Singapore 19.28 hrs

Cycle 4 session A of chemo is done. Nicole had a quiet session with Anna and Daulet visiting her.
Before the chemo, she met Dr. Karmen Wong to get the results of the blood test. Of the three tumor markers, CA 19.9 is still above the reference range of 39. It stands at 50.4 compared to the last reading of 71.2 - an improvement, though not as large as we were expecting. Dr. Wong remarked that this slowdown of the progression is normal. She still feels confident that cycle 4 will show improvement.

The blood cell counts, though not cause for alarm yet according to Dr. Wong, show the side effects of the chemo drugs.

Total white cell count stands at 2.6 below the reference range of 4-10. Dr Wong however prescribed an injection of Neupogen, a white cell production booster. According to information from the web, Neupogen is the trademark of a pharma company for filgrastim. Potential side effects: bone pain. Nicole will have the shot tomorrow afternoon as Neupogen can be administered safely only 24 hrs after chemotherapy.

Nicole's haemoglobin count stands at 11.8, slightly below the reference range of 12.0 to 16.0. Dr Wong is not recommending any treatment for this. Nicole will have to adopt a diet and life style that will boost and conserve her energy respectively.

Dr Wong agreed that Nicole sees a traditional Chinese medicine ("TCM") doctor for Chinese medicine and herbs that can be used to boost both the white and red cells.
We plan to see a TCM doctor as soon as we can get an appointment.

Well, I was somewhat disappointed with the limited progress since the last test.
I am more worried about the white cell count as we will have to stop chemo if the count goes below a certain level, thus the preemptive shot of Neupogen. Fortunately there is one last session of chemo to finish the 4 cycles. We hope that by then all the tumor markers will be within the reference range!

I am also concerned about the risk of infection. We shall be avoiding going to places where there are big crowds, avoiding meeting people with flu and staying home.

We are still keeping our travel plan unchanged. We shall have the next blood test results on April 17 afternoon. Our flight to Mauritius is planned to be on April 18. We leave it to God's will.

We continue to praise God with His gift of love: the visits of Anna and Daulet to be with Nicole, the terrific and healthy meal prepared by Anna which we had for dinner. It is such a touching and valuable gesture by Anna. Thank you.

Good night.