I mentioned that we had rounded the corner and were headed up another hill. It is the hill of sleeplessness. Whether caused by sinus congestion, a reaction to a med, post traumatic stress disorder or a combination of all of the above, we are all more than a little spent these days.

To see Naomi awake, one is sure she is improving. Her swelling is greatly reduced, she laughs and plays games and colors in bed, she walks without owies or favoring her side.  But to sleep in the same room with her, you would think the opposite. She moans and whines and cries almost non-stop. She gasps for air and sits up straight and fast because she cannot breathe. She alternates between reliving her pain from the surgery and fighting with her sisters. Poor Niamh is nowhere close and yet to blame for a whole lot! Little Caitriona is constantly being told to “stop it.”  I am sure there is humor in there somewhere, but to sleep-deprived parents who are watching her like this every night, it is taxing to the mind and body. How does she wake with such a smile on her face and the ability to say that she slept well and has no pain?

Aaron and I have brainstormed some ideas and found that a med was introduced on the 18th and these nights started on the 20th. Respectful of our wishes and the fact that we found nightmares, hallucinations, congestion and constricted airways all on the side effects list for this med, her dr today took her off of it. Goodbye micafungin! And good riddance, too. Already tonight, I am seeing a difference. She is sleeping peacefully on and off with occasional bursts of snorting or fighting with those troublesome sisters. We also have her on FloNase, a sudafed-like decongestant and saline drops. Oh, how she hates these things going up her nose. A catscan (that now makes three in the past 10 days) showed that her sinuses are congested (duh!) but not blocked (whew!) and structurally, great “with the ENT saying that he sees no reason to perform any surgery on her.”  Well, in my tired and pessimistic mood tonight, I am thrilled for that. I was almost sure that anyone brought into the circle of referring physicians would have some surgery to offer to fix her woes and then a list of medications to prescribe, too.

After a meeting with her oncologist/hematologist tonight, I do have renewed faith in her team. There are rays of light shining through. These dark clouds just need to clear. The darkest clouds being her abdomen being slow to heal and the bleeding she is experiencing from it and her restless sleep. Those are the areas in which she (and we) needs prayer.

The best news of the month is what I will close with tonight. Her neutrophil count DOUBLED overnight. For those of you who do not want technical data, you can stop and celebrate here.

But as a math and anatomy lesson for all my fellow homeschoolers (and anyone else interested, too)…..

The ANC count is something we follow very closely because it gives us an estimate of the amount of infection fighting cells in her blood and how at-risk she is for infections. This is her absolute neutrophil count. Neutrophils are the white blood cells that fight infection caused by bacteria and fungi. To compute the ANC, we take the percentage of segmented neutrophils plus the percentage of bands neutrophils and multiple that total by the white blood cell count. Then, we multiply that total by 10. This gives us the approximate amount of neutrophils per microliter. Normal ANC is 1500. To be severely neutropenic and at serious risk for infection is to be at or below 500.

So, to show you with some of her actual labs….
10/16/13                10/22/13            10/26/13
WBC             2.1                 2.2                       1.8
segs               0                     1                          2
bands               0                   0                          2
lymphs             98                99                        95
monos               2                  0                          0

The segs, bands, lymphs, and monos add up to 100. Those values are a percentage of the WBC value. So for the 16th, we take (0+0)*2.1*10=0. She had an ANC of 0.
For the 22nd, we take (1+0)*2.2*10= 22. She had approx 22 neutrophils per microliter. Still way below the 500 mark for getting out of severely neutropenic.
For the 26th, we take (2+2)*1.8*10= 72. She had an ANC of 72. This is her highest since September 23, when she was admitted and tests started to diagnose her.

Ideally, the different cell types should fall within these ranges. Naomi is very high in lymphocytes and very low in all the rest.

• Neutrophils: 40% to 60%
• Lymphocytes: 20% to 40%
• Monocytes: 2% to 8%
• Eosinophils: 1% to 4%
• Basophils: 0.5% to 1%
• Band (young neutrophil): 0% to 3%