Joel went to Vernon this morning to get his Vincristine. His counts were all so low so he had to go back for a transfusion. Platelets were fine, around 120 but that was because he had a transfusion a week ago. Hemoglobin was 77 so that is the cocktail he gets today. White cells were at 0.4 which means his ANC will be next to nothing. So, Joel will be staying home tonight and not going out with friends as previously planned. I don't think he will protest too much or give me puppy eyes as he is feeling wretched and has been throwing up all day.
So this was the last chemo for the Delayed Intensification I phase. Joel is scheduled to start Interim Maintenance II on August 4th but chances are his counts will not be recovered by then as they are still in a downward spiral. Interim Maintenance II will take 57 days and it consists of Methotrexate every 10 days, but not in dangerously high doses as last time so he will not be needing any antidotes. He will also get Vincristine every 10 days, spinal methotrexate on days 1 and 31, and PEG-Aspariginase on days 2 and 22. The PEG-Aspariginase is now being given in a drip through the port instead of two needles in the legs. Joel prefers the drip plus it is much safer as with the needles, the whole dose is given instantly and if a reaction occurs it is more severe. With the drip method the injection can be stopped as soon as a reaction is noticed.