This past week, Julia had several clinic visits to check her blood counts. Monday, Julia’s platelets were low and she needed to receive a transfusion. Back to clinic again on Wednesday and Friday, but this time transfusions weren’t necessary although her hemoglobin and platelet counts were low.
Beginning Sunday (Mother’s Day), we started to give Julia daily Neupogen injections in preparation for a stem cell harvest. These shots will help to build up Julia’s white blood counts (similar to the Neulasta). Julia’s white counts were low all week and it seemed to take longer for recovery than with the Neulasta injection that she usually receives after chemo, but then again, her recovery is coming from a lower starting point after a third cycle of chemo.
John and I split the duties for giving Julia her injections. I would draw the medicine into the syringe and John gave the shot with Julia sitting on my lap. Wednesday there was an abrupt change in our strategy. John had to work late and since the shot need to happen around the same time of day, I had to give Julia her injection. There is a first time for everything. I had to prepare Julia for the change in our system – not an easy thing for the girl that likes routine for all her medical procedures. Julia and I walked through the steps, placing the numbing cream on her arm and gaining her approval to proceed once I could recite all the steps, including counting… 1,2, 3 before giving her the shot. Nervous as I was, I prepped the syringe and gave Julia her Neupogen. “You know what, Mom? That didn’t hurt at all – you were even better than Dad.” Relieved, we got through this little hurdle and the rest of the week, I was appointed to give Julia her shots. I still am not sure if I was truly “better than Dad” or if Julia wanted to make me feel better since I was so nervous about giving her an injection.
Julia’s ANC hit a 1 on Wednesday, so rather than take a chance with picking up an infection, we kept Julia home from school this past week. She was pretty tired with a low hemoglobin count, but quickly got “bored”. She worked on homework and did a few arts& crafts activities. By Friday, counts started to rise and so did Julia’s energy.
Monday, we were back to clinic. Julia’s white cells have recovered. It appears that her hemoglobin and platelets are on the rise, but since they are still low, we will need to head back to clinic on Friday. Until then, Julia gets to go back to school, see her friends and enjoy being a second grader. Since Julia’s white counts are recovered, she will have her stem cell harvest completed next week. Daily injections of a larger dose of Neupogen will begin Sunday morning. Julia will be admitted to the hospital on Tuesday, after Memorial Day. She will have a procedure to place a central line for the harvest. At 10:30 that evening, she will receive another drug called Plerixafor. The stem cell collection will be the following morning. Julia will need to sit still for about 4 hours while they take her blood, remove the stem cells and then return her blood (minus stem cells). Later in the afternoon, we find out if they have collected enough stem cells. If they have not, the procedure happens again starting with the dose of Plerixafor later that night. Since Julia has had so much chemotherapy, they are expecting that she will need to go through the harvesting process at least 2-3 times. They will then freeze Julia’s stem cells in preparation for a possible stem cell transplant.
Julia will begin chemo again (Cycle# 4 of Topotecan) on Monday, June 3 and have scans at the end of this cycle. These scans will give us insight to whether the Topotecan continues to work and if the tumor has shrunk to a “minimal state of disease” so that a stem cell transplant can take place.