Went to the Hematologist today

[flcyclist]

Went to the hematologist today for the first visit as recommended by the Gastro.  At yesterday’s appt with the Gastro, he did a CBC so the hematologist would have recent numbers to look at.  I had to follow up to make sure the results were available at the appt.  They forgot and faxed them while in the waiting room.  I had a chance to review the numbers prior to the doc arriving and was hoping that we would continue to keep an eye on the levels since the ANC returned to 574.

The hematologist is affiliated with a cancer treatment center, so they frequently monitor patients undergoing chemo.  His approach was not as conservative as mine, since I was hoping to monitor the levels, rather than jump into the neupogen shots.  I thought best to not push things too much since he did a good job of scaring me about potential infections and result of high fever, etc.  So looks like I begin with 2 shots per week to start, monitor the levels as I go and follow up with an appt in 2 weeks.  

He did indicate that most have no sides, but some have “achy bones” from the neupogen.   Anyone experience this reaction to the shots?  Not looking forward to it, but do realize I don’t want to reduce the SOC trt and jeopardize any positive outcome at this point.  So far UND at 4 weeks @ <43 IU/mL test.  Plan to do the more sensitive <5 IU/mL Heptimax test in one month.  

Trt began on 04/21/2011 with Pegasys (180 mcg/week), Ribovirin (1200 mg/day).  

Following are my results to date:

ANC (1500-7800 cells/uL): 03/04-1692; 05/05-466; 05/19-570; 05/27-325; 06/08-574

Hgb (13.2-17.1 g/dL): 03/04-14.1; 05/05-13.6; 05/19-13.0; 05/27-12.8; 06/08-12.7

Platelet cnt (140-400 Thous/uL): 03/04-165; 05/05-146; 05/19-136; 05/27-135; 06/08-119

WBC (3.8-10.8 Thous/uL): 03/04-4.0; 05/05-3.4; 05/19-2.7; 05/27-2.8; 06/08-2.8

Does this approach agree with those that have gone down a similar path?  Thanks in advance….. ;)

And go BB’s. hehe.  ;-)

[laproch]

Thanks so much. I guess I'm kind of all over this site asking questions and looking for answers. I'm doing a lot of outside reading so thanks for this informative link...and the welcome.

[flcyclist]

ANC - absolute neutrophil count.

While going through trt, your doctor will monitor your counts by ordering a CBC, along with less frequent PCR tests to monitor the level of virus.  When certain levels get too low, the doc will hopefully prescribe rescue drugs, rather than dose reduce.

The following article explains the terms associated with the low blood counts sometimes resulting from trt with interferon.

http://www.chemocare.com/managing/low_blood_counts.asp

Welcome to the forum.

[laproch]

What is ANC? ...yeah, I'm new to this. :)

I know my platelets are only 86 (K/ul), is that too low to consider treatment?

Is there a place on this site that explains all of these labs?

Thanks.

[flcyclist]

Thanks Trish,  I'd like to thank you and the other warriors on this forum that have gone through this battle and continue to come back and give us advice and encouragement.  These words of encouragement mean so much and can brighten up a dark day.  Thanks for being here for us.

Cheers :)

[flcyclist]

Yeah, I responded with vigor ;)

ANC went back up to 1.2, so will stay with the 2x per week neupogen shots for another 2 weeks and go from there.  

[Trish77]

Good luck with this.  Neupogen reportedly acts fast so hopefully your ANC will "respond with vigor".  :)  Don't be surprised if you end up on a neupogen maintenance dose for the duration after your ANC dropping like this early in treatment.  Kudos to your team for going this way instead of a dosage reduction.  

[flcyclist]

Had the first neupogen shot yesterday, will have another on Thurday.  The plan is 2x per week for 2 weeks and have an appt/blood draw with the hema to discuss the numbers next Thursday.  Hoping my ANC also responds with vigor.  ;)

Can't really tell if any sx felt, other than a little extra yucky this morning..  Minor achy feeling, but nothing worth noting.  Feeling better now.  

Thx for the feedback.  Cheers.

