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Neutropenia - WBC - Doctor's Advice
JmJm you were very helpful in the topic about neutropenia and neupogen, from a post I did yesterday. My doctor still has not called me, but her nurse did (after 3 calls). She tells me that if the ANC falls below 500, that's bad as they'll have to reduce the Interferon and I will probably won't attain SVR (exact words). Only way around that is for me to have blood work each week to monitor the ANC. I told her that it's already been 2 weeks since they saw my ANC count was 694. YES, I wan't another blood test first to see what they are. I don't want to take this drug if I don't have to. Besides the side effects of it, the cost is unbelieveable and I don't think the pharmacy will take unused returns, if it's not needed. I am getting so worn down with having to fight (it seems) in order to just find answers to my concerns. I used to think I had a positive attitude, but lately I wonder.
my doctor wouldn't give me ANC unless it fell under 500 either. It went back up again on it's own with out the neup.
I simply cannot understand WHY they would cut down your interferon knowingly destroying a chance for SVR instead of giving you neupogen.
As you are still over it you aren't in danger yet anyway - we can hope it does go back up. Until then be a germophobe (that is truly what I've become) and pray for the best.
Doctors - I dont understand them one bit sometimes.
I simply cannot understand WHY they would cut down your interferon knowingly destroying a chance for SVR instead of giving you neupogen.
As you are still over it you aren't in danger yet anyway - we can hope it does go back up. Until then be a germophobe (that is truly what I've become) and pray for the best.
Doctors - I dont understand them one bit sometimes.
I'm a little confused. Are they offereing you Neupogen if you ANC falls below 500 or are they going to reduce the interferon of your ANC falls below 500?
Hard to comment without knowing all your stats, etc, but in general reducing the interferon is not a good idea in terms of SVR, as your nurse says. Preferable is to take the Neupogen, but hopefully that will become academic as they appear willing to wait for another blood test. Good luck with your next test and let's hope your ANC gets higher.
-- Jim
Hard to comment without knowing all your stats, etc, but in general reducing the interferon is not a good idea in terms of SVR, as your nurse says. Preferable is to take the Neupogen, but hopefully that will become academic as they appear willing to wait for another blood test. Good luck with your next test and let's hope your ANC gets higher.
-- Jim
I apologize for being unclear; the past few days I have been a little "off balance" so to speak.
The nurse said that because my ANC was under 750, Neupogen was needed; if they fell to 500, then the interferon would be reduced. (None of this was ordered by doctor, only the Nurse Practitioner, and told to me via the other nurse). I told her that February's blood work showed 689 ANC and March blood work showed 694; not much of increase, but not a decline. She then said, "if you won't take neupogen, then you must have weekly blood draws to monitor so that we can catch it if it goes to 500". SO, I'm going this week to have another blood draw for this.
The nurse said that because my ANC was under 750, Neupogen was needed; if they fell to 500, then the interferon would be reduced. (None of this was ordered by doctor, only the Nurse Practitioner, and told to me via the other nurse). I told her that February's blood work showed 689 ANC and March blood work showed 694; not much of increase, but not a decline. She then said, "if you won't take neupogen, then you must have weekly blood draws to monitor so that we can catch it if it goes to 500". SO, I'm going this week to have another blood draw for this.
I'm so glad you asked them to do another set of labs before taking the nuepogen. Good for you for speaking up. I think you can make a better decision after you get your new labs. Hang in there and keep me informed. I'm just waiting for my labs to be faxed. I took nuepogen for 3 weeks and it did not make a huge difference for me in the last 2 weeks plus i had that bad bone pain. I will post my labs when i get them.
Wow. That's sort of like treatment blackmail, isn't it. :( I really don't know what to advise then. In general, you really don't want your interferon reduced. Personally, I'd try to negotiate with the doctor to allow me to continue with full meds but put me on Neupogen if ANC falls below 500. Not sure I'd want to gamble the success of my treatment on a blood test
-- Jim
-- Jim
Meant to say "negotiate DIRECTLY" with the doctor. Going through two levels of nurses is often not the best way to get things accomplished. Hopefully, you will reach an agreement that you will take Neupogen if ANC drops below 500 but you will not have to reduce your interferon. If the doctor is still not agreeable, then you might consider sucking up and taking the Neupogen rather than gambling on the blood test. Good luck!
-- Jim
-- Jim
I was real confused to but I think she's saying that for some reason she WONT take the neup?
Well, that's a different issue, but I thought she was saying that she *preferred" not to take the Neup. Obviously, if she won't take Neup under any conditions than the only option if she follows her doctor's advice is to lower the interferon which will probably reduce her chances of SVR. BTW if you're still reading, check out the thread (about 4 down) "A Date with Peg and Riba". I think your input would be valuable there.
