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January 20, 2005 -- Maintenance #7 (Days 1-14) Just to give you a quick background on ANC and fever... Since Katie has a subcutaneous port, we worry when she gets a fever because it could be the sign of a potentially life threatening bacterial infection. Low-grade fevers of 100.4 for three temperature takings in 24 hours or one temperature taking of 101.2 for warrants a trip to the ER or oncology outpatient clinic (if it's open). There, the child is put on antibiotics which vary depending on how the child appears and height of the fever, and a CBC is done. Some of the blood taken is sent for a culture to see if anything bacterial grows. If the child's ANC (absolute neutrophil count) is under 500 and has a fever (as mentioned above), they are admitted for observation for a minimum of 24 hours. If a culture grows, the fever continues or they are still neutropenic (ANC under 500 - which means they can't fight infection on their own) the hospital stay is longer and will last until the ANC goes up, the fever is gone and the infection is gone. If the child's ANC is over 500 and their appearance meets certain criteria, there are some cases when the child just gets a 24-hour antibiotic and is sent home. With all that being said, after Katie had her spinal tap and VCR, she experienced headaches, leg and back pain for a week. She was in too much pain to go to school. On top of that, she started running a low-grade fever of 100.3 (just 1/10 of a degree under the cut-off of 100.4) starting on the evening of Monday, January 10th. The fever continued for four days. She still was running the low-grade fever of 100.3 on Friday, January 14, so I took her to see Dr. Julie. Her ANC had dropped to 819. Since her ANC was over 500, she could continue to take her meds and chemo at home, and I was to call if her fever went up or continued through the weekend. Katie's fever went away by Saturday and she was back in school yesterday. She was very grumpy and whiny last night so I took her temp and the fever of 100.3 was back. Here we are today. Her temp this morning was 100.4. I've got the hospital bags packed and my mom is ready to take Kyle in the event that we have to stay at the hospital. Right now, I'm waiting to take her temp again (she just ate) and quickly writing this update. If her temp goes down, we've bought some time and may not need to go anywhere. If her temp stays at 100.4 or goes up, we are heading to the outpatient clinic at CHOP where she will be evaluated. Dr. Julie is at CHOP today (and every Thursday), so we will get to see her. Her temp is 100.9. I'm going to finish packing stuff for Katie to play with. I hope she doesn't get admitted and have to stay for her birthday tomorrow. The weird thing is that she really likes being in the hospital!!! I'll keep everyone posted. Katie's fever continued until we got to the hospital. After getting her CBC (ANC went down to 629) and talking with Dr. Julie, Katie was going to be allowed to go home with her port still accessed. We were to return to KOP clinic in the morning for another CBC to see where her counts were going. I asked to have her temp taken one last time before we left because I was worried that we would get home and have to turn around and go to the ER a few hours later. Katie's fever went up again, so she was given three different antibiotics in the day hospital and was admitted for a minimum 24-hour stay. She has developed a nasty cough and is loosing her voice, now --not a happy camper. If you have a moment, please leave her a message in her guest book to wish her a happy birthday. Hopefully this will be a short stay. Here is Katie's ANC and chemo/meds since last update: January 14, 2005: ANC 819. Continue 100% chemo/meds at home -- 50mg (1 tablet) 6MP every Mon-Sat evening and 100mg (2 tabs) every Sun evening, increase weekly MTX to 17.5mg (7 tablets) on Wednesday evenings, 2mg DEX 2 times per day for 5 days (January 6 pm through January 11 am), 1/2 tab Bactrim 2 times per day for 2 days (Friday through Saturday), 1 Viactiv daily, 1/4-1/2 tsp Zofran every 8 hours or as needed for nausea, 1/2 capful Miralax as needed for constipation/hard stools. January 20, 2005: ANC 629. Inpatient on antibiotics. Hold all meds/chemo. NEXT: January 21, 2005 -- Maintenance #7 (Day 15) |
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