2/10/10 Wednesday
Today was one of the worst days of our lives together … now less than 12 hours from the diagnosis… that took only 6 hours from admission. Teri went from some shortness of breath and palpitations over the past two weeks to being markedly anemic. Since she stopped her iron supplements 3 years ago, we initially thought this could simply be from iron deficiency. In short order, I took Teri for a transfusion in the Emergency Department yesterday morning, and then later heard from the ED physician that she had ‘blasts’ on her blood smear. Oh, oh. ‘Blasts’ sound like they belong in a kids comic book or computer game, but to a physician represent shock and awe. I made some noise about doing the key test – bone marrow aspiration – today. After the hospitalist and residents examine Teri, Dr. G. the oncology fellow tells us that he has asked the technician to stay late as they normally don’t do them in the afternoon. She receives two units of blood. At 4 pm her left iliac crest (hip) is numbed over a previous bone marrow site (1975), she squeezes my hand. She gets a bone marrow aspiration and biopsy with discomfort occurring after the needle is in when the marrow is pulled into the syringe (common). At 6 pm Teri gets the call on the preliminary results. These immature lymphoblasts are overwhelming her bone marrow (blood factory) and attacking my wonderful 37 year partner. Acute myeloid leukemia – AML.
Today was one of the worst days of our lives together … now less than 12 hours from the diagnosis… that took only 6 hours from admission. Teri went from some shortness of breath and palpitations over the past two weeks to being markedly anemic. Since she stopped her iron supplements 3 years ago, we initially thought this could simply be from iron deficiency. In short order, I took Teri for a transfusion in the Emergency Department yesterday morning, and then later heard from the ED physician that she had ‘blasts’ on her blood smear. Oh, oh. ‘Blasts’ sound like they belong in a kids comic book or computer game, but to a physician represent shock and awe. I made some noise about doing the key test – bone marrow aspiration – today. After the hospitalist and residents examine Teri, Dr. G. the oncology fellow tells us that he has asked the technician to stay late as they normally don’t do them in the afternoon. She receives two units of blood. At 4 pm her left iliac crest (hip) is numbed over a previous bone marrow site (1975), she squeezes my hand. She gets a bone marrow aspiration and biopsy with discomfort occurring after the needle is in when the marrow is pulled into the syringe (common). At 6 pm Teri gets the call on the preliminary results. These immature lymphoblasts are overwhelming her bone marrow (blood factory) and attacking my wonderful 37 year partner. Acute myeloid leukemia – AML.
I call her sister T., our best friends, the kids, my father … I sob over the kitchen counter. Shock and awe, I know the long road ahead.
2/11/10 Thursday 4:50 am
Sleep does not lie easily upon me. I am not an early morning. But this morning everything I see and feel is heightened. The warmth in her recent embrace. Her missing presence at home and in bed. The bright Windows 7 chime as the computer springs to life to write this. The screen saver of our recent Italy trip – Rome (in a day). The arduous road ahead. The uncertainty. The visceral gut inverting feeling.
I read the National Cancer Institute article on AML. Its medical Greek, I have to read it again. It’s not encouraging. I look at the medical literature in China – Mainland and Taiwan.
Why did this happen? Why of all people to Teri, the most caring, unselfish and do-gooder I know? What good can come out of it? What can I do?
2/11/10 10:30 pm
It’s been an unending 24 hours. We have tears and cracking voices talking about the known – the blood cancer label – and unknown – the prognosis and treatment course. Two units of blood take her hemoblogin (red cells) from 6 to a 9 g/dL, a PICC line is placed (from right elbow to heart) to provide stable IV access, and MUGA scan to assess her cardiac status prior to chemotherapy. Based upon recommendations from my pediatric colleagues, we have requested that that per primary oncologist be Dr. H. He is in clinic and will come later.
Dr. H. is sharp, direct, thoughtful and positive. Time seems to slow down. It is helpful that we ‘know’ each other through one of his medical school classmates who came to learn about cyclic vomiting syndrome from me. An 6º interlinked medical world. What we learn is that it is a bad cancer with not-so-good overall numbers that vary for the individual based response to initial therapy, on chromosomal (translocation) and cytogenic markers, and other risk factors. So far she doesn’t have the bad markers for Philadelphia chromosome and promyelocytic cells but she doesn’t have the good ones, mostly found in the young – she’s in the middle. She will be started on chemotherapy, cytarabine over 7 days of continuous infusion and 3 pulse doses of idarubicin. She will be hospitalized for a month to monitor for remission and most importantly to monitor the anemia (low red cells), neutropenia (low infection-fighting white cells) and thrombocytopenia (low clotting white cell) that result from the chemotherapy that kills good as well as malignant cells. The initial therapy is the same regardless but the markers and initial response will determine the subsequent treatment course, including bone marrow transplant. Remission numbers are 50% after 1st, 20% after 2nd and an additional 10% after the 3rd round. Then how to maintain it … He says they are in the upper echelons in outcomes, mainly by hawkishly monitoring the known infectious complications. She needs a second bone marrow aspiration tomorrow to get samples for additional cytogenetic markers. Poor girl, but takes this on this repeat procedure with equanimity.
I pose the question about whether Chinese ethnicity affects the treatment regimen or responsiveness. For example, there are significant differences for in metabolic rate (and sensitivity to side effects) of sedatives. I e-mail a pediatric GI colleague who I visited at Taiwan National University last June. She gave me the name and cell phone number of the leading adult leukemic expert there. Professor T. and explains that the treatment is largely the same with slightly improved responsiveness, that there are no modifications in dosing and they do not recommend any adjunctive supplements or Chinese herbs. I have asked a question no one else did. I got an answer from one of the highest authorities. I contributed. I feel better, momentarily.
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