Good morning,
              I did a google and the def. of netrophils is, a type of white blood cell important in the defence of the body against infection.  Segment -divided into or made of distinct segments. I'm no doc. and this is what I found thru a google sea
rch.

Good day Dyce

Thanks for your feed back.  I thought his WBC were falling real fast. The neutrophils are called Segmented Neutrophils, I'm not too sure what the different is. The normal range is 42-44, and actually his is 26.9, it was within normal range a few weeks ago.  We see his doctor on Tuesday so I have alot of questions to ask.  I have a hemologist that I am going to call tommorrow and get an appointment ASAP.  I'm 41 and hubby is 48 years old.  The biopsy report looks pretty bad, at least thats what the doctor says.  All I know is that we will not go down without a good fight!!!! With postivie thinking, good diet and a lot of prays we will make!  He has been very lucky so far!  He has had no adverse reaction to the medication.  He keeps asking me if I'm sure that I gave him the medication. He says he can't feel the shots and them acutally looks better the next day. BUT he has Hep C b1..... Hopefully the lack of side effects is a a good sign.  We have both been so lucky to find this site because it has given us alot of helpful information!!! AND HOPE!!!

The office was hematology-oncology so most of the pts were there for other purposes and 'rescue' drugs were a staple of many pts course of care. The the office ran like a machine. The best part were the people who ran the machine.  It's like they had an office policy that a patient can't leave without 3 employees saying 'good morning' . Unusual. Wish they did car repairs.

Can anyone tell us what is considered a normal drop in WBC & Neutrophils counts?  Husband had his 2nd injection and 2nd week of ribo and WBC were 5.8 and are now at 3.4 and neutrophils are 58.1 and are now 23.3.  I'm kind of scared cause this seems like he's dropping pretty fast.  The way las Vegas is it will take 4-6 weeks for him to get an appointment with a hematologist and he'll be at zero by then.

The office my husband went to was a hemotology-oncology office.  And it is amazing how they handle their patients.  

Boy, if we could get car repairs in that fashion.  Bada bing, bada boom and TLC to boot.  AHHHHH

I wish that they would treat all patients on treatment (that drops your cbc), with the same care. Maybe in the future, hoping near future.

cajun

Sorry to hear this about your hubby. Normal whiteblood count is 4.8 to 10.8 and neutrophil is 2.2 -8.6. I don't understand the neutrophil number because in my research I never seen it numbered like that. His wbcount is low and that does seem fast.I'd bring this to the attention of the doc right away so your hubby does't drop to low affecting the administation of the hcv meds. They need to get him refered to a hematologist right away. Please let us know how it goes and welcome here.

Sincerely, Dyce

I am putting this in motion before things happen.  I don't want to faint on the floor.  My last cbc was on 2/20/06,
WBC...2.8 . RBC...3.2 . HGB...10.6 . PLT...114, my cbc a start
WBC...6.6 . RBC...4.4 . HGB...14.4 . PLT...184.  I have had a consistant slow drop each time and I have had 3 drops thus far. I was told I could take another drop as long as it was not drastic.  I thought better to go to their other office that is further away from me, for a sooner appt./ that is me being pushy.  I see hemo on Tuesday.  I just want to get a jump on things and not have it get to a serious low level.  I remember what you had to go through in your postings and I am trying to take that to heart and be pushy, pushy; am not in a danger zone yet, but I don't want to go there either. Thanks for your concern.

On another note, I read your post about your father.  We worry so much when they get older and more fragile.  My mother in law fell at my house and all she thought it did was bruise her eyes because of her glasses. Said she was sore in her ribs but nothing much and had all believing she was okay.  Well the next day her daughter brought her into the doctor and she had broken ribs. Sometimes they don't complain even when it could be serious. Hope your dad feels better soon.  Keep an eye, even if they say no.

cajun

What is your hgb?  I can understand sending someone to a hemo doc if there is time - but I'm not understanding why if your hgb is really LOW he couldn't start the process and get you on Procrit right away instead of making you wait like that.

