It's Monday, and I'm back in Boston.
Spent the weekend at home in NY with Tim and the girls. Halloween party Friday night. TaeKwonDo Championship on Saturday. Sunay: Church, help Kaia maky a pumpkin that looks like Thurgood MArshall for a school project. And preparation for Hurricane Sandy's effects - bringing in the patio furniture, turning over the trampoline and basketball hoop, getting out the flashlights, candles, etc - before hitting the road back to Boston. On my way back to Boston Sunday evening, I passed LOTS of utility repair trucks heading east on the Mass Turnpike.
Reassured by numerous calls from Ryan's residents and intern over the weekend updating me on his status. They were on top of everything. I've gotta give it to these young doctors. After my less-than-gracious temper tantrum on Friday it had to take a lot of guts to call me!!!
Relieved when I arrive in Boston to see Ryan doing quite well. Still having some nausea, but minimal headache over the past 2 days.
What's happening to him now?
His RBC counts are fairly stable at Hgb 11 and Hct of 31. Platelets have dropped to 58,000 (83,000 yesterday; normal over 150,000). WBC 150. That's 150 - not thousands. Eeeek!!! Normal is 6,000-10,000. But I guess that's the goal, isn't it? To wipe out his own WBCs which could still hold some cancer cells.
Sometime in the next day or two, he'll need platelet transfusions - when he reaches 10. RBC transfusions will be done when he hits Hct of 21. As a surgeon and OB/Gyn, I'm accustomed to transfusioning when a patient's Hct is around 25 - but that is in patients who may loose more blood and whose cause of anemia is blood loss, and therefore they've also lost the iron necessary to make more red blood cells.
In Ryan's case, he hasn't "lost" blood - he just isn't producing the red cells, and they naturally only live for about 120 days. The difference is that his body still has all his iron from his RBCs, which the body reclaims as cells naturally die, then recycles into new cells (when the marrow is working, that is). So giving him lots of RBCs to get him non-anemic (normal is Hemoglobin/Hgb over 12 and Hematocrit/Hct over 36) could result in too much iron in his body.
His blood chemistries are normal, no signs of organ damage from the chemo or radiation.
He has lost 9 pounds since admission. No appetite, even when he's not having nausea. He's mostly eating cereal and milk (Lactaid rather than normal milk, since the combination of chemo and radiation cause damage to the intestinal lining, which makes most people lactose intolerant until it all heals). Diarrhea is also common due to both the damage to the GI lining and the GI antibiotics. And starting to get itchy skin, which is also common.
Current medications?
--Tacrolimis and methotrexate to minimize graft-versus-host disease, or rejection of his body by Meghan's cells
--Mouth care meds: an antifungal and another med that he swishes around like mouthwash several times a day to keep him mouth lining as healthy as possible
--Antibiotics which are not absorbed but stay in his gastrointestinal tract to minimize his natural intestinal bacteria
--Antifungal pills (swallowed) to prevent fungal infections
--Antivirals to prevent viral infections including "opportunistic" infections such as shingles.
--Antacids and prilosec to minimize gastric acid effect on his stomach and esophagus (the GI tract is very sensitive to both chemo and radiation, and ulcers can develop)
--Magnesium: to replace what his body loses after chemo and radiation
--Multiple nausea meds: scopolamine patch, sublingual Zofran, IV Zofran, Compazine, Ativan
--Pain meds: options of oral or IV if needed
--and probably more I don't know about yet............
(It's going to take a excel program to keep up with his meds when we leave the hospital.....)
What can we expect?
--Mouth sores (mucositis) - chemo and radiation affect the fastest growing cells in the body: cancer cells, blood cells, and the cells that line the GI tract. They told us that almost everybody gets mouth sores and, sure enough, Ryan just texted that he has his first sore. These can be severe enough to prevent eating, and sometimes require serious pain meds and IV nutrition.
--Transfusions of RBCs and platelets
--More diarrhea
--Hair loss which should occur next weekend
--Fevers and infections - hopefully minor, but sometimes serious
--Possibility of severe liver or kidney problems
--And in about 7 days - Day T plus 11 - we should start seeing his WBCs increase as Meghan's stem cells start functioning and producing cells
It is VERY reassuring that things as going precisely according to plan / routine. All of his symptoms seem to be less that many others experience. Whew..........
And I am so grateful for the nurses who are providing so much TLC and emotional support as well as necessary medical care. The team of doctors seems to have gotten past the rough spots and are now very responsive to his needs - probably a valuable lesson for the physicians-in-training, and they have risen to the occasion superbly.
Thanks to the missionaries and temple workers whose names I don't know who came by this weekend after a call from the social worker, and provided love and support in my absence. Sadly for Ryan, he isn't allowed to eat the homemade pumpkin chocolate chip cookies. So Sophia and I stepped up and took care of the problem!!
Thanks to all the church friends and Tim's co-workers who are providing so many meals for Tim and the girls!! But they're all getting spoiled - they really don't need desserts with every meal!!!!!
Also very grateful that Hurricane Sandy chose to come ashore south of Boston. The city is pretty much at a stand-still due to closure of the "T", but I think I can forget the Katrina-like effects on the multitude of huge hospitals so close to the coast here in Boston.
I think I'm starting to relax........
---Barb
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