Weekend Retreat

So Brooke got away for the weekend and spent a few days in an exclusive facility:  very pricey, room service for every meal, people attending to her every need.  Despite the fact that every word in that previous sentence is true, she's not hoping for a repeat anytime soon. Brooke was released from the hospital this afternoon after the last couple of days of "rest and relaxation" at Utah Valley Regional Medical Center in Provo.

The short story is that Brooke got very sick and her white blood cells essentially disappeared a few days ago.  Thursday she started feeling really lousy and by Friday morning about 4:00 a.m. she was running a fever.  Any fever during chemo is a big concern because one of the side effects of chemo is that your white blood cell counts can get knocked down, and that keeps your body from being able to fight off infection as it normally does. 

We called the clinic Friday morning and they wanted her to get in right away to get checked out.  They did blood work on her and found that her white blood cells were critically low.  Brooke's condition is known as neutropenia.  A little explanation here would probably help.

Here's a brief summary of neutropenia:  Neutropenia is characterized by an abnormally low number of neutrophils. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infections. Patients with neutropenia are more susceptible to infections and, without prompt medical attention, the condition may become life-threatening.

There are three general guidelines used to classify the severity of neutropenia based on the absolute neutrophil count (ANC) measured in cells per microliter of blood:
Mild neutropenia (1000 ≤ ANC < 1500) — minimal risk of infection
Moderate neutropenia (500 ≤ ANC < 1000) — moderate risk of infection
Severe neutropenia (ANC < 500) — severe risk of infection.

Okay, my words again.  With that explanation in mind and understanding that the normal range is 2000 - 6500, Brooke's neutrophil count at the clinic was 40 - dangerously low.  We talked through a couple of possibilities with the doctor, but it was clear the best thing to do was admit her to the hospital immediately which is what happened.  Her red blood cells were low too -- not as dangerous but still has a big effect on how you feel.  By this point, she was so weak and ached so badly that I had to put her in a wheelchair to get her out of the clinic and into the hospital.

After being admitted to the hospital, they did a complete set of blood work again, and at this point her neutrophil count was actually zero.  The concern, of course, was that any infection could become very serious very fast because her body at that point had really no way to fight any kind of disease.  They started her on some heavy duty antibiotics (the doctor called them the "big guns," appropriate for a Cannon!), which they continued to give her for the duration of her stay.  They also sent her home today with some antibiotics that she will be taking for the next while.

She continued to have a fever through the day Friday and on into the evening -- it was over 102 about 7:00 that night.  They tried to figure out what was causing the fever, but never did.  They did blood cultures, chest x-rays, etc.  She sort of felt like she had the flu -- feverish, sore throat, and she ached everywhere.  At the end of the day, they're guessing it was something viral, but they're really not sure.  Regardless, the doctors were looking for two things before she was well enough to go home:  1) no fever for 24 hours, and 2) improving white blood cell counts.

Thankfully, her fever broke Friday night and didn't come back.  By Saturday, she was generally starting to feel better.  Her blood counts improved, but slowly.  On Saturday her count was 100, still in the category of severe neutropenia and at severe risk of infection.  Today, her count was up to 700, still neutropenic but not severely so.  She still needs to be very careful about being around anyone who might be sick, or being in any kind of crowd.  The doctors felt good about the positive trend, and combined with the fact that she hadn't had a fever for about 36 hours, they discharged her from the hospital.

Brooke is happy to be out of the hospital.  She hasn't had much of an appetite these last few days, and as you can imagine, hospital food didn't do much to help on that front.  She ordered things that sounded good, but they never really tasted good to her.  By last night, she joked that she had ordered everything on the hospital menu that sounded good to her so it was time to go home.

We're not sure what this means going forward.  At different times, we've heard that they may either delay chemo or change the dosages of her chemo.  Brooke goes back to the oncologist Thursday, and at this point, is scheduled for chemo on Friday the 8th.  We'll see how that goes.

We're happy to have her home and, more importantly, glad that she's feeling better.  She's regained her strength and has better energy, at least relatively speaking.  Again, we know there have been many people thinking of her and praying for her.  We've had a number of people tell us they put her name on prayer rolls.  We're humbled and grateful for the support.

Best to all of you-

John