The Razor's Edge

Howdy all, Bill here for a change.

We had our monthly visit with oncologist Dr. Marschke last Wednesday. The main focus of our conversation was coming up with a new strategy to attempt to get more chemotherapy medicine into Michelle in each 4 week cycle. The last cycle didn't work out too well, as you probably surmised if you've been keeping up with these blog posts.

For those of you who haven't been following closely, Michelle's last chemo treatment was almost 4 weeks ago. The day after treatment, she received her first dose of the white blood cell growth factor medicine, whose purpose was to stimulate Michelle's bone marrow to produce more nutrafils, the white blood cells that kept falling too low to treat. The medicine was a success at addressing the too-low white cell count, but unfortunately her platelet counts fell below the line and we had to cancel her scheduled treatment 2 weeks later.

Dr. Marschke said he's walking a razor's edge with Michelle's treatment. While he could give her a second growth factor to boost platelet production, that drug would effectively be working against the white cell growth factor because bone marrow blood cell production is something of a zero sum game. There's only so much work the bone marrow can do and when we stimulate it to produce more white cells, it can impact the production of red cells and platelets. The razor's edge comes in because our primary guiding principle is to first do no harm, and the Dr. is very concerned about pushing too aggressively with treatment and putting her back in the hospital.

Where does this leave us? After much discussion we decided to lower the treatment threshhold for the platelet count slightly and try again to get 2 treatments in over the next 4 weeks, one every other week starting Tuesday 10/27. The threshhold had been at 75,000 and Michelle was at 71,000. The absolute floor is 25,000, below which it will be very difficult to prevent her from breaking out with bleeding everywhere, since the primary job of platelets is clotting and controlling bleeding. We set the new floor at 50,000 and increased blood count monitoring to 2 times per week instead of 1.

In other news, Michelle's antigen level (tumor marker) is back above 200 again, at 248. It was up to 211 in September, then back to 134 at the beginning of October. This is, of course, a little scary. We'd like to see it go back below 55 and stay there, but at least it's not in the 1000's. The truth is, this is just a number, and it's part of the roller coaster of this disease. It doesn't mean anything to Michelle's day to day experience. It simply confirms what we already know: we need to find a way to get back to a consistent treatment plan where we can get at much of the drugs into her over a set period of time, while keeping her as strong as possible to continute to tolerate treatments.

It's important to celebrate the things that aren't happening as well. Michelle is NOT vomiting on a regular basis. She is NOT bleeding uncontrollably. Perhaps most importlanty, Michells is NOT experincing elevated bilirubin levels, jaundice, liver pain, stomach discomfort, difficulty with eating or digestion, etc. Yes, her energy levels continue to taper off, and she requires even more sleep now (up to 14 hours per day), but her waking hours are good. She has taken up rug hooking, and enjoys going for walks outside when the weather is nice (not too many more nice days left, unfortunatley.)

We had a great prayer meeting at Karen Lowe's house this last Monday evening. It's been over 2 months since the last get together, and we all had lots of catching up to do. Somehow the conversation inevitably turned to the local balloon hoax that captured the attention of the world in the last couple of weeks and put our hometown back in the national spotlight again. The next prayer meeting is scheduled for 4 weeks from now, on Monday November 16 at 6:30, again at Karen's.

Some of you may have heard that I spent the morning in the ER recently. I was having severe abdominal pain, but all the tests for bad stuff came back normal. The doctor thinks it could be an early precursor of diverticulitis, but at this point the only treatment is anti-inflammatories (ibuprofen) and rest.

My brother, laid off since early July, found a job and left this week for cross-country drive to his new home in Halifax, Nova Scotia, Canada, where he will be the project controls engineer for a major ship-builder.

We have also firmed up plans for Michelle's entire immediately family (parents, 2 sisters, and their husbands and kids) to get together here in Fort Collins just after Christmas. It should be a lot of fun, and gives us a bright spot to look forward to.

TTFN,
Bill