Transfusion and 1-2 more Rounds of Vidaza ordered

Today's appointment, January 21, 2015, at the Cleveland Clinic was a long one! We had a snowy and slick drive up to begin with. Once we arrived, the routine blood work was drawn and we waited for the numbers to come back. Neither of us expected the need for a transfusion since his counts were still up on Monday and he had just had a transfusion last Thursday. 

To our surprise his hemoglobin fell from over 9 to 7.9 in just three days. The type and screen took 2 hours and the first unit of blood didn't arrive until almost 2:00 pm. The rest of his counts were low: White counts at .79 or 790; ANCs at .55 which is still considered Neutropenic. His platelets were lower at 36,000 but at least no transfusion of platelets were needed. This is the first time he has had to have another transfusion within 1 week. Usually, he has been able to go about 2 weeks before needing one. The doctor was not too concerned about this. She explained that the low counts and need for transfusions can happen because the bone marrow is still sensitive to changes after a transplant. 

We couldn't go upstairs for his doctor's appointment because he was getting his transfusion, so she came down to his treatment room along with our nurse coordinator. 

First, we learned that she has NOT received ANY of the blood work results that has been drawn in Dayton. So, it was hard for her to evaluate how well his counts were rebounding a week or two after chemotherapy. (Ugh. Why does this surprise me!). 

She could tell he has lost weight and showed some concern about his appetite as a result of feeling nauseated from the Vidaza. She recommended that he take a Zofran every morning before getting chemo.

She also prescribed Cipro (antibiotic) for him to take when he becomes neutropenic the first week after chemo. 

All these preventative medications were discussed as she wants to do 1-2 more rounds of Vidaza. So he will be starting round 3 on February 9, 2015. Then, he will return to Cleveland two weeks after that for a follow up visit. If his counts are able to rebound well after 2 weeks, she will likely schedule a 4th round for March 2015. Then a bone marrow biopsy after that. She also said she might do the biopsy after the 3rd round in February just depending on his counts and his chimerism results drawn today.

Since he didn't get a breathing treatment of Pantamidine, which is an antibiotic treatment they have been using instead of Bactrum (which he has an allergy to), she has ordered a blood test to check his CD4 counts to judge how these helper white T-cells are doing. They can be suspecting to going down after chemo and they are needed to help fight off bacterial infections like pneumonia. 

We didn't get home until about 9:30 pm. I'm sure I've made some errors in this blog because I'm so tired. 

More to follow.