Day 147 - 3rd verse same as the first

     Earlier today Evan completed another session of chemotherapy.  We got postponed for a day, but the doctors said this wouldn't present any additional risk to his treatment plan.  This morning Evan received two chemo drugs along with a drug to help minimize damage to his heart.  He came home a little sleepy and groggy, but we just figured it was from waking up early.

This morning at the clinic receiving chemotherapy.

     His blood counts continue to look solid, especially considering how much his body has been through.  Next Monday Evan can remove Keflex (antibiotic) from his daily schedule.  We've started steroids back up this evening and these will run until next Thursday.  The expectation is that his appetite will go back into overdrive and his demeanor will be best compared as bi-polar.
     Now on to the subject of his appetite and ultimately his weight.  This morning he was down to 20kg (44 lbs).  Cristy and I took our foot off the gas because we've been able to feed him in the evenings via his feeding tube.  During this time we've focused on healthier foods so in my mind it hasn't been a complete loss.  Overall his body looks much better.  After this next round of steroids Cristy and I will need to make sure we stay on top of his caloric intake.
     Cristy found out more about Evan's chemotherapy schedule following Delayed Intensification.  It appears I was mistaken on when he'll begin Long-term Maintenance.  His next round after DL is called Interim Maintenance II.  At a high level this will include chemotherapy every 10 days, so not drastically different than right now.  I'm unclear what the dosage sizes will look like;  however, as usual it will probably be tailored to Evan's bone marrow characteristics.
     You may have noticed my comment earlier about Evan being groggy and us chalking this up to a long day.  Well, that may or may not have been the case.  However, upon waking up from his nap he was running a fever.  I called Cristy while leaving work and found out she was waiting on a call back from the doctor, but he was already up to a temp of 102.  It was rush hour so I told her to start heading that way and I'd meet her there to either take Evan or Nolan.
     As normal, they took a blood sample, monitored his vitals, administered some antibiotics (Zosyn) and gave him some Tylenol.  Upon getting to the ER the nurses took Evan's temperature and he was already down to 99 - 100.  His heart rate and respiration were a bit high, but Cristy noticed they were high at the clinic this morning too.

This evening in the ER awaiting next steps.

     One more thing I wanted to note in today's blog was regarding Evan's nadir.  Some may remember this is the point of a chemotherapy cycle in which the blood counts are at their lowest.  The doctors calculate his nadir from today's chemo will fall sometime around Thanksgiving.  Evan's counts will likely take a dive again during the second half of Delayed Intensification (in December) after he starts some different medications. The nurses have warned that blood and platelet infusions may be required during this time.
     While this will definitely hamper our availability during the holidays, we hope it will give us something to be thankful for once we're through this trying phase.