A definite maybe

BOX SCORE
Element	Current	Std. Range	Trend
Hemoglobin	9.1	13-17	^
Platelets	141	140-375	^
ANC	2190	1800-8300	^

Just a short update today. Yesterday was blood draw day, and you can see in the Box Score that all of my counts went up. In fact, referring back to my previous post, I am now more normal than abnormal. While hemoglobin is lagging  behind, my platelets and ANC have moved into the "Standard [normal] Range." Hemoglobin is generally more stable than the other counts, because it is contained in red blood cells (RBCs), which have a significantly longer life span in the body than the other blood elements. (Their lifespan in the body, e.g., is on the order of 30 days versus 72 hours for platelets.) Consequently, the bone marrow does not produce RBCs as rapidly as the other blood elements. 

After the blood draw yesterday, we had a consultation with Dr. Brow. The intent for this meeting was for us to learn the outcome of the bone marrow biopsy (BMBx) that was done last week. Unfortunately, the results had not come in time for the meeting. Nevertheless, we did learn some interesting things about coming attractions. 

First, I will get a referral to Dr. Cook at Oregon Health Sciences University (OHSU) regarding bone marrow transplant. If you are a regular follower of the blog, you may recall that on two previous occasions when we met with Dr. Cook we learned two essential facts. Number one is that, as of those meetings, no suitable donor had been found in the world-wide database comprising some five-hundred-thousand donor volunteers. Secondly, Dr. Cook told us in September, 2022 that even if a donor were available, I was considered too old for a transplant. Now, before you go shouting "ageism," the reason I was considered too old is that past a certain age (for these purposes 75 years) the statistical risk of the procedure itself resulting in death, instead of giving life, is high enough that it is inadvisable to risk it. 

Why then am I being referred to Dr. Cook again? Good question. The fact is that my response to three different chemotherapy regimens has been so unusual, in that I have suffered very few side effects or debilitating outcomes, that the Kaiser Permanente tumor board wants to leave no stone unturned in offering me reasonable treatment options. The fact is Dr. Cook may very well say again, "It's just too risky. The university won't take a chance on your life." It is also a distinct possibility that there simply is still no suitable bone marrow donor available. 

Whether or not there is a donor available, the decision about transplant rests firmly in the hands of the Almighty. If you are a praying person, please pray with us that the Lord will reveal His will to us in a timely manner. 

The second thing we learned from Dr. Brow yesterday is that I will most likely go back to the hospital at least once for a short visit to receive "consolidation" chemotherapy. This is likely to happen whether or not I eventually were to undergo a transplant. Essentially this procedure is a lesser dose of the chemotherapy I just had, although Dr. Brow said that the most potent of the three meds I last received (Idarubicin: Ida for short) would not be repeated. Had I been more alert, I would have asked her the reason for that decision, but I believe I know. We learned during my recent hospital visit that there is a maximum lifetime dosage of Ida, because of its toxic effects; I suspect I reached that limit during my last visit. The other possibility, as Jill pointed out, is that they may be saving whatever capacity I have left for receiving Ida in case it is needed in a future scenario. 

When any or all of the above procedures may happen is still not certain, because the recent BMBx outcome has not yet been reported. So, now you know  as much as we do about my future treatment plan. I will definitely have some future treatment...maybe.

Wait for the Lord;
Be strong and let your heart take courage;
Yes, wait for the Lord. (Psalm 27:14)

Source: https://bible.knowing-jesus.com/topics/Waiting-For-God~s-Timing