ryan had an appointment at coh today. he was scheduled for "the works-" by that i mean that he was to have the maximum slew of meds to kick off the start of a new cycle of long term maintenance. this happens every three months. this morning, he had a spinal tap and i.v. vincristine. he was also referred for and had an ultrasound of his testicles. i know it's not your everyday conversation, but the reason for the ultrasound was to make sure that there weren't any leukemia cells hiding down there. during a routine check up, his nurse practioner, debbie, felt that he needed an ultrasound since she wasn't 100% confident about the physical examination. with leukemia, the testicles are a common relapse site. i didn't think much about it, other than "better safe then sorry." well, the good news is that his utlrasound was clear. he is fine down there.
i didn't realize what may have planted the seeds of suspicion until later, towards the end of our visit. i had a conversation with debbie before we left, and she explained that ryan had "2% blasts" or immature cells present during his last visit, and today, he had 3% blasts present. i'm not sure if the blasts were detected in his blood stream or via the spinal tap that he had today (i was thrown too off guard to think about asking for clarification, but i will do so at our next appointment). blasts are immature white blood cells and their presence could be due to either relapse or because his body is readjusting after fightig a serious infection, which in his case, he has been recovering from lengthy infections and his anc just a couple of weeks ago was very low, at 100. debbie & dr mueller both think that the blasts are "recovery blasts" (as in recovering from the series of infections), so much actually that dr mueller didn't mention them last time because she was quite convinced that was what they are, but today, when the blasts still showed up and there was 1% more, it raised a red flag. he is scheduled to have a bone marrow biopsy next monday, to rule out a relapse. its kinda scary, but there are lots of signs that they are recovery blasts and not relapse blasts. he is doing really well, for one, with no complaints, no fever, no pain and tons of energy. not exactly the types of signs you see when someone has relapsed. additionally, i have heard from both debbie and some online pediatric cancer bulletin boards that i frequent, that recovery blasts and scares like this are not at all uncommon during treatment. i guess its just our turn to worry.
so this week will not be as relaxing and happy as i had envisioned, but by the same token, i am doing my best not to obsess about it, because after all, we can't do anything and won't know anything until after his biopsy next monday. and things can always be worse. we will do our best to focus on all the positive and will enjoy spending the holidays with the kids (although i can't help but think that this was supposed to be a "calculus christmas," not a leukemia christmas!).
ryan was supposed to start back on his oral chemo meds at half dose until his next visit in january, but that has now been halted since the meds can mask a relapse. no oral meds and we are back at coh next monday at 7:30 am. i will keep you all posted and will try to still get around to posting the pictures from our holiday train ride sometime this week.
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