Thursday, June 11, 2015

Energy Down, White Counts Up



            David’s energy is going down and his white blood cell counts are going up, from 13.73 on Monday to 29.48 today. The percentage of blasts in the bloodstream is also up, from 79.0% on Monday to 89.1% today. Meghan, the nurse practitioner, increased the hydroxyurea from 4 grams/day to 5 grams/day.
            On Monday, 8 June, David, Jim, Matt, and I went to David’s medical appointment. We gave Dr. Fathi a written statement of David’s wishes; Dr. Fathi read it aloud and we had a frank discussion. Then Linda Kafkas, the outpatient case manager, came in to discuss “bridge to hospice”. For now, David will continue to receive treatment: blood and platelet transfusions and hydroxyurea to try and curb the white blood cells (which are 89.1% leukemic). We plan to have hospice at home, which will start when treatments fail.
            I strongly recommend that anyone who is ever going to die or loves someone who someday will die read Being Mortal: Medicine and What Matters in the End by Atul Gawande. He is a Boston-based surgeon who has pondered end-of-life issues and writes about them. He describes the failings of modern medicine in dealing with the important decisions around death and gives concrete suggestions for improving the journey we all must take. It’s well-written and full of thought-provoking stories. I’m on my second read-through. Each time I understand his message more deeply and see more clearly how it applies to our situation. I’m grateful for his insight and wisdom.

Saturday, June 6, 2015

Back Home Again


           David stayed inpatient at Lunder 10 for 9 days, Memorial Day to 2 June. Last Saturday, 30 May, Jim and I flew to Utah for Sam’s and Savannah’s wedding in the Bountiful, Utah temple. Our son, Matt, took the train from Chicago, arriving in Massachusetts Monday evening, 1 June, so he was able to bring David home on Tuesday. Matt is staying with us for the month of June. As always, David is in a great mood, having a sibling visiting. Last night we played Ticket to Ride: Europe for three hours. Matt won, much to David’s chagrin.
            David still has a cough, due to the pneumonia. He doesn’t have much energy, but enjoys sitting on the couch and talking. He’s on an antibiotic, Moxifloxacin to treat the pneumonia. His nausea and throat pain are gone: presumably the clinical trial drugs caused those side effects.
            Today David went to Lunder 10, outpatient, for platelets. On Monday we’ll get back into the twice a week routine: Mondays and Thursdays at Cox 1, outpatient MGH. The WBC (white blood cell) count is good: 10.10. Hematocrit is 26.9, platelets were 8 before today’s transfusion.

Wednesday, May 27, 2015

Pneumonia in Lunder 1092

David returned to Lunder Monday morning, Memorial Day. He hadn’t eaten anything for several days, was dehydrated and terribly nauseated. He had no appetite and severe pain in his throat. Dana, our favorite Lunder 10 nurse, who works weekends and holidays, started IV saline and some Ativan, which is very effective for nausea, (as well as anxiety and insomnia). The Ativan got rid of the nausea and knocked him out minutes after it started flowing into his vein.

Ours was an unscheduled visit, and the infusion room was full. Dana put us in the patient and visitor lounge and taped a sign on the door, ‘Lounge Closed’. Last May, late in our time at Walter Reed, there was a night when David couldn’t sleep. We walked down the hall to a lounge and he lay down on the couch. “This feels so good!” he said. The sweet nurse on duty let us stay, even though it was against procedure to have a patient sleep in the lounge. Such a simple pleasure, to get out of bed and nap on a couch.

In the Lunder lounge, David was quite comfortable. Dana said, as she worked, “I’m trying to keep him out of the emergency department.” She succeeded. He moved into room 1092 Monday afternoon.

David hadn’t taken his clinical trial drugs Monday morning. On Tuesday I arrived at Lunder 10 around 9 a.m., to deliver the refrigerated BYL719 study drug. That was unnecessary: Dr. Fathi stopped the MEK 162/BYL 719 clinical trial. The drugs were not lowering the white blood cell count and were probably causing the throat pain, nausea, and lack of appetite. It’s disappointing.

            Tuesday they took a chest x-ray to investigate his hoarse cough and discovered pneumonia. Later in the day they did a CT scan, which showed a large consolidation (not a good thing) in the upper right lung and little dots scattered throughout the lungs. Since a lung infection could be TB (tuberculosis), we all have to wear heavy-duty masks, which are hot and bothersome. But I certainly don’t want to either contract or pass along TB (or any infectious disease). It’s quite unlikely he has TB, but they must take precautions.

            At 5:30 p.m. this evening David was sleeping soundly. He was in good spirits yesterday, and sounded chipper on the phone this morning, but now he’s conked out. Yesterday afternoon he spiked a fever of 104°. When Jim arrived to visit, the nurses were busy applying ice packs in an effort to lower his temperature.

            R’el, Peter, Xiomara, and Andrew drove up from NYC Friday night for the holiday weekend. David enjoyed playing with Andrew and made some videos on his iPod. Happily, Andrew has decided to enjoy his Uncle David’s company, even when his mother isn’t in the room.

            Saturday night we watched a Captain America movie, Winter Soldier. R’el synchronized the start of the movie with Matt in Chicago. At our house R’el, Peter, and David sat at their laptops (as did Matt in Chicago) and messaged commentary as the movie progressed. I was content to just watch the movie. David did comment afterwards that he missed a bit of the action while typing and reading comments.


            The goal for now is to get David strong enough to come back home, one day at a time.

Monday, May 18, 2015

Low Energy



David had little energy or appetite this weekend. This morning his hemacrit was down to 19.9 (so he’s quite anemic) and platelets were at 8 (they are shooting for 40). The WBC is 6.77: David will stop taking hydroxyurea today and we’ll see if the study drugs can maintain the low WBC count.
Annie came by T to MGH; she arrived from Wisconsin at 1 a.m. She’ll visit for about 64 hours, then fly to China for a summer study abroad.