My Dr. put me on neupogen when
WBC dropped to 1.8 (ALERT) and Absolute Neutrophils dropped to.8 (ALERT) around the 4th week of TX (I'm now at week 17 of 48 and I do Neupogen injections every 2 weeks).
Before starting TX the numbers were 4.9 for WBC and 3.0 for ANC.
I believe the risk with dropping WBC and ANC is mostly a lowered resistance to infection, making one far more susceptible to getting sick. (In my former job working with 500 kids per week, I was sick all the time even before tx).
I've read other posts on forum that say some doctors don't worry about ANC until the levels are below .7 or even .5.
My Dr. called me the minute he got the labs showing low WBC and ANC and immediately started me on neup.
I can't tell what the sides are with regards to low counts. I know I feel like cr*p most of the time. Biggest problems are being short of breath, fatigued and very weak. But that could be coz HgB levels dropped 3 points in the past 3 months from 14.5 to 11.4.
I've always maintained that most of us on tx have a high RDW. It stands for red cell distribution width. Since we are taking meds which destroy our blod cells and are having to manufacture new ones. For some reason that causes a variation in red blood cell size and shape. I asked my PA and a nurse practioner what it meant and waht it stood for and they couldn't remember. They were very nonchalant about it so I read up on it myself. I've noticed many people post with this result. I guess our medical teams are programmed to respond to sifnicant factors and nothing else. I have had several test with 0 eosinophils several times but both pcp and hep c team act as if it's nothing.
Did you do the reflexology with the mystery man?
I don't believe your WBC's are as critical as your Hemo......White cells are immune system if I'm correct...But it's your reds that you really need to be worried about,whites too yes...But its your red cells that carry OXYGEN to your body.....Your Heart is your motor and red cells are the little red wagons that carry gas to the motor..NO Gas, No motor....
Low whites leave you majorly open to infection and in the case you get cut you may bleed out...In this case of being Anemic they would give you EPOetin = Procrit, to stimulate your bone marrow into producing red blood cells....
Ideally is to have your Hemoglobin 10.0 and above,but not below...
This is very true..There does have to be a balance...Bottom line is they will look at your Hmg then everything else as a whole...
See I had hgm 7.4.....ne#1.3..wbc3.3..rbc2.25..hct 22.1...but the month before my hmg was 10.9...hct 32.8..ne#1.27wbc,rbc were 3.44...3.37 respectively......They weren't too worried until the hmg dropped low like it did.....Somehow I got lost in the shuffle and they didn't catch the big drop over 2 weeks of cbc's.By then I was VERY SICK.....I thought I was going to have a heart attack because of the lack of OXYGEN....I could hear the blood rushing in my ear from my carotid that" sounded" like 200 beats a minute...I thought my heart was going bounce right out of my chest....
40K units of EPO and a week in bed and 6 weeks of 20k units of EPO ...
Now... :):) that was funny - (well, not really funny... but I can just see you doing a self incision and drainage of the 11 cm place that was not cellulitis - lol.......REALLY not funny). My husband (back in the 70s) did a self I&D on himself (no... actually his buddies did it to him, telling him he needed to get the "core" out) and .... to make a long story short he wound up in the hospital on IV antibiotics and the docs asking him "are you NUTS???"
IMHO, normal levels in both types of blood cells are equally important. I mean if you have the red blood cells distributing O2 but succumb to a massive infection due to lowered resistant it won't matter. I mean if you have the motor fueled by the gas but don't have the armor to protect the little motor from attack, your motor will still be unable to function optimally:)
The absolute neutrophils is the wbc that interests drs as far as rescue drugs.This is my fav website for info: Lab tests online.
Re: ANC I've taken the following quote:
What does the test result mean?
NOTE: A standard reference range is not available for this test. Because reference values are dependent on many factors, including patient age, gender, sample population, and test method, numeric test results have different meanings in different labs. Your lab report should include the specific reference range for your test. Lab Tests Online strongly recommends that you discuss your test results with your doctor. For more information on reference ranges, please read Reference Ranges and What They Mean.