I mean a five week wait is ABSURD you could be in the hospital well before that.

NUTS.  Just NUTS.

I just had another count drop about a week or so ago; HepC doc sent me to Primary doc to get my referal for Hemolologist.  Hemo doc's nearest office to me, could not see me for 5 weeks; but their other office (further) could see me this Tuesday and then they will send my chart to the office closest to me to continue.  The hemo doc will chart me and then instruct me. And, I did do a little pushing to get this started. Just stay on top of things and you will get things through/be pushy if need be.  There is nothing worst than being in blood count drop limbo.

Flguy:  When my husband was going through Hodgkins/Chemo, his doctors office had all that equiptment there too.  Isn't that wonderful.  I was amased how fast and everything was right there at that office with no waiting.

I actualy haven't played golf in about 20 years - not since I blew out my hip water skiing in 86. That was when I had a houseboat in Sausalito, but that's another chapter.

Anyway, golf at dawn! Me and my buds would play poker all night, then as the sun came up we'd twist up a few fatties, find an open beer store, and head out to the links. Ah them was the days. Tequilla shots on the greens at 7:00.

Hey your Dad sound like he's doing well. That's great.

congrats on starting on your journey, betcha it beats waiting to start any day...please keep us posted!

Oh, don't I know it! spent a little time in Buffalo visiting some friends...you got a much tougher hide then me! I had enough of those winters when I spent a few years living in Berlin, for one of the winters it was the coldest in Europe for 100 years, just my luck huh? for around a month it was 30 below...thought I was going to die for sure, then I was afraid I wasn't going to, ha ha! Good luck to you and I hope youre having a great weekend! and it's warming up! (the change of seasons is sooo beautiful though, that you must really enjoy!)

Goofie Boy: Well, in terms of golfing analogies, I was thinking more about Bill Murray in Caddie Shack other than Thurston Howell the III, ha ha! Just kidding my little brother up North...did you know my dad could still break a 80 at in his 80's? thought that was pretty good, he's placed in a number of amateur senior tourneys...he still plays 4 times a week, even it's just hitting balls...ouch! He's 98 this month...I used to play a little, I'm a pretty good putter...elitist though it is...nothing beats walking on the greens early in the morning when the sun's coming up in the sky...

Wow I wish that they that at my joint!  I have to go and wait forever while people who seem to come in after me go first (LOL I'm sure they aren't but it feels that way) and then wait a full day for the results.

That is so cool. Totally awesome.

PS I agree with Jim it seems there is way too long a lag time between diagnosing the anemia and getting the Procrit or Epogen.  That is why we NEED to insist on regular CBCs every week at first you know? Even every two weeks is just too far apart.

I mean they KNOW about what week it starts going on generally so why not just take the precaution. Oh yeah MONEY LOL.

Thanks everyone for the post. This is something that needes close attention. Monday I'm calling the office and getting the imfo on the hemotologist so I can get refered right away. The way my insurance is set up I can self refer myself to specialist. Also I'm calling caremark on getting thier guidlines on approval of blood boosters. I can't see suffering any more than needed .

  Thanks again, Dyce

I go to the lab each thurs(shot day) and get my cbc done then on monday my hep docs nurse calls me with all the numbers, and we talk about how I'm doing. I am at the lab for all of 10 minutes,(very nice people) then my nurse gave me her number in case I need anything ie. sleeping aids  or such. then to top it off, my drugs are shipped to my front door. I use PharmaCare and they are the greatest bunch of people, and I am very fortunate that my doc and his nurse take the time that they do. I hear some real nightmare stories
lilmoma

The hemotologist had a 'cbc machine'.  They draw the blood into a vacuum tube, insert the tube into a door on the machine, machine hummed a bit, a full cbc report popped out. When i did not get neup I was in/out of the office, including waiting, within 5-10 minutes.  If neup required, maybe 10-15.  As long as I was on time, they'd take me first. We got in a groove.

