Zero to Twenty 😰

On June 4 Wes and I rushed to the ER in the middle of the night. He had a fever, and we suspected it was the result of neutropenia from the barrage of new and harsh treatments in his current phase, Delayed Intensification, and from experience we knew he’d get admitted.

Neutropenia is the state of having an extremely low Absolute Neutrophil Count (ANC). Neutrophils are a form of white blood cells that fight infection, and a healthy adult has a count in the 1500-8000 range. Several types of chemo he is given suppress neutrophils as a dangerous side effect, leaving the patient with a severely compromised immune system, unable to fight off even the most common bugs. When Wes was checked in to the ER, his ANC was zero.

This isn’t the first time he’s been neutropenic, and he has usually recovered quickly. He’s tended to have pretty good numbers throughout treatment, allowing him some measure of normalcy – going out, seeing friends, all under reasonable precautions but he hasn’t had to live as a Bubble Boy. Low ANC has been a common cause of delays – some treatments can’t proceed, or he can’t be discharged, until he’s at a minimum number – but it’s usually come quick. Days. Right now we’re waiting for him to hit 200 without an infection, as if he picks up an infection somehow they may not discharge even if his numbers return.

This time Wes has been in the hospital for two full weeks at ANC = 0. One of our favorite oncologists noted that he’s at the tail end of nearly 8 months of chemotherapy that has peaked in the past month, and his body is just not able to regenerate as quickly as it has before. This is to be expected. It was strange comfort when she cautioned to keep our hopes down for quick discharge, because it could easily be weeks before release and that she wouldn’t be particularly concerned until we’d been there for two months. She also warned that in this state, his neutrophils could recover a little, and then backslide – that unlike previous rounds, even once they start to come back it could take longer, and be less of a straight line from zero to 200. Yikes, but OK. Expectations level-set. He wasn’t going home quickly, but he’s in no crisis.

In fact he’s been feeling pretty good, all things considered, and knowing what we do he’s in the right place. If he was at home, neutropenic, we’d all be on constant state of alert; at the hospital they monitor him around the clock, his exposure to germs is very limited, he’s kept on IV fluids and antibiotics nearly 24/7. It’d be impossible to give him that kind of protective shield at home, and trying would be enormously stressful and risky. He’s needed a few transfusions of blood and platelets, but that goes hand-in-hand with his current condition, and it’s actually fun to see how his energy and attitude directly correlates with his blood counts.

Yesterday his ANC came above 0 for the first time since arriving. He registered a 20, which is a good start, but today we’ll see whether that number holds, grows, or recedes.*

Meanwhile, everyone is making the best of it.

* Update: morning labs came back. ANC has returned to zero. This is disappointing for sure, but the upshot is that it’s the first sign of recovery in two weeks, so it’s still a good sign if you ask me (and you did). Something good is brewing in that marrow.