T+6 Shock and Awe

BOX SCORE
Element	Current	Std. Range	Trend
Hemoglobin	8.7	13-17	^
Platelets	26	140-375	v
ANC	800	1800-8300	^

I remember when the Iraq War, sometimes called the Second Persian Gulf War, began in 2003. As the news agencies trained their cameras out of hotel windows in Baghdad, their reporters and correspondents went on and on about what to expect. President George W. Bush had warned Sadam Hussein and the Iraqi government that they were about to experience an attack of "Shock and Awe." When the fighting began, the allied powers began bombarding this ancient city with bombs and artillery fire the like of which had rarely been seen, at least since World War II. 

It was shocking, and it did instill awe in those who saw it on TV. I suppose that was nothing compared with  what it did to those who were residing in Baghdad, and of course the hope was that it would have the same effect on Hussein, the despotic ruler of Iraq. 

Yesterday, was day T+5 in my transplant journey, which signaled the beginning of a new focus of treatment modalities. First, there was the massive load of fluid in my body, which was the result of a continuous IV drip of saline solution during the time that I was receiving my final two doses of chemotherapy. Part of the reason for this mighty flushing is that Cytoxan has a propensity for causing crystals to form in the urine, causing damage to the bladder. The more fluid that is flushed through the urinary tract the better. But when the chemo was no longer a factor, I was left with a body resembling the StaPuft Marshmallow Man of Ghostbusters fame. 

The first order of business was to get rid of all that water (I gained 16 pounds in a couple of days). There's a medication that is often used to reduce excess water in people who have high blood pressure. It's called Lasix. I was put on Lasix yesterday, and lost 8 pounds overnight. The stuff works, and now I look more like StaPuft, Jr. 

In addition, the new regimen includes Filgrastim, which I have had before, to stimulate growth of white blood cells. In the past, before the transplant, the Filgrastim would begin working after a few days. My ANC would begin going up, and after a several more days it would skyrocket way above the standard range. So, I welcomed the beginning of this treatment, since my ANC  has been MIA for a couple of days. 

This morning when my lab work was complete, I got a notice that the results were available to view on the OHSU  website. To my shock, I read the awesome fact that my ANC  was at 800. I've never had such a leap in ANC when the count had been at zero. 

How to explain this miraculous development? The first thing I thought of was the Filgrastim...but it never acted this quickly before. The next thing I though of was the transplant. Maybe I'm just accustomed to old man bone marrow that has been abused with multiple kinds of chemotherapy. But now, I have young man marrow. (I learned the donor is a young, healthy male.) Could it be that the cells are more vital and respond more quickly to this stimulant medication? 

When Dr. Mariarz, the current Hematologist/Oncologist (HemOnc) on duty came by this morning to do rounds, we talked about this development. His theory is that I may have a few of my own marrow cells helping to push the number up. But he did acknowledge that the fresh, young marrow cells certainly are part of the equation. He also admitted, as did Paxton, his PA, that this is a pretty unusual response for day T+6. They agreed it is more like what they expect on day T+8. They also warned us that ANC can vacillate and not to be surprised if it is lower tomorrow. Acknowledged; this is not our first rodeo! 

Although, I occasionally refer to things or occurrences as "awesome," in general I believe that word should rightfully be reserved for God and His works. And particularly in this case, I would argue that the ANC report for today is awesome, not because it is unusual, but because it is the work of the same awesome God who has carried me through nearly three years of chemotherapy and now a bone marrow transplant with fewer than predicted difficulties. And perhaps, I should also clarify that my shock in reading the report this morning was based on my human experience with the behavior of the hematopoietic (blood production) tissue (marrow). 

Now to him who is able to do immeasurably more than all we ask or imagine, according to his power that is at work within us, ²¹ to him be glory in the church and in Christ Jesus throughout all generations, for ever and ever! Amen. (Ephesians 3:20-21, emphasis added)