The bone marrow mysteries

September 5 was day 29 of Delayed Intensification, but as I noted in my last post, Hope didn't make counts; her ANC was 240 and needed to be 750 to begin the second month of this phase. We returned Wednesday, September 10th,  for a second try - still no go. 640. And again, Friday the 12th -- third time's a charm, right? -- certain that she would make it and we'd be off to the races. But... it was 730. Certain we'd make it this morning, the 15th, we found it stalled out at 730. Her clinic nurse Lisa said, "Bone marrow isn't an exact science."

It's a confounding idea. On the one hand, we get copies of her labs every visit with long lists of numbers - and it sure looks like an exact science. The percentage of neutrophils, eosinophils and basophils, grams of hemoglobin per deciliter, and counts of platelets and white blood cells per cubic millimeter, creatinine and bilirubin, glucose and aspartate aminotransferase. It's a flurry of numbers and we have gradually learned which ones are most meaningful, which drugs can elevate which levels, and when the highlighting of a number as "abnormal" (light gray) or "panic" (dark gray) is something to be concerned about -- and when it isn't.

But the numbers don't always behave as you might expect them to. They trend correctly, but day to day something that should be going down because of chemo might suddenly blip up, or vice versa. We are told to expect it to take 7-10 days for her counts to hit bottom after chemo, but on day 14 she's still heading down. Or, with another drug, her counts bottom out in 2 days and then start to rebound. And it all seems fine - no one seems concerned. We ask again and again, "But is it OK that...?" Yes, it's fine.

We've learned so much about this world of leukemia, but there's so much that is still a mystery.