Wednesday, January 2, 2013

More answers

Posted by Becky

The attending doctor came in right after I posted my last update, so we have some more answers.

Magnesium and potassium supplementation is because Leif's electrolytes are low. This could be because the chemo affected his kidneys, so he's peeing out more electrolytes than usual. This low electrolyte level could be responsible for the leg cramps. Also, what with the fevers and so forth, he might be a bit dehydrated, which can also cause cramping. Leif's getting some extra IV fluids, drinking plenty of water, tea, & lemonade, and maybe the supplements will also help soon. His blood pressure has been running a bit low - not super low for Leif, who tends to run low anyway, but low enough that some extra fluids can't hurt.

The folic acid supplementation is because his hemoglobin has been so low. They've ruled out bleeding, and think it's mostly because his bone marrow is so suppressed by the chemotherapy. He may also have a small amount of autoimmune hemolysis taking place; that means that his body could be breaking down red blood cells (not just the transfused ones, but his own, too), which can happen with lymphomas. His Direct Antiglobulin Test was positive, but he doctor says he's not experiencing "brisk hemolysis" - his LDH level, which is used as a marker for hemolysis, is normal. Anyway, the folic acid is to support Leif's bone marrow in cranking out red blood cells as well as it can.

They have not been giving him Neupogen shots to boost white blood cell production, because they don't want to risk making his spleen leak or rupture. However, his monocyte count is above zero today. Monocytes are the first type of white blood cell to start coming back, so this could be an indication that his bone marrow is starting to recover. If so, that would be quicker than he recovered last time he got this chemo regimen.

He's cleared to get celery with peanut butter snacks if I wash the celery really well for him, and we're getting him a donut cushion to sit on. The surgeon recommends not using those, but Leif found his donut more comfortable than the surgeon's recommended soft pillow. His butt soreness is worse since they drew the fluid out a couple of days ago.

The doctor also gave us a pep talk, told Leif that he's looking good, and that the whole team is really pulling for him. After a trying few days, it was nice to hear some rah-rah-rah. Now Leif's winding down to an audio book of our old favorite, Mrs. Frisby and the Rats of NIMH.

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