Update on Coby & his current hospitalization

Here are some details of what has been going on with Coby this past week:

Friday 4/22/11 - Coby went to the ER for his regular pre-lomustine CBC check (Yes, I take him to the ER for blood draws now).
The results came back a little low.
WBC 3.6 (normal value 4.0-18.2)
Seg Neutrophil 2.05 (normal value 2.5-15.7)
Platelets 116 (normal value 140-540)
RBC, Hgb, Hct were all in normal range
I was nervous to give the lomustine (chemo pill) on the 26th because of the low values noted above, but I did anyways - I was told it was ok to give & we've had no problems with the lomustine prior to this.

Thursday 4/28/11 - Coby was not acting like himself, he was lethargic, had thrown up a couple times & started to have some diarrhea, so I took him to the ER. When we arrived Coby had a mild fever but recheck temps were normal. We had determined it was high when we arrived because of anxiety and excitement. Coby did have fluid administered under the skin to keep him hydrated and another CBC was drawn. This is now 2 days after the lomustine (but these symptoms could not have occured this quickly from the chemo). We were also instructed to hold the Atopica (allergy med) until Coby's GI symptoms resolved (Atopica can cause GI problems). We also were instructed to hold the daily leflunomide.
CBC results from this visit:
WBC 3.3 (normal value 4.0-18.2)
Seg Neutrophil 2.18 (normal value 2.5-15.7)
Platelets estimated 100-150 (normal value 140-540)
RBC, Hgb, Hct were all in normal range

Friday & Saturday 4/29-4/30 - Coby was eating ok, more active, seemed more "himself".

Sunday 5/1/11 - Coby started to appear not himself again, was a little lethargic, threw up breakfast and lunch. He ate dinner without vomiting.

Monday 5/2/11 - Took Coby to the ER for another CBC since it was now 6 days after the lomustine.
CBC results from this visit:
WBC 2.5 (normal value 4.0-18.2)
Seg Neutrophil 1.50 (normal value 2.5-15.7)
Platelets estimated 108 (normal value 140-540)
RBC, Hgb, Hct were all in normal range
Despite the low values, we thought they would start increasing now that Coby had reached the low part of the lomustine (where it was the strongest - the nadir). The plan was to have another CBC drawn in one week to determine if we could restart the leflunomide. It was decided Coby would have no more cytarabine injections - he completed 10 rounds of the injections & the lomustine would also be stopped - he completed 9 rounds of this.

Tuesday 5/3/11 - Coby started having diarrhea & was not eating very well. The diarrhea persisted throughout the entire day. I bought some special food for him, which he ate. He felt very hot when laying on my lap, but I did not check his temperature - I just wrapped him in a cold wet towel. I was hoping the next morning he would be better......

Wednesday 5/4 - Coby continued to have diarrhea & didn't eat breakfast so I decided to check his temperature - it was sky high at 104.9. I wrapped him in a cold wet towel & rushed him back to the ER. Coby was admitted for severe leukopenia and pyrexia with a concern for sepsis given the bloodwork. He was bright, alert & responding. IV fluids & IV antibiotics were started.

Thursday 5/5 - Coby continued to be bright and alert. His temperature had improved to a high normal range. He ate ok and had no vomiting or diarrhea.

A CBC was drawn again. The values were all low:
WBC 2.0 (normal value 4.0-18.2)
Seg Neutrophil 1.00 (normal value 2.5-15.7)
Platelets estimated 100-150 (normal value 140-540)
RBC 4.07 (normal value 4.48-8.53)
Hemoglobin 9.0 (normal value 10.5-20.1)
Hematocrit 29.1 (normal value 33.0-58.7)

I went out to visit Coby. He was happy & excited to see me, but eventually calmed down & just slept on my lap. He is very skinny. Because of his neutropenic condition I had to wear gloves while I visited.

Friday 5/6 - Coby's fever returned overnight & was running 103.5-104.0.
Another CBC was drawn and the numbers continue to decrease.
WBC 2.1 (normal value 4.0-18.2)
Seg Neutrophil 0.84 (normal value 2.5-15.7)
Platelets estimated 100-150 (normal value 140-540)
RBC 3.19 (normal value 4.48-8.53)
Hemoglobin 7.3 (normal value 10.5-20.1)
Hematocrit 22.7 (normal value 33.0-58.7)

This is what our neuro says is happening: Coby's bone marrow has cumulative injury from months of chemotherapy and is not going to recover quickly. This white blood cells will likely stay low for several days, weeks to even months. This is actually ok as long as the lining of his GI tract comes back which will be much faster. He had some very close to liquid brown diarrhea this AM. He is barking, active and strong. He has had no vomiting and eating a little, but not as much this morning as last night. They have replaced the IV ampicillin with IV Unasyn - this has a broader spectrum of activity & hopefully will take care of whatever infection Coby has going on. As soon as the diarrhea resolves and he is eating better, he should do well. It will just take time. I anticipate Coby being hospitalized over the entire weekend. :-(