Days 8, 9 & 10 Consolidation – It’s Gooood.

I’ve been afraid to update this blog, because everything has been going so good, and I don’t want to jinx it by pointing it out. But, I owe it to of you who cares enough to follow Courtney’s progress to keep you in the loop. And I owe it to all of you who have lent us your support and who have kept Courtney in your prayers to tell you how much they’ve helped. The bottom line is Courtney is doing remarkably well.

We’ve been waiting and somewhat expecting the chemo side effects to kick in, and although she has felt some nausea and has lost some of her sense of taste and smell, the side effects have pretty much been limited to just that. Her headaches are all but gone, and she’s gained strength and energy each day since she’s been home. She’s making it easy to forget that she’s in the midst of a course of chemotherapy. But we can’t forget because we still have to be diligent. Her WBC counts still have to drop to zero before they go back up and we can consider her done with this round. As of today, her blood counts are steadily dropping.

So far, we’ve been to the BMT clinic twice: Monday and today. Monday we went so she could get a shot of Neulasta. This drug is supposed to help prevent a nutropenic fever, a condition relating to a really low amount or altogether lack of neutrophils. That’s pretty much all they did. She didn’t even have a blood draw. They didn’t expect her counts to be so low, so they put of running blood analyses until today.

Today’s visit to the BMT was slightly more eventful and much more informative. While they did draw her blood, the counts indicated she didn’t need any blood products, but probably will on Friday. They’ve already ordered the platelets.
Her counts for today:
WBC = 3.0 (low)
HGB= 9.1 (low)
Plt = 44 (low)
Neutrophils = 2.9 (normal)

Dr. Vusirikala (Dr. V), Courtney’s oncologist for this round of chemo and for the transplant, came in to give us much more information regarding the bone marrow transplant and its timing. Speaking of the transplant, I just realized I never shared the fact that Tracy, Courtney’s sister in Italy, will be the donor. It turns out that she is the only match amongst her siblings. So, needless to say, she will be making another visit to our home in the near future.

The timing that Dr. V gave us could change depending on how Courtney feels during the coming weeks, but it’s still nice to have a plan. So, taken from Kelley’s notes and subsequent email sent the family, here’s the plan as it stands now:

Nov.12th: Courtney will start pre-work up testing which could last 3 days.
Nov. 26th: Tracy will go for pre-work up testing.
Nov. 30th: Anticipate all of Tracy's blood work and test result will be back for confirmation
Nov. 30th: Courtney goes to UT Southwestern (outpatient) for removal of PICC line and insertion of new line (neostar? Three tube line on opposite side of Hickman).
Dec. 3rd: Courtney is admitted to BMT unit; will receive dilantin as preventative for seizures
Dec 4th: Courtney starts Chemo – this is a 7 day course of Busulphan (4 doses every 6 hours on four days) and Cytoxan (two doses).
Dec 7th: Tracy will start injections for 3 days; she will not be admitted at any time
Dec 9th: Courtney will get Prograf (an anti-rejection drug). This is a drug that she will likely be on until for over three months after the transplant.
Dec 10th: Harvest Tracy's stem cells. This may not require a catheter but may be done through a regular IV. They will determine this prior depending on the size and strength of her veins.
Dec 11th: Bone Marrow Transplant

Discharge is contingent on: Resolution of toxicity of chemo effects, resolution of infection if one occurs, recovery of WBC counts and resolution of graft versus host disease (GVHD) should it occur (10-15% chance for acute GVHD).

Dr. V also shared with us the fact that while Courtney will probably feel pretty crummy during the BMT treatment, she probably won’t feel as bad as she did during her first round of chemotherapy. We hope and pray that this will be true. It would be nice if she never feels worse than she does right now . . . which is, in Courtney’s own words, “Goooood…considering cancer still sucks and chemotherapy is still crappy.”