42.7? It's All Relative

            On Friday, 5 December, David’s white blood cell count (WBC) was down from 95 to 42.7: a comforting ending of a difficult week.

            On Monday, 1 December, David’s WBC was 90. That means the number of white blood cells, over 65% of them leukemic blasts, had more than quadrupled, from 21.9 to 90, in just a week. The doctor increased his dosage of hydroxyurea from 1 to 2 grams. On Tuesday, the WBC was 91, so the hydroxyurea was increased to 4 grams. Wednesday the WBC was 95, and the hydroxyurea was increased to 6 grams.

            Dr. Gaby Hobbes, filling in for his regular oncologist, Dr. Fathi, initiated a very serious conversation with us on Tuesday. She told us that a WBC of 90 was really high. [When David got very sick in Korea, last March, his WBC was 147. Remember, 4.5 to 11 is the target range.] She explained to us that having a WBC of 90, of which about 76% are leukemic blasts, can cause sudden, serious complications. The leukemic blasts are “sticky” and can clog capillaries in the organs, including the lungs and brain.

            We started discussing hospice, with the clear understanding from Dr. Hobbes that if hospice care is started, David would still be treated with chemotherapy, as long as it was effective. There’s absolutely no expectation that the leukemia can be stopped; we hope that the chemo can slow the progress of the disease.

            And the high dose hydroxyurea did slow the leukemia this week. On Thursday, the WBC was down a bit, to 76, and Friday it was 42.7. That’s nearly three times the October 26^th count, but it’s all relative, isn’t it?

            David continues to look good and is not in pain. His beard is looking absolutely presentable, though not very long for a man who hasn’t shaved since March.

Friday was the fifth and final day of decitabine. It takes about an hour to administer via IV. Now we hope for the WBC to decrease. Decitabine is much gentler than the previous chemotherapies David has had. The regimen is 5 days of decitabine every four weeks or so. We won’t know for a few cycles if it is effective. If the WBC starts rising quickly again, we’ll know it’s not working.

            David, Jim, and I attended the Cambridge Stake’s annual Messiah Sing at the Belmont Chapel last night. The soloists and orchestra was excellent and the chapel was full of enthusiastic singers. It’s a wonderful way to start the Christmas season.