moving target

     As we left yesterday's appointment with the leukemia doc, I turned and looked at my dad.  There was an expression to him that was not content to be confined to his face.  No, this feeling of utter and complete perplexion was so vast in encompassed his entire being - his gaze not focusing on much, his shoulders slumped and his back bent over.  He had been doing so well.  His energy had begun to return indicative of him making his own blood.  The sixth and final round of chemo was his "victory lap".  There was then to be a break of a few months, at least enough to allow my mom and dad to spend Christmas together without any distractions of chemo fatigue or nausea.
     But then in a moment, last Friday we found out his neutrophil counts had plummeted.  No sixth round of chemo until we have a better idea of what was going on.  His overall white blood cell count had decreased substantially, as well.  And the red blood cell count had dipped ever so slightly.  Just enough to make the picture extra confusing.  The PA asked my dad, "you didn't already have chemo, did you?"  Because this is what his numbers would look like immediately after chemo.  Only he hadn't had chemo.  The numbers were supposed to be going up.  Cancer didn't read the chart.  His numbers went down.
     More bloodwork and a bone marrow biopsy and wait until yesterday.  I'm not going to go into all the details right here and now (my studies are beckoning) and it's where medicine becomes art.  Things are very subtle, very nuanced.  Lots of shades of gray.  I'll explain a bit later.  For one reason or another (or yet another or another), my dad is no longer making any neutrophils.  I don't mean they're low.  I mean zero, zip, nada.  He's never had neutrophil counts this low at any time in the process.  And even the couple of times he did get really low, those are the times we ended up at the ER for neutropenic infections.  The good news is - and yes, there is good news - we know that his CLL is not acting up because all the other counts look good and the bone marrow confirmed it.  Likewise, we know that he didn't develop a different type of leukemia (not that common but it does happen).  We also know that it's not a game changing addition of a disease called Myelodysplastic Syndrome (MDS).  Adding that to the mix would have greatly complicated things, and I mean greatly. 
     So the ship changes course for the hundredth time.  Or, the thousandth time.  I lost count.  No victory lap of a sixth round of chemo (it would have the potential of doing more harm than good given where he's at now).  No break of six months.  And a greatly reduced ability to fight infections in the interim.  It's stem cell transplant time.  Fortunately, one of his brothers is a FULL match.  That's a very, very, very big deal.  FULL as in 10 out of 10 markers match perfectly.  That lessens the chance of rejection substantially.  He's already booked a flight down to Houston so they can begin to assess him.  They need to perform a pretty comprehensive physical exam and make sure he's fit enough to donate.  I would say I don't anticipate any problems but nothing has gone as planned with this disease.....
     As to when my dad starts his end of the deal, that's not clear yet.  We need to wait on the results of a few more tests.  And to be honest, there won't be definitive answers then either.  Possibilities, maybes, kinda sorta, like I said, it's where medicine becomes an art.  Depending on those, we're talking potentially sometime in September or probably October.  So as my dad likes to say, "we wait, and we wait, and we wait...."