My son is in LTM and has been off oral chemos for two weeks due to low counts. First his counts went too high so they increased his 6mp. Now they've dropped too low; he actually had a blood transfusion last week and I must admit I thought those days were far behind us. So even since he's been off the oral chemo for two weeks his ANC is 480. His oncologists are not opposed to him going to school but they say the decision is up to us. I know there is alot of bugs going around but he seems fine and doesn't want to miss more school. (3rd grade) My question is at what ANC count do you allow your children to attend school?
Lots of people would, but I'm a worrier and wouldn't take the chance. I worried when my son went to school last week with an unknown ANC of 800 after an illness (found out the day after). But then again, I'm a teacher, so maybe that factors into my schooling decisions as well. I would definitely wait for over 500 though. Maybe check with the teacher about bugs in the classroom?
Thanks for the idea, I did email the teacher and see how healthy her classroom is and proposed if she could have him sit at a separate table from the other children and then not have him attend lunch in the cafeteria so he is not exposed to the whole school. We are so far into this and things have been going relatively well that sometimes I think I'm becoming a little to relaxed. I need to step back and remember how serious an infection would be to him with an ANC of 480. Thanks for responding! I appreciate your comments.
Yes. I have sent my preschooler to preschool with an ANC of 200. That was not the norm, but I did it a couple of times with the onc's blessings. COG has recently decided that it is so impt that our children go to school that they should be sent to school when feeling good, often regardless of ANC. Our oncs were adamant from dx on that the most serious dangers to our CKs were the danger from the bacteria within their own bodies when their ANCs are low, and those dangers exist whether they go to school or sit at home (or sit in the hospital -- btw, taking a child to the hospital with a low ANC scares me much more than taking that child to school -- hospitals are germ factories in a magnitude schools could never reach).
So that's what I did and think. BUT, this is your child, and you have to do what you are comfortable with. I realize you are just gathering opinions here, which is a good exercise to see other people's experiences. Whatever decision you make will be the right one for you.
Yep - Aidan went to school regardless of his ANC which dipped in the 200s quite a few times. His zero ANCs came during vacations but we still did stuff anyway. Maybe being on the bactrim helped keep away other infections but he never caught anything but colds. Not even the flu or swine flu when that was going around. My son was in treatment from 1st to 4th grade. And missed only 1 day each year. But again, I stayed ever watchful and on the look out. And I'm with Ann on the fact that the hospitals are where the real bad germs are cause that's where people go when they are REALLY sick. And we take them there all the time!
It's a personal comfort level decision and there is no wrong answer.
All the best!
Thank you for all the responses. Interesting on how the opinions are almost split 50/50. As I write this post, he is at school. After talking with the teacher again this morning, she is going to explain to the kids the importance of hand washing and will have all the kids wipe down their desks today. He will also eat lunch outside of the cafeteria. As we all know, this is not the cure all solution but it certainly doesn't hurt! He wants to be at school and he says he feels great! I've been following some other posts and it puts me at ease to realize how many other children in LTM are on this new roller coaster of keeping their counts stabilized. He will not get another CBC for two weeks so that will mean he"ll be off oral chemo for 4 weeks. That is kind of unsettling but it is what it is. I'm not complaining, we've made it through the first two years (his has a little less than a year left on AALL0434 dx with T-Cell ALL in Dec 09) and our approach is a little more relaxed as well. We have always tried our best to keep his life as "normal" as possible. With the oncologists blessing he's been able to continue playing baseball, basketball and even flag football. Thanks again, I appreciate everyone's comments!
I would send, as long as Gabbie wasn't "sick". The ANC is only one indicator in the bodies ablitiy to fight off something, and she has as much chance of catching something out in public, or school, as she does catching something her siblings have brought home. She's caught plenty of that, and avoided quite a bit too. Its a crapshoot really. If she is ready to go to school? I send her. The mental/emotional boost she gets from going far out way any possible risk. Gabbie NEEDS people, I feel the social interaction does indeed help her stay as healthy as she can be. Her oncologists says, "send her" IFshe does get sick, we'll treat her. So, we do.
Our docs just say, if the child feels well, let them do whatever they want to live their lives....so based on that - we do a lot - but sometimes afterwards, I feel like an idiot - we went to an international farmers market last Saturday, with tons and tons of people --- come to find out yesterday, that my daughters ANC is Zero ...Opps...but so far, she's fine...and we had fun - so I guess I can't look back. Of course, now that I know she's Zero -- she's on lock down at home!! Good luck! b
Our oncs were conservative and said no school under 500. I sent her in anyway under 300 one time and she didn't get sick. Her ANC was usually in the 500-1200 range, and during LTM she was still hospitalized 4 times for about a week each when she had fever + low ANC. The one serious time we had been to a holiday party in her classroom at aschool and there was a sick kid who sneezed on Kelly, and her mom was like "well she had a fever this morning but really wanted to come to school for the party...." I was like really????!!!! 2 days later Kelly was in patient with swine flu and pneumonia. I feel like my daughter is still a little "socially inept" due to her time in isolation, so I do think no matter the risk, we need to send them in to school to be a normal kid.
Our oncs say it depends on how the child feels and they ok atttendance with an ANC of 0. During frontline in 5th Grade, Joey only went occasionally. When he was in 6th grade (LTM, original DX Aug. 2008) he made it to school about 60% of the time. He really didn't want to go was the larger problem as he'd started in a 700+ kid Middle School and felt awkward. The school never really got Joey and it wasn't a good fit for him. We had support from the Home/Hospital program. Following his Aug. 2010 relapse, Joey didn't attend school at all. This year, we've transferred him to a small parochial school for 8th grade. He only has 27 kids in his class and there are less than 300 in the whole building PreK-8. Joey has only missed about 20 days and they were all either during Nelarabine or steroid weeks.
As with so many other things, you need to make a decision and be OK with the outcome. Here's our story. My son (in 4 year old Kindy, 4 mornings a week) started LTM just before school started with rock star ANCs (1300-1900) until February. Before that he got only a minor cold in October, avoiding strep, tummy bugs, etc. In Feb. his ANC crashed to 120 but with "a lot of Monocytes (on a Thursday). We sent him Monday; Tuesday it was 480, Friday back down to 130. Uh oh. Sure enough, Sunday he got a fever and ended up inpatient with RSV, ANC 96. I am OK with our decision. It was the first time we'd dealt with neutropenia and had been so lucky until then, we did what we felt was the right thing. He'd had a rough time before the dive and was very happy to return to school (missed a lot of days the weeks before due severe hypoglycemia).