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. :-(

Hospital Update

one night in the clinic & this is the update from our neurologist who called the clinic this morning:

"Coby's temperature is still elevated but down to about 104 degrees. There has been no further vomiting or diarrhea. His blood glucose became a little low so they gave some IV glucose to correct that. He is continuing on IV fluids & antibiotics. He would not eat any dog food so they fed him a little cooked steak & rice. For this stage of treatment that all sounds good for now. Hopefully within another 12-24 hours the fever will fully resolve."

More updates to come when available.....

Coby has been hospitalized

Coby has been hospitalized with a fever of 105.7 - he has caught an infection & is now septic. Thankfully, we caught it early enough today from the symptoms he was exhibiting - shivers/tremors, diarrhea, vomiting, lethargic. I knew in my gut something was wrong, emailed Dr. Sisson (our neurologist in Boston) who suggested bringing him to the ER. We did just that & if we had not, Coby would have died. Coby had a fever of 105.7 indicating sepsis. He is currently at the hospital where he will remain for a few days. He is receiving 3 different IV antibiotics and IV fluids. They ran blood work and as Dr. Sisson predicted, Coby's white blood cells/neutrophils were very low. The normal "low" (for neutrophils I think...I don't have his lab work with me) is around 5500...Coby's level was 260!!! Either way, it was SUPER low!!! The goal is now to get them back to normal, get rid of this infection & hopefully be home by Christmas. Coby will be off all his chemo medications for right now & only on the zonisamide for his seizures.

I am not sure of the medically correct reasoning for what has happened, but it has something to do with Coby no longer being on prednisone & because of that, he is unable to handle such a big chemo load like last month. It was confusing when I was explained that over the phone, so I apologize if I am totally wrong. Once I have a correct answer, I can repost.

On a positive note, there is a "silver lining" to the situation according to Dr. Sisson: His chance of relapse is lower because the cells causing the disease were severely damaged the same way his normal cells were which made him sick.

I will continue to post updates as I receive them! For now, positive thoughts & looking forward to having Coby home for Christmas. Here are some pictures of him this morning when I thought he was only shivering b/c he was "cold".