Day +6

My Blood Count Today:
Red Blood Count (RBC) 79 (Normal 130-180)
Platelet 11 (Normal 150-50)
White Blood Count (WBC) < 0.1 (Normal 4 - 11)

I am still considered fine, even with mild throat pain, mild flu and cough. The appetite is still good.

I received my 3rd doses of Methotrexate this afternoon at four o'clock. Only one more dose left to be given on day +11.

I am now immuneless with WBC less than 0.1. This situation will last for about 2 weeks, even with the administration of Neupogen. We pray that there would be no serious infections within this waiting period. Infections is marked by fever where body temperature increased to or more than 38%C from normal 36%C. Once this happen, the doctors have to investigate the causes of infections. Chest X-Ray will be taken to see if the lungs are healthy. At the same time, the blood samples will be taken from different parts of the body for culture to determine whether they are infected with virus, bacteria or fungus. If I were not mistaken, in my case, the blood sample has to be taken from all the 5 catherters (lumens) , 2 from the arm, 3 from the neck. As mentioned earlier, catherters are similar to electrical sockets installed on the body but are used to administer drug through the vein, draw and transfuse blood. Another blood sample have to be taken from one of the arms. Taking blood sample from any of the catherters is not painful at all, but drawing blood directly from the arm is painful. Without waiting for the blood culture result, the doctor will administer intravenous(iv) antibiotic immediately.

In my case an iv antifungal drug which is called Amphoterisin B will also be given. The Amphoterisin B is needed because I was infected with a fungus called aspergillus during my second cycle of chemotherapy. Not like iv antibiotic which can be administered within 1 hour per dose without much reaction, the administration of Amphoterisin B is very tedious. First the patient has to be put to sleep using two iv drugs called Pethidine and Phenergan. These drugs acts like morphin , it sooth the patient in order to reduce reaction from the Amphoterisin B. Then the Amphoterisin is administer intravenously through a flow control machine. The flow rate (ml per hour) is depending on the tolerancy of the patient towards the drug. The highest flow rate used so far is 100ml per hour. Therefore for a dose of Amphoterisin B diluted in a normal saline of 500ml would take at least 5 hours to deliver.

One thing I need to mention is that the drugs Pethidine and Phenergan are addictive, once you have it, you would long to have it the next day. They will make me so relax and peaceful and go to sleep before I am able to count to 10. If you cannot sleep at night, these drug might be helpful :-), but never say that I recommend them to you.

Despite the relaxation and soothing effect with Pethidine and Phenergan, my experience with Amphoterisin B is terrible. Frankly speaking, no one would like this drug, some patient still cannot tolerate it even with the help of Pethidine and Phenergan. Instead of going to sleep, they are shivering there even the Amphoterisin B is administered very slowly, say 30ml per hour. I experienced kidney impairement after 19 doses of Amphoterisin B, a dose each day. The impairment was marked by a very high level of the creatinine in the blood, 1.6 mg/dl compared to normal range of 0.6-1.2mg/dl. But the treatment of fungus has to continue, therefore, the doctor changed to a better iv drug called Cancidas. This drug is administered like antibiotic, without much effect, either on reaction while receiving the drug or organ function impairments. The only undesirable effect is that the price is very high, a dose would costs RM735. The first dosage is called loading dose with a higher volume than the following dose. It costs me more than RM1000 for the loading dose. Therefore I paid about RM5700 for 6 doses only. Hopefully, I would be able to claim this amount back from somewhere else. After this, I never stop taking oral antifungal drug Itraconazole (Sporanox) from middle of March this year until now. You can see how tedious is to handle the fungus infection. But please don't worry, for normal person like you with functional immune system, the likelihood of fungus infection would be very slim.

Apart from low WBC, my platelet count is also extremely low. As you know, platelet take parts in blood clot, low platelet count makes one very prone to bleeding. On the other hand, the red blood cells are helping in carrying oxygen to the tissues and organs of the body. A low level of red blood cells makes one get tired easily.

The nurse transfused a single donor pack of platelet to me in the evening. I will be receiving two packs of red blood cells tonight. Transfusion of platelet take less than one hour, but transfusion of red blood cells take about 3 hours per pack. So tonight until tomorrow morning I will be busy receiving red blood cells. All the transfusion has to go through a leukocytes (white blood cell) filter to remove the donor white blood cell. This is important to minimize the risk of transmission of diseases such as CMV, to reduce GVHD to the recipient. Non-transplant patient does not need this filter for blood transfusion.

I have too much stories to tell you, but I think I have to stop now. See you next post :-)