Celluitis IS NOT THE SAME as Cellulite........Celluitis = EDEMA...The swelling of the soft tissue with fluid as to make a seal to block of poison from travelling thru the body, a CONTAINER so to speak......
I only drained out about ,just guessing about a 1/3 cup,myself before I went to the ER..The ER Doc properly lanced it,and was squeezing and trying to keep up with the flow but he had to quit and just cup his hand with a handful of gauze to cathc it..Probably All told when it was done maybe a smidge less then a half cup of pus. An STANK!
As far as lucky...I wouldn't say that at all....In retrospect, ya that wasn't fun....But remember I did a VL test and I came back UND <50....And 2 months after that I'm NO HCV RNA DETECTED.....NONE...
SO PRAISE GOD!!!! YEEEEEEEEEEE HAAAAAAAAAAAAAA!
C: I love thermometer stories. Lost mine a while back and life just isn't the same. I only trust the outlawed mercury thermometers. sorry to hear you were sick. Sounds like tx! Don't you think cellulitis should be treated with antibiotics?
Mad: So whats the diff between cellulitis and infection? I've always seen it treated with antibiotics. Sorry, you don't sound too lucky with medical tx!
Hi Grandma. I don't know that there are "symptoms" of a low ANC other than what happens to those who become immunocompromised -- and that would be acquiring infection and/or inability to heal or worsening of a current infection. When my doc at Duke gave me his take on the low ANC that occurs in patients on treatment, he said it's really not the same thing as what we think of when we think of those who are "immunocompromised", in that we (the ones with HCV with low ANCs from treatment) are not necessarily at "high risk" for opportunistic infections like other patients who are diagnosed "immunocompromised'. He said it's a totally different ball game with HCV treatment and low ANC from the treatment and that most - for some reason - do OK even with the low ANC until it gets really really really really low (lower than .5). He assured me that even with a low ANC on Hep C treatment, it does not carry the same dangers as a low ANC would for ... say someone with HIV or AIDS (just picked those two out of the air). We were discussing the low ANC and the initiation (or lack of) of Neupogen to treat a low ANC and the fact that VX-950 and HCV 796 do not allow rescue drugs for their trial subjects. He was trying to assure me that even with my history of an infection the first time I attempted treatment in 2003, it was because this infection was THERE already (it was underlying; I just didn't know it was there) when I started treatment, and it took like a rocket when my ANC bottomed. I was low on wbc's going in and the rbcs. BUT - since it's all stable now (the infection and the labs), he thinks I would do OK without Neupogen even if my ANC were to bottom out again on treatment. He said if it did (while in a trial) that they would lower the dose of Peg/Rib and monitor. He said on regular SOC (i.e. not participating in a trial), I would get the rescue drugs - both Neupogen and Procrit. I've got another hepatologist who is not too sure if it's wise in my case (given the fact I did have the low ANC and infection and anemia once already on treatment very early in the game and had to be pulled) to treat without the availability of rescue drugs. Both docs think I'm on the "border" as far as having to make the decision to treat (they both agree I am OK in the watch and wait mode for now given my biopsy results from 2003 (3/2), a recent fibrosure (1-2 / 1-2), and my labs over the past three years).
If you are on SOC and can get your doc to prescribe Neuopogen if your ANC starts bottoming out, ask for it is my opinion.
As far as anemia (low hemoglobin), that is where "symptoms" can really knock you around - most will begin to feel terrible (short of breath, exhausted, no energy, headache, fast heart rate) when your hemoglobin starts falling out. I don't know about that RWD thing -- what is your hemoglobin ? What was it starting out as compared to now.
As far as bleeding tendencies, you'll want to discuss your platelets, PT, PTT, INR (clotting times / factors). Those can take a beating, too -- and so keep an eye on those or make sure your doc explains those to you, too. Also, (according to both of my docs - since I am worried about my platelets and bleeding tendencies) with Neupogen they sometimes see a slight increase in the platelets, which is good.)
I'm sorry - I can't remember if you are on treatment or not, but if you are and your anc and hgb are falling out and you can GET the rescue drugs, get them. Best of luck.