-- Jim
-- Jim
Yes, I will take the Neupogen if I absolutely have to, but I don't want to if there is a chance that it can stay above 500. And, I would like to actually talk to the doctor, not the nurse. Is there anything that can boost our white blood cell count, on our own? Exercise, within reason, as tx takes a toll on stamina.....Vit C? Vit E? I eat a fairly health diet, but I know it could be better. I tend to have a little something sweet at nite (not much)....sugar is not the best I hear.
I don't know of anything that will boost your nuetriphils, but i do know that they do bounce around a lot the highest mine went on the neupogen was 2.0 and that was only for one week, even with taking the shot for two more weeks it dropped down to .9 i just got my labs back and it is still .9 so I'm hoping it stays there for 2 more weeks of tx. I don't think you should lower your interferon. Wait till you get your labs back and then make your choice about the nuepogen. Let me know what happens. Take care, Anita
forgive me, but you said your neutrophils are .9 and they were 2.0 on neupogen. is the .9 = to 900; I get confused as my blood work from Quest shows 694 Low Reference range: 1500-7800 cells/uL; I will keep you posted. I will go tomorrow for a blood draw for the ANC. Are you a geno 1 or 2?
I'm a geno 2 and from canada so our labs read different yes the highest my nuetriphils went was the first week i took the nuepogen they went to 2000 and then i continued on the nuepogen and they dropped the next week to 900 and i took my last shot last wed and they are still 900 so i have been as low as 500 without nuepogen and they bounced up without nuepogen on there own. Hope this helps you.
Yes a "0.9" usually corresponds to "900" (and so on). The number provided is usually multiplied by 1000 to get the actual result. Also FYI, you can boost your neutrophil reading somewhat by exercising as vigorously as you can just prior to getting your blood drawn (by just prior I mean within minutes of the blood draw). We all have quite a few neutrophils in our bodies that are basically just "hanging out" in tissues which are not circulating in the blood. Some of these stationary neutrophils can be shaken loose and returned to the circulatory system by engaging in vigorous exercise. The increased blood flow and muscular exertion mobilizes many of these stationary neutrophils which can effectively increase the neutrophil reading in your labwork. My doctor told me that if you were to measure a runner's ANC's right after running a marathon, they would read thousands more than they would from a "sedentary" reading. So obviously the more vigorously you exercise, and the longer you do it just prior to the blood draw, the higher your neutrophils are likely to be measured.
Also, keep in mind that neutrophils have a shelf life. If your labwork is being processed on a weekend and/or it's being shipped out to a remote lab, this can also cause falsely low readings. Neutrophils can "die off" (for lack of a better descriptor) while sitting in the sampling tube over a few days while it's waiting to be processed (over a weekend possibly) and/or sitting inside a box while in transit to the remote lab. This can result in a lower reading than what it might otherwise be if the sample was run at a local/in house lab and without delay.
I had a low neutrophil reading once (~600) and the specter of IFN dose reduction reared its ugly head. My next lab sample I ran up and down several flights of stairs just prior to my blood draw. I was really tired because I was also anemic, but I did it for about 10 minutes and it got my blood pumping. Then the lab sample was processed at the hospital's in-house lab instead of sending it off to an out of state lab over the weekend. Those two things apparently did the trick, the result was 750 on the nose which saved me from the IFN reduction.
Lastly, if you're really worried about the sides of the neupogen look into whatever minimal dose you can take, which should reduce the odds of negative side effects. Take care and good luck with your treatment.
Also, keep in mind that neutrophils have a shelf life. If your labwork is being processed on a weekend and/or it's being shipped out to a remote lab, this can also cause falsely low readings. Neutrophils can "die off" (for lack of a better descriptor) while sitting in the sampling tube over a few days while it's waiting to be processed (over a weekend possibly) and/or sitting inside a box while in transit to the remote lab. This can result in a lower reading than what it might otherwise be if the sample was run at a local/in house lab and without delay.
I had a low neutrophil reading once (~600) and the specter of IFN dose reduction reared its ugly head. My next lab sample I ran up and down several flights of stairs just prior to my blood draw. I was really tired because I was also anemic, but I did it for about 10 minutes and it got my blood pumping. Then the lab sample was processed at the hospital's in-house lab instead of sending it off to an out of state lab over the weekend. Those two things apparently did the trick, the result was 750 on the nose which saved me from the IFN reduction.
Lastly, if you're really worried about the sides of the neupogen look into whatever minimal dose you can take, which should reduce the odds of negative side effects. Take care and good luck with your treatment.
thank you for your post on the ANC numbers. I go to a Quest lab so I assume they send blood out....I planned on going tomorrow Fri. for the draw. I'm trying to get the blood draw to within 7, 8, 9 days of seeing my doctor which is on 4/23. I would assume I'm sitting on the fence with anemia. I am very light headed, dizzy, off balance, and rising up from a sitting position too fast makes me light headed. Just sitting doing nothing---I feel plain "worn out". I am making myself to the simple things--make the bed, wash clothes, fix food to eat (that's really hard as food isn't inviting). I feel that if I exercise too vigorously, I may faint on the way in to the lab.
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