First office visit

04/21 10:25
ANC 304
APC 1026

Today was our first visit to the doctor's office. We got a tour of the clinic, including the choice of Seashell, Giraffe or Mushroom rooms for upcoming chemotherapy visits. The tumor is definitely shrinking. The doc can tell just by feeling it that it is smaller. He is thinking of waiting until Alan has completed the second VAC treatment to do an MRI, rather than doing at CAT scan sooner, so we can get a complete view of the shape of the tumor. We know it's shrinking away from where we can see and feel it on his abdomen, but he would like to see if it has shrunk at the back and other interior angles as well. Since Alan would need to be under anasthesia to do an MRI, it would be best to wait until the chemotherapy has had a chance to really attack the tumor.

Today the nurse drew blood from Alan's port. We put some Emla cream on the site before coming to the office, so he didn't feel any pain from the needle. He was more upset about being held down, and of course, the vitals that were taken earlier. That silly blood pressure cuff again!

The doc and the nurse were surprised to see the rash on Alan's chest. The doc thinks it might be a fungus that developed under the bandage while he was covered up for so long. It wouldn't take much to get it wet. So we add another prescription to the regimen. The doc also upped his dose of Tylenol with codeine, so hopefully, our little man won't be as cranky.

During the exam, we offered Alan a little snack, which he accepted by opening his mouth rather than grabbing. The doc said to expect some regression - Alan will want to be babied, even as he still demands some independence.

The cryptic letters and numbers at the top of this post were the results of Alan's blood test today. His white cell count low was understandably low, as shown by a high lymphocyte ratio The lymphocytes are not affected by the chemotherapy. When the production of the other blood cells affected by the chemotherapy slows down, the ratio of lymphoctyes to the rest of the cells will rise, indication a greater risk for infection.

ANC is the Absolute Neutrophil Count - a count of the white blood cells that kill bacteria and an indicator of Alan's ability to fight off infection. 1500 is normal in a healthy child. The new normal is between 200 and 500 - still at a high risk for infection, but to be expected in a chemotherapy patient. If we dip below 200, then we are at a very high risk. APC tracks another kind of blood cell which will eventually boost the ANC, so a combined APC and ANC can indicate if Alan's immune system is heading for an upswing.

Being a new chemo mom, I was doing a lot of chicken scratches on Alan's lab results and typing furiously into the phone. Finally, I asked one of the docs if they had a beginner's guide for parents new to the process. He gave me a copy of Childhood Cancer: A Parent's Guide to Solid Tumor Cancers which helped me clarify and remember some of the information. I found some more details at the St. Jude Children's Research Hospital website's Did You Know page on blood products and blood counts.

There will be plenty of posts on the topic as we try to digest all this information and what it means. Part of The New Normal is knowing what Alan's counts are and what it means to our day to day living. Stay tuned for a more complete explanation of the APC after Alan's next office visit on Friday when we have a chance to ask the docs for more information.