no, not the chair for blood draws. She sits at Janine's workstation and plays spider solitaire while she has her labs done). Janine did the finger stick, as usual, and ran the sample through the handy desktop machine that analyzes the sample. I leaned back against the counter, watching and speculating about what numbers the machine would reveal. I figured stable or slightly dropping white count and ANC, stable hemoglobin, and an upward trend on platelets. The machine hung up temporarily, recounting the platelets (hint: this is not a good sign). When the numbers finally registered, everything was lower than it had been last Friday, including hemoglobin which had dropped to from 10.2 to 6.5 (remember we transfuse below 8.).
I started trying to figure out how to work a transfusion into the schedule. To buy time I asked Janine to run the sample again. She did, and when the numbers finally percolated out onto the screen, everything was even lower, including her hemoglobin which had dropped to 3.2. I looked over at Erin, bebopping to the music coming from Janine's workstation and wondered how she had walked up the four flights of stairs to the doctor's office with 25% of normal hemoglobin. The only thing that popped to mind was "Funny, she doesn't look that dead to me."
Rather than panic, we drew a second sample and had more reasonable results:
HGB 10.2 (same as last time and a helluva lot better than 3.2)
WBC 6400 (normal)
ANC 4500 (normal)
PLT 84,000 (headed in the right direction)
The only other news from UPA was that both of Erin's ears looked red from having all that standing water (or mucous or snot or whatever) between her ears. So she won a ten day supply of amoxicillan to nip the infection in the bud. I'm not ordinarily that quick to the trigger on antibiotics and ear infections, especially when Erin has decent counts. However, the presence of her PICC line and the certain hospitalization we earn with any fever over 101 makes me much more risk averse. I can take a little antibiotic-induced diarrhea in exchange for sleeping in my own bed at night.
Background on "Don't Expect Me to Eat Food That Sat Next to Pee":
Starting a new clinical trial always involves jumping over hurdles in the form of tests, evaluations, and screenings, so that the investigators have a baseline on various aspect of the patient's health before they start. One of the last minute items stipulated by the study was a twenty-four hour creatinine clearance measure. This involves one blood draw and collecting all of Erin's urine for twenty-four hours. I always try to break news to Erin ahead of time, because she really doesn't like those cancer-related surprises (who does, come to think of it?). Anyway, she was not down with the idea of collecting her urine for a day, mainly because she hates the way the little commode hat smells after the urine has sat there ripening for awhile. I told her that she wouldn't have to smell it. I would just pour it into a jug and stick it in the refrigerator. You would have thought I had offered to store dead lemurs next to the butter, "I just hope you don't expect me to eat a bite of food that has been sitting next to pee!"
It turned out that Erin's creatinine has been normal for so long that we didn't need a urine collection. That eased both Erin's concern about pee storage and my worry about collecting a clean sample if Erin had antibiotic triggered runs.
Maybe the title of the post should have been "Dodged Two Bullets."
In other news, Erin has enjoyed her first complete week at school since the semester started. It will culminate in the fall dance tomorrow night. She made it to piano for the second week straight, and though she's not cleared for soccer yet, things are feeling more normal than they have in a couple of months. Of course that may change on a dime, especially in light of treatment resuming next week. In the meantime, we're hoping for a gorgeous weekend.