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TRANSPLANT

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DAY +2
Recover
Friday, August 30

We are watching Simon's counts. He reached the state of being "neutropenic" around Monday, which means he has a white cell count of 0.5 or less. That means any fever has to be treated as a possible bacterial infection (chest x-ray, blood and urine cultures, and IV antibiotics).

He is holding his own on red cells and platelets (although he's at a very low platelet count, and we need to avoid activities that might cause bleeding, such as nail clipping, since his blood will be hard to clot). He will receive blood transfusions if he falls below a hemoglobin of 8.0. He will receive platelets to keep him over 10. His blood is now drawn daily around 5:00 am, and the results pretty much plan our day.

Today Simon's mouth/throat pain has been more intense, and he is now on a very low, continuous dose of morphine. We can administer additional doses as needed with the "pain pump". He's pretty sleepy, but his voice came back today, and he managed spurts of conversation. For such a chatty guy, losing his voice is a big deal.

Miriam is well enough over her cold that she was able to visit again this evening and wave through Simon's window at him. Simon managed a genuine big wave from his bed, but he wasn't feeling too great. Miriam enjoyed various foods (the stuff Markus had brought for dinner, popsicles, the cake from Simon's tray, etc.).

By about 7:00 pm, we saw the first signs of a fever. Once he hit 38.9 C (101.3 F), he was put on the fever/neutropenia protocol. In came the x-ray lady, in came the nurse with many containers for blood cultures, and in came the IV antibiotics. He's also hooked up to his IV nutrition, so there's a lot going on on his "pump tree". A dose of Tylenol, which he bravely pushed into his mouth on his own despite the pain of swallowing, has helped lower his temperature, which peaked at 40.1 C (103.4 F). He has a bit of a rattly cough. Oh my.

Still, he's sleeping quite peacefully, except for the bladder urges that wake him every 90 minutes or so. And we had a lot of fun watching Wallace and Gromit together this evening. He's very insistent that we watch at his favorite parts.


GLOSSARY

BLOOD COUNTS
WBC (white blood cells; infection-fighters) normal range: 4.5-13.5 K/MM3
Hemoglobin (carries oxygen in blood, low=anemic) normal range: 12.5-16.0 g/dl
Hematocrit (not totally sure, but related to red blood cells) normal range: 36.0-49.0%
Platelets (blood clotters; low means risk of internal/external bleeding) normal range: 150-450 K/MM3
ANC (absolute neutrophil count; basic measure of immune system) normal range: 1.8-10.1 K/MM3

GLUTAMINE an aminio acid that can reduce mouth sores after intensive chemotherapy. Not commonly used at UM Hospitals, but hightly recommended by other parents in our Neuroblastoma listserv community. Dr. Yanik said it would be OK to try it and ordered it for Simon.

MYEOLOABLATIVE destroying of bone marrow. Pre-transplant chemotherapy is designed to kill off all bone marrow in the body. The transplant introduces new cells to create new marrow.

NEUPOGEN white blood cell production stimulating agent; injected subcutaneously while WBC is low.

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TODAY'S COUNTS
WBC: 0.1
Hemoglobin: 10.4
Hemotocrit: 29.8
Platelets: 19
ANC: can't be calculated with such a low WBC
Transfusions: none

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