[oneofthree_]

I, too, am with youon this SOC. Seems like you started a few weeks before me. My ANC dropped to 420 by week 4. They started me on neupogen 2x weekly. Gavethem too myself at home for 2 weeks. ANC responded with vigor. Shot up to 1800. They said, 'Whoa! no neupogen for 1 week. Check your CBC next week"  At next CBC they dropped to 520. Now doing neupogen 1x week. Nurse said my body just really liked the neupogen. No real sx noticed. Maybe achey in the am some but who knows which med is causing it.  Tina (oneofthree)

[frijole]

flcyclist
I agree with Dave.  You may already be beyond that point of backing off of neupogen.  You don't want to risk having them reduce your interferon dose.  I will look for the study, but I do think that ANC of 400 was the bottom of the acceptable, even for Hep C patients.

http://www.google.com/#hl=en&sugexp=ldymls&xhr=t&q=anc+and+hepatitis+c&cp=19&pf=p&sclient=psy&site=&source=hp&aq=f&aqi=&aql=&oq=anc+and+hepatitis+c&pbx=1&bav=on.2,or.r_gc.r_pw.&fp=b1b3bccdf7105184&biw=861&bih=556

sorry about that -- I looked for "tiny URL" to reduce the size, but it appears to be gone now.  This article uses reduced Peg before Neupogen so it isn't the one I was looking for.

frijole

[spectda]

Id be a little uncomfortable at 325 to not start the neupogen. I know that many people don't develop infections with low anc but you are really at the line.

There a few people that developed severe infections while on tx presumably because of very low anc.  I developed an infection when mine went to 280 at week 6 and it took several rounds of increasingly stronger antibiotics before it resolved even after starting the neupogen which I had to take for the remainder of my tx.

I had dull deep pain and and overall feeling of ill-being for a day or two after each neup injection, but of course many people have no ill effect.

Good luck
-Dave
  

[flcyclist]

Tomorrow night will be shot 8.  Yes the ANC went down to 325, but came back to 574, so was hoping to monitor closely, rather than start neupogen.  I need to explore if there might be a significant difference in having the rx shipped to the house or have them do it at the office.  It would be much more convenient to do the shots at home, but since they will be monitoring closely each week, I'd have to go to their office anyway.  I'll explore that one.  

I was tempted to take same information you mentioned about Hep C patients and low ANC levels.  I might use that one for a future visit.  

Thanks for the feedback.........

[frijole]

I am glad you now have a hemotologist -- it was one of the best things my GI did - hook me up with (my choice of) hemotologist at the beginning of treatment.   I had the same issues as you - I didn't want to take the Neup as soon or as often as the hemo said.  You have dropped awfully fast - isn't it 4-5 weeks?   I managed to hold mine off until my ANC reached 400 but then I gave in -- still that was week 15 for me.  Then I just took it every 11-16 days with weekly CBCs to monitor (gosh, I hated that). By 30 weeks I was taking it every week.  

The hemotologists associated with oncology departments (mine was too - maybe they all are) are really jumpy about ANC.  I took in studies to show that ANC could go a lot lower  with Hep C patients not incur the infections that cancer chemo patients do.

However you have dropped so low in such a short time, it is worth doing what the hemo says.  Like fl guy, I would wait for the results, consult with the nurse and decide when to take the procrit and neupogen each week.  You have to go there for shots?  I just had an rx to do it at home.  

frijole

[meakea]

Glad you got the hematologist on board!  I never had to take Neupogen but I do recall hearing several people on here talk about the achy bones from it, at least initially.  Keep marching...  :)

[flcyclist]

Both of these were scheduled appointments.. He just wanted to have the results available for the visit to save time I'm guessing.  This was a very large trt center and I would imagine they do have their own pcr and other machines for routine bloodwork since they do so much of it.

Since i'll be going there for the shots 2x/week, they will do the blood draw, so no more visits to Quest for some time. Yahoooo.

[FlGuy]

Some hematologists have CBC machines in the office and can run a CBC in about 3 minutes.  Before you go hoop-jumping with labs in advance you might ask the Hema folks if they have such a gizmo.  It saves lot of time.