I’m not proud to say it but every time I hear the word “nadir,” pronounced “nay-der,” I just can’t take it seriously and it feels like it should be followed by “dude.”  Anyway, on to the point.  I only recently learned of this fantastic word which is surprising given it’s presence in our life on three other occasions.  Upon looking up the definition, I learned some pretty interesting facts.  It comes from the Arabic, “nazir,” which means “opposite.”  Apparently it can be used figuratively to mean the lowest point of a person’s spirits and it can also be used to refer to the lowest point reached by a celestial body during its apparent orbit around a given point of observation.  In our life, it is the final explanation provided by Wikipedia that is meaningful today.  “In western medicine, the term nadir is used to represent the lowest level of a red blood cell count while a patient is undergoing chemotherapy.  A diagnosis of neutropenic nadir post chemotherapy typically lasts 7-10 days.”

So yeah, all of that to say, we’ve hit bottom today at last.  On this, the 14th days since Allistaire began her fourth round of chemo, her Absolute Neurtrophil Count, ANC, hit zero.  I was so elated this morning to hear the good news that she had finally reached bottom.  You  can’t go up until you’re all the way down. They didn’t even start doing CBCs, (Complete Blood Counts), until day 7 and then her ANC was around 1,200.  The following days it was 1,500, 12,00, 550, 175, and 10.  Now we wait to hang out at zero.  Another dad, whose daughter is here with a relapse with AML, said that when she went through this round, her ANC was zero for about 25 days.  I asked the doctor about this and he said that it will probably take longer than Allistaire’s previous round and might be more along the lines of the first round.  In response I told him that in the first round, Allistaire’s ANC stayed at zero for 18 days.  He said that that was probably a bit on the long side too.  So, not sure what to think but I would guess definitely over a week and possibly closer to two weeks.  Of course once it starts to come up it will take at least a week I would guess.

Please be praying for protection for Allistaire’s wee sweet and vulnerable body.  She literally has almost no white cells in her whole body which means she has no defense against marauding invaders.  Today she was pretty tired and grumpy a fair amount.  She is much more reluctant to eat.  She is also drinking less which tonight necessitated she be hooked up to her IV while she sleeps to get fluids in.  Her little bottom is already getting a bit pink and she had some impressive diarrhea tonight as well, (much akin to the last time though so far not as frequent.)  She is also quite close to needing blood as well which could be another significant factor impacting her fussy spirit.  Her hematocrit, (red blood cell count), today was about 22 and they will transfuse at 20.

Another bummer part of her day today was her need to get her next dose of Synagis.  Synagis is the brand name for Palivizumab, which is used to prevent RSV, a respiratory virus.  Because Allistaire’s little leg muscles are so small, she actually had to have two shots of it, one in each leg.  I held Allistaire with her back against my chest, she sitting in her crib, and another nurse holding her feet.  Two other nurses simultaneously administered the shots into her thighs.  We opted for shots so that she would need to be hooked up to her IV for an infusion of the drug.  Every time they access her lines, there is the added risk of infection, so we all work hard to minimize the number of times they are accessed – thus the choice to give shots instead.  Needless to say, Allistaire was extremely upset by the whole thing including being restrained and then having “stickies,” (bandaids), on her legs.  The big shocker for me was how much this drug costs.  I knew it was expensive because our good friends at Regence Blue Shield decided not to cover it, but I had no idea just how expensive.  The cost for these two shots this morning totalled $14,000.  Crazy!!!!  She gets this every 30 days during flu season, which apparently here has really only just begun.  Oh, I should add, lest you faint at the thought of us having to pay for it – Allistaire is covered under Medicaid as her secondary insurance through the state of Washington.  This means anything that Regence doesn’t pay, Medicaid does.  Again a huge blessing!  Because Allistaire was in-patient for 30+ days, she automatically qualified for a Long Term Care program based on her income level.  My favorite part of the application was where they asked if Allistaire was “running from the law.”