Back in March, Dorthy had her daily chemo dose increased due to two months in a row of a high ANC (absolute neutrophil count.)  The ANC is a calculation based on her levels indicating her body's ability to fight off infections.  Her immune system was "too healthy" for a kiddo receiving treatment.  In the maintenance phase of treatment, our goal is to have Dorthy's ANC in the range of 500-1500. 

Ever since we upped Dorthy's chemo, she has been struggling to adjust.  For about a month and a half, she has been having terrible stomach cramps and pains, and her nausea feels ever-present with frequent vomiting.  At the beginning of April, she had another spinal tap followed by a week of steroids. The side effects of the spinal tap (vincristine injected into her spinal fluid) were heavy-hitting.  Her whole body was aching, particularly her back, legs, and feet.  At this appointment, we discovered that her liver levels were above range. 

 

We have been in and out of clinic often due to various symptoms/ behaviors. About 3 weeks ago she was hit with Covid which landed us in the E.R. due to a high fever.  They pumped her with antibiotics, but her levels kept dropping through the next several appointments.  She had a liver enzyme test done to see how her body is metabolizing the daily chemo. The metabolite test came back last Thursday with news we did not want. She’s not processing the daily chemo (mercaptopurine) properly anymore. This is the cause of the high liver levels, stomach pains, and nausea/ vomiting. Our oncology team is pausing chemo for a week and then resuming at half the dosage in addition to introducing allopurinol to her daily regimen throughout the rest of treatment. The allopurinol's job is to help direct the chemo to the bone marrow rather than attacking her liver.