Phrexit 

I personally, like almost half of UK and perhaps most of the world, was shocked by Brexit. I hope November is not as shocking as this, when the US elects its next President. On Tuesday June 28th, Rachana celebrated her ‘phrexit’; she exited Phase 2 of her treatment, which was exactly two months from the date she came home after the 1st phase in the hospital. When we realized this, I said ‘time flies’ and quickly realized that didn’t sound good. Rachana was like ‘are you crazy! – it did NOT fly’.

Does time fly? Maybe it does but that does not mean you don’t remember the experiences from that journey; memories don’t fly away. We arrive at the present thinking we’re quite far from where you started, true; but the journey is still vivid and it’s easy to recollect the sights, sounds and experiences. Good or bad, it’s great if time flies. You get a chance to collect more memories and still live a lifetime in a treasured moment.

Phase 2 didn’t want to say a cordial goodbye. On Tuesday night Rachana’s temperature started climbing around 4pm. By 9pm it reached 101.2 and we called the clinic who predictably told us to drive down to the ER. We took our ‘hospital bag’ and drove down. It was the usual routine in the emergency – xray, blood, swabs, urine, ECG and a CT scan because her jaw was aching. After the initial test and not finding anything unusual, they started to give antibiotics through IV and around 4 am moved us to the now familiar 11th floor; we settled in for whatever was left of the night.

The next day, Wednesday, was bad. Fever of around 100 was cycling every 3-4 hours, she was having chills, and multiple aches. The doctors didn’t find any virus or infections but told us they will keep her under observation for a few days. Her hemoglobin dropped to 6.2, platelets to 12 and ANC to 30. It was the lowest we’ve seen these counts in two months. She had no energy left, was running a fever and had aches all over. It was worse than what you are imagining reading this. They gave her blood twice in the last 4 days and that stabilized things a bit. They also gave her a shot that stimulates the bone marrow to produce more blood, which in turn can increase her counts. All those things worked and Thursday was a little better. Fever, chills, aches were a little under control and she was less tired. Friday was again incrementally better, and some of her friends were here to cheer her up. On Saturday the day was good but in the evening the fever showed up again. It was basically a few hours of fever, chills and aches; they collected some blood sample to test for infections and then gave some tylenol, which helped. We’ll be in the hospital till her white counts and ANC climb up a little more, which’ll probably take 2-3 days.

The doctor’s conclusion is that it’s a neutropenic fever. When the blood count is low, the white blood cells are low,  so the neutrophils (the actual infection fighting cells in the white blood cells) are low. This condition i.e. being neutropenic with a fever is a bad thing because the body cannot fight any infections and fever is usually a sign on an infection. Things can escalate quickly  if the infection is not treated quickly. But in half of these cases the fever goes away after a few days without giving any indication to the doctors as to what it actually was. This happened to Rachana once earlier too. The game plan now is to control the fever with antibiotics and give Neupogen shots, which will stimulate the bone marrow to produce more blood, which’ll increase the white blood and that’ll keep the fever away .

Next week is an off-week so she doesn’t have chemo. If the blood counts recover and cross the minimum threshold of ANC at 750 (it’s 80 today) and Platelets at 75k (it’s 30k today), Phase 3 will start on July 11th and go on till end of August with chemo every 10 days. Phase 4 will go from mid Sept to mid Nov and that will be the end of this tough and aggressive chemotherapy. It’s already July and I hope the rest of year flies by quickly too.

 

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