17 Come (Mon)day

Noon

            Ralph Vaughan Williams used “Seventeen Come Sunday” in his Folk Song Suite. I love the tune.

I wish I’d posted a week ago, when David’s WBC was a comforting 6. By Monday, December 15^th, it was 17 and today, December 18^th, it’s 38. Doubling in three days. Doing the math, unchecked it could be 310 just nine days from now, December 27^th. The blast percentage has risen from 55.7% to 67.0%.

And he’s been unable to keep the hydroxyurea down.

            Hydroxyurea (Hydrea is a brand-name) kills blood cells in the bloodstream, but does not attack the source of the leukemia in the bone marrow. It keeps the symptoms of a high white blood cell count at bay, but eventually, unless the decitabine kicks in, the blasts produced in the bone marrow will take over, clogging the capillaries. The lungs and brain are especially susceptible, reducing the oxygen exchange in the lungs and potentially causing bleeding in the brain.

            As Judy Foster, the nurse practitioner, explained, decitabine is a more ‘elegant’ drug than the others he has had, which work by brute force, killing fast-growing cells, such as leukemic white blood blasts, but also red blood cells, causing anemia, and platelets, heightening the risk of uncontrolled bleeding.

            We’re at Cox 1, the MGH outpatient clinic, where David is resting while he receives saline fluid to treat his dehydration. They’ve given him an anti-nausea medication and will try a dose of hydroxyurea in a little while. Unfortunately, there is no IV form of the drug: it has to go through his digestive system.

            Judy offered David the choice of returning to Cox 1 tomorrow or being admitted to the inpatient Lunder 10. For now he’s opted for the outpatient route.

            She’d like to give him a liter of fluid, so we’ll be here until at least 3 p.m. Glad I brought my computer and Kindle. Sorry David doesn’t feel well enough to do anything but rest in a darkened room.