While I'm here - HI BUG :) !! and Wyn (great to see you both :) and MadBrad :) Nice to meet you. Best of luck to you. Whew - madbrat, I'm glad to see they got you the drugs! I bet you felt awful; I hope you feel much better now. Wyn you doing OK? Bug ? You OK? Ya'll sound ok :)
Bug - I thought about you (and your thermometer) last week - lol. I had the FLU (or something). OH GAWD it was awful, and whenever I stuck that thermometer in my mouth to check my temp (and prayed it would be below 100), I thought about you. Fever got as high as 102, and I felt like I'd been run over - sheets hurt, scalp hurt, hair hurt, everything hurt, no vomiting or diarrhea - just total body pain and headache and slept slept slept. It only lasted 2 days (the fever part), thank goodness, but it did scare me, (and I was kind of obsessing over the thermometer - lol). It was the first time I had taken TWO Extra Strength Tylenol in at least a year! The stuff works! I didn't have to take it but twice.
Nice to meet you too....And I pray that you get healed.....
Yes I'm in great shape NOW...LOL.........Thank God...Thats all over...
You know,to top all that off ,I GOT AN INFECTION in the injection site of one of the EPO shots.....My son had Strep....I steptococcus beta in it....It swelled up to 11 cm's...I kept tell the Doc it WAS INFECTED,And they kept saying it was just Celluitis......because they couldn't feel a soft spot...For almost 10 days I suffered emensely from this.I never knew such acute constant pain that was increasing........I finally got fed up with it and poked a whole my self and all this nasty gagging EWWWWWWW pus came out,and I ran to the ER.....After lancing and draining,shot of Vanco..And a script of bactri d50.....I was glad to back to my docafter 3 days to get it looked at and say I TOLD YOU SO..........At any rate...Its all good now...All that happened in my 11-12 weeks of tx and I was UND.....And now No HCV RNA detected....Thank you Jesus.....
I had no choice....My sister is a surgical tech with 15 yrs exp.....And I had gotten a straight pin and poked it in the injection site hole..Which was easy to see,My skin was soo tight in had no texture to it bright red and shiney....I began to squeeze while I was on the phone with my sis and a stream about as big a #2 pencil went running down my arm..OMG...what a relief.....I was gagging...It was a good thing I did this,it began to cut off the circulation to my lower arm and was creeping up my shoulder..I could have lost my arm or died from it...
There's a sunk in spot there now...My doctor opened it up more to make sure it was all drained out...He's 6'3 and he said the hole where the pocket was ,he could stick his whole thumb in.....
LOL.....In the words of an acquiantance " That almost made me throw up a little"...........LOL
Your ANC is looking great, to me! Best of luck to you with the REST of the treatment (did you hear the Paul Harvey ring in there?) :) I don't know anything about the A/G ratio. I think I used to, but... it's all a big gof now.. I mean fog now. You hang in there. Sounds like you're doing very good on treatment with the exception of sleeplessness. Maybe the doc can help out with some "please help-me-sleep" meds? Insomnia - no fun.
Madbrad.. what a story! Ya... could've been a bad deal had you not done the I&D yourself! I bet you DID just about do a *buick* with that kind of drainage coming out of your own arm. You own your sister - hehe. Cellulitis? Infection city!
Bug, it was an outlawed mercury thermometer. I'll never be able to take my temp again and not think of you ...and now - outlaws :) Have a good one!
No, I didn't do reflexology on Dave yet. I really don't have the energy. I would prefer he call in Sept. when tx is over. I need my energy to fight this virus and these medicines. It's hard to find all your questions. He seemed to think his health was good and he didn't need a session. It's takes a lot more energy to work on a man than a little woman. I used to mainly work on women.
I take a sleep aid that gets me asleep and sleep until 2 a.m. Then I wake up every hour or 2 the rest of the night. I have wild dreams in color and double sound. Sometimes I remember them. If I take a Tylenol PM I can sleep until 4.
Thanks for all your kind words and help.
Those infections in the arms sound really terrible.
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