I took Simon to the oncologist and the news was mixed. On the very good side, his bilirubin was down from over 9 to only 2.3! This is still almost three times normal, but quite a drop, and enough of a drop to safely give him the full dose of CCNU. Because it seems likely that the heavy doses of steroids he got last weekend (and your prayers!) killed off enough lymphoma to bring the bilirubin down and make him feel good (more on that later), he also got a dex shot with the CCNU.
The bad news is that his PCV was down to 11 on the machine reading and 9 on the hand reading (the latter of which is supposed to be more accurate). The oncologist suggesting transfusing him again, but I decided not to because it only raised his PCV by one or two points in the past and because, probably due to the steroids (and your prayers!), he is feeling much better than when he needed transfusions in the past. And I had promised him I would not leave him there. The oncologist agreed this was fine, that you transfuse the patient and not the number, and that as long as he is bright we can try to ride it out or I can bring him in for a transfusion later. We discussed Epogen again and decided not to put him on it. The reason is this: Simon's anemia is regenerative-- he is still making red blood cells-- but the problem is that the lymphoma has taken over so much of his bone marrow that he has little bone marrow left to make the red blood cells with and so makes many fewer. When the lymphoma is killed off, his bone marrow bounced back. When he responded to chemo previously, he went from a PCV of 11 to one of 33 in two weeks. If we can kill enough lymphoma, with the chemo and/or steroids, his bone marrow should bounce back again on its own. If we can not kill enough lymphoma, the Epogen will not save him because the lymphoma will take over all of the bone marrow. And he seems so much better on fewer medicines that I really do not want to keep adding things to his little body that do not have a high probability of helping him (granted, the CCNU does not have a high probability of helping, but if it does it will take care of the root problem which the Epogen would not). The oncologist was rather surprised to be treating Simon again. When I asked him to give me a probability of the chances that CCNU will help Simon, he said "all bets are off with Simon. I'm not going to try to predict anything with him anymore." Simon is very far from out of the woods, and his PCV is obviously a big worry. But I am going to try to treat him like a love bug, rather than a number, and just be glad he is feeling so good and happy while he is. Thanks for all your prayers (and please keep them coming!), Michelle P.S. We took a bunch of pictures yesterday and today of simon looking really silly and cute, laying on his back for belly rubs and looking and Buddhas, and wanted to share them with you because you all have been so involved with his story. However, I tried a way of posting them for free on the web but it did not work (photobucket). If anyone knows of a different way I can do that and send you the link, I will.