Mr. Beagle is right - I do see a hemogologist as well. I was lucky because my primary care doctor who set me up with the doc in charge of my hep IS a hemo doctor also.

Totally necessary to have someone in your corner who understands about how horrific the anemia truly can be. Some doctors (from what I see in here) don't have any understanding or compassion.  I am SO GLAD we had discussed rescue drugs BEFORE I started treatment (at the advice of those in here). So when it happened - we were all set.

Still it took some time and problems to get it to go through my INSURANCE company.  I hadn't planned on THAT and in that time I got much worse than I would have been had I known that.

so make sure in advance (general for everybody) that you not only discuss it and line it up with the doctor but also that they have someone make sure that it will go straight through on your insurance.  

Debby

I was told to expect that I would probably need blood boosters from the start, but Ins approval had to wait for my numbers to fall. Approvals came quickly and it has worked out fine for me. I don't see a Hemotologist, my Hepatology clinic takes care of everything. I get CBCs weekly, and see the Doc every couple months. Communication is mostly by email.

From my perspective, perfectly normal. I had a standing cbc every monday at a hemotologist.  Walked out with the blood report in my hand.  If anything needed (neupogen in my case) thet'd inject (hemo's decision) and send me on my way with a report to my GI. In fact, I NEVER saw my GI during tx, only just before it started. I had pre-written perscriptions for liver panels and pcrs before tx started and just followed along on a spreadsheet the GI and I made up. I finished 6 months, 2 months ago and still have not see the GI since before TX. Phones and voicemails only. Except for tx itself, all was smooth. Did see my PCP and Endo guy a couple of times just to make sure I was covered. Good luck Dyce - enjoy the ride asd much as you can.

It is not only normal, it is great news, Dyce.  Hemotologists are blood specialists, and they are much better prepared to handle the drops in blood counts.  I go to the hemotologist's once a week for CBC's (only see the nurse - havent seen the Doc since my first visit, but that's okay) and I only go to the GI treating the hep C once every 3 months.  Ask your doc to give you the referral now, so it will be easy to get in when you need to.  Sometimes it is hard to get an appointment when you need to.  

I wish all the doctors did this
frijole

I think you hit the nail on the head when you asked "is there really enough time..."

After reading many experiences here and on other discussion groups, I've come to the conclusion that there's often too much of a delay between what should be warning symptons, for example of anemia, and when Procrit is administered.

If your doctor doesn't make Procrit/Neupogen decisions himself, then I'd push to see the hematologist now on a proactive basis.

What you want is an understanding between your doctor and hematologist, that they will do everything in their power to safely keep you on the treatment drugs, and will act in a proactive manner, whenever that makes sense.

Keep in mind a couple of things. First, Procrit takes 2-4 weeks to kick in, so if they don't test your hgb frequently and don't act proactively, you may suffer needlessly; and second, Procrit if your doctor or hematologist doesn't stock these drugs themselves there can be a delay getting them because of insurance, etc. Therefore, getting an insurance pre-approval makes sense even if you may not need it.

My hepatologist is very agressive with Procrit but has never sent me to a hematologist.

All the best with treatment.

-- Jim

You might ask to be referred now.  My doc waited til I was so low I ended up at short stay for Neulasta shot, Riba was reduced for three weeks and one Peg shot cut in half whhile waiting for the Cancer Doc appointment.  The first available appt was 4-5 weeks out.

Dunno about others but for me it doesn't take long to fall down but takes twice as long to get back up.

Would be nice to have a script waiting for you, even if you don't need it.

missmiss

My above post must have crossed.  But yes they do send them to blood Drs.  My hep dr. has one on staff.

BB

Good morning, the doc I go to is a liver doc. and he is txing alot of hcv patients. Yesterday when I was at the office a ambulance brought a guy in who was completely yellow. That was a dire situation and comsumed all the docs time while I was there, so I didn't talk directly to him. I thought I read post here where liver docs. sent patients to blood docs.

Dyce