70) Medication adjustment

The very first oncologist we met after E's diagnosis explained leukemia, and the course of treatment. I mostly remember his words, and they went something like this:

"With a leukemia diagnosis, something has gone wrong with the bone marrow. Instead of making regular cells, the process has become defective, and the result is an overabundance of blasts. The course of chemotherapy reboots the system, and keeps it artificially low for a couple of years in order to fix the defect so that the bone marrow starts producing cells normally again."

Over the course of treatment, the patient will receive copious amounts of blood tests. It's important to monitor the state of different types of cells in the blood, because you want to ensure that levels for things such as white blood cells, neutrophils, platelets, etc. are in the Goldilocks zone - not too high, and not too low. Counts that are too low increase the chances of bleeding or bruising, and increase the risk of infection. Counts that are too high increase the chances of relapse.

E is currently in the maintenance phase, and he has bloodwork done every 2 weeks. The last 3 times, his neutrophil counts have been slightly higher than normal. SickKids makes a medication adjustment when they observe 3 consecutive higher results, and now that's what happened to us. When last week's results came back, and the neutrophils were again up, we received a message from our satellite clinic to increase his 6MP. He used to get half a tablet 4 nights a week, and a full tablet 3 nights a week. He now receives half a tablet only 3 nights a week, and a full tablet 4 nights a week.

Am I worried about this development? I don't think so, not overly. I don't believe either SickKids, or his nurse practitioner are worried about the climbing counts. He's 2. He's growing. Eventually, medications are going to have to be increased to account for the change in his body mass.

I'm not doing cartwheels that we have to increase the dose of a medication that is toxic to the point where we have to handle it wearing a mask & gloves, but I'm relieved that the likely cause of the increase is a growth thing, and not a leukemia thing.