Neupogen it is

Things are still pretty difficult up here. Andrew's still not breathing on his own, and he's still almost 2 pounds overweight. I thought throughout this whole thing that we got off (relatively) easily because it seems like older kids, and especially teenagers, just felt a whole lot worse. It turns out that with these kinds of infections with AML patients, babies actually do worse than older kids, accumulating hard-to-clear fluids and just feeling a lot worse.

So, bad news first. Andrew didn't just have strep--he had multiple gram-positive organisms in his blood. The micro people are still preparing their report as to what it all is, but it's definitely more than just strep. Depending on what the organisms are, we may or may not have to pull his line (some are notorious for attaching to the line and staying there). He's getting lasix (a diuretic) to try to control the fluid overload. Also, he needed another platelet and another blood transfusion. He hit 40.2C today (104.4F), which is a new record for him.

The good news is that he's finally started to pee significant amounts again! This is great news! I can see the weight come off of his face, hands, and legs really well. His eyes, especially are more than just squints. This is the best news today for sure. Also, none of the repeated blood cultures that they've drawn have grown anything since the first day, meaning that the vancomycin worked fantastically well on the bacteremia in his blood. It also means that although they may have to pull his line, it's less likely. Another bit of good news is that he's not sick enough that he throws up the tylenol, or else we wouldn't be able to get his fever down. They really need to approve IV tylenol sometime soon, for all of our sakes.

We have debated back and forth since Andrew got this infection whether or not to give him Neupogen. Neupogen is an enzyme that stimulates granulocytes (Neutrophils are granulocytes). Historically, oncologists have been wary of giving it to AML patients because it revives the marrow (shortening the length of neutropenia by a few days), but it also spurs the growth of cancer cells, if there are any. I'm not any sort of cancer girl, and I really don't know much about the overall theory of what the chemotherapy really is doing to him (other than the actual mechanism of the different chemos). I don't know if they expect it to wipe most of the cancerous cells out and leave just a few to his own body or if they really think they obliterate all of them. Depending on which theory it is, it influences this decision for us. Our primary oncologists said that theories of an increased risk of relapse are not supported by the data, and he didn't see any significant downsides, so we went with the neupogen shot. The only downside is it might not work (and thus it would be a shot for nothing), or it might work well enough to make his bones really achy. Either way, though, we didn't see any significant downsides.

Thanks so much for the prayers, I'll post more later.