01-04-08 to 01-07-08

01-04-08: Brandon woke up from his nap with a fever of 103.5. I called Dr. Henry at PCH and he recommended he go to the ER. We chose Northwest Medical in Tucson. His labs showed a WBC of 2.0 and and ANC of 4. Tylenol, Gentamicin and Cephepime were started. He was transferred to PCH via helicopter

01-05-08: ANC of 0, Hemoglobin 8.0, Platelets 536. Due to these counts, it was determined that a blood transfusion was necessary. Brandon's coloring and energy level noticeably increased after the transfusion. Blood work pre and post 3 am Gentamicin dosage. Dr. Henry met with us about Brandon's treatment. He said "there is a delicate balance of finding the right treatment for each individual child. To be aggressive with LCH, it is necessary to give the maximum amount of chemotherapy but causing the least amount of discomfort to the child. Neutropenia is to be expected and is just part of the course. In some cases, monthly blood transfusions are necessary." Dr. Henry also expresses some surprise that Brandon is receiving Vinblastine in addition to Cytarabine. He said this was likely the reason for Brandon's recent crash.
01-06-08: ANC of 145. Dr. Henry orders a sodium serum level to check for DI as Brandon has been drinking and wetting excessively.

01-07-08: ANC of 224. Sodium serum levels come back normal with zero indicators for Diabetes Insipidus. Chris speaks to Dr. Wood about the use of Vinblastine. Dr. Wood said that Dr. McClain had suggested it to remain as aggressive as possible, but to end it if Brandon does not tolerate it well. The treatment plan will be to continue Cytarabine for 5 consecutive days every 28 days, decrease Vinblastine dosage by half and administer between Cytarabine doses. If Brandon continues to crash, Vinblastine will be dropped from the treatment plan. Brandon is discharged from the hospital late in the afternoon.