Archive for August, 2010

August 31, 2010

8-30-10 Monday

 Hope you all had a good weekend, it was a good one here.

Status: 8.75/10. Went for a walk with Lisa and Rachel, feeling stronger daily.  

Events:  One of our quickest trips to Hopkins.  White cells and neutrophils keep climbing, and labs looked so good they said to go home.   We’ll check in Wednesday, and look forward to fewer and fewer days each week at Hopkins.

Comments:  My recovering lab results after the second round of chemotherapy are paralleling what we saw after the first round.  Although it could be argued that my feelings of wellness, strength, appetite, and endurance are just increasing at the same rate as my white cells but not related to them, I feel strongly that they are directly related to the white cell number.  Those white cells are either producing some good substances or blocking some bad ones.  In either case, I’m feeling good now and look forward to  feeling even better over the next few weeks.

Love,                                                                  

-Bruce

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August 26, 2010

8-26-10 Thursday

Status: 8.5/10. Feeling better each day.  

Events:  A quick trip to Hopkins with great lab results – my all important neutrophils are almost at the normal level and look to keep climbing.  My hematocrit is the highest it’s been in months, so walking around is almost effortless, and my platelets are above my set goal.  They topped me off with one bag of platelets (want to keep them high to help the GI tract heal) so no need to go back there tomorrow.  Good to stay at home.

Comments:  Platelets – those tiny little elements in the blood (smaller than red blood cells) that are so important in your ability to form a clot and stop bleeding.  Each transfusion comes as a “bag of platelets” that may contain anywhere from 200-600 milliliters (that’s about ¼ to ½ a quart).  But I wondered how many actual platelets were in those transfusions.  It turns out somewhere between a quarter to a half a trillion platelets.

  Now a trillion is a tough number to get your arms around, especially when talking about dollars and deficits, but it’s a huge number.  If I had gotten a platelet every second, it would take some 30,000 years to finish that one bag.  Luckily, it was done in about 30 minutes (the math majors among you may want to quickly figure out how many platelets a second that was).  And hopefully that’s enough to keep me at good levels, heal that spot in the GI tract, and move on.

  Look forward to a quiet few days, and I’ll touch base with you on Monday.  Have a wonderful weekend.   

Love,

-Bruce

August 26, 2010

8-25-10 Wednesday

Status: 8.25/10.  A good day.

Events:  A very good night’s sleep, not having to get up early to go to Hopkins.  So I was able to stay home and get some chores done, Lisa was able to go to work and do a story for WNT, and the kids were out playing with friends.  Nice to have a normal day.  Off to Hopkins in the morning for counts.

 Comments:  Good friend Ruth Zwick (wife of fraternity brother Ken Zwick) graciously agreed to drive me up to Baltimore tomorrow.  I’ve known Ruth for more than 40 years, and it made me think of how long I’ve known all the good friends on this list who have been so considerate.  Some only a few years and some much longer (I count my Mom and Dad as the longest).  But all have helped me through these times, and I’m fortunate indeed to know people who are so kind and generous.  I’m a lucky man.

Love to all of you,

-Bruce

August 25, 2010

8-24-10 Tuesday

Status: 8.0/10.  What’s a difference a day makes. Feeling good.

Events:  Got a good night’s sleep and made our usual way to Hopkins.  White cell counts and neutrophils keep climbing, and platelet and blood transfusions have increased my counts to much, much safer ranges.  No evidence of continued bleeding, blood pressure 130/70, pulse 70 – that’s more like it!  And they’ve given me the day off tomorrow – they’ll check my labs Thursday. I’ll continue on antibiotics for a week after my counts return to normal.  As my oncologist says, “Nothing like antibiotics and white cells.”

 Comments:  I couldn’t contend with all this without the world’s best patient advocate, chauffer, and nurse by my side.  Today was an ordinary day – Lisa packed up our usual day supplies (lunch, snacks, meds, etc.), drove me to Baltimore, started my thrice daily antibiotic infusion, stayed with me throughout the transfusions, arranged care for the kids, dropped me back home, made it live for World News, put a piece together for tomorrow’s Good Morning America, and back home now to spend the evening with the kids.  Got to find out when they accept nominations for Mom of the Year.

 Love,

-Bruce

August 24, 2010

8-23-10 Monday

Status: 7.0-8.0.  What’s a weekend without some excitement.

Events:  Trying to let my “raw” GI tract heal when I had another GI bleed Sunday.  I knew it instinctively when I had a moment of weakness and sudden fatigue, and climbing a flight of stairs was accompanied by shortness of breath.  Vital signs at Hopkins today showed a low blood pressure and high pulse rate, and my hematocrit dropped 6 points.  Felt much better after blood and platelet transfusions. [I’m using up a lot of blood products, and they only come from one source.]  So consider donating blood, it’s truly a life-saving gift.

 Comments:  Whether from an occult GI bleed or a knife wound in a back alley, a sudden loss of blood initiates a series of compensatory physiological events.   As the blood pressure drops (just as puncturing your garden hose will diminish the stream), the heart has to beat faster in order to deliver the same amount of blood to tissues, so the heart rate increases.  Then, to keep the vital organs (brain, heart kidneys, etc.) supplied with oxygen-containing blood, a large number of vessels in the body constrict to shunt blood preferentially to those critical organs.  The blood supply to areas that aren’t critical (such as the skin) are shut off – thus the sudden paleness (“he turned white as a ghost”).

  The kidneys virtually shut down in order to keep as much fluid (and pressure) in the body as possible.  Signals are sent to the brain to spur the thirst mechanism, since drinking fluids substitutes for the lost blood volume.  But in substituting water for blood, you dilute the blood and decrease the percentage of red cells (the hematocrit falls).

  So, my sudden weakness  and fatigue were from lack of blood flow to my brain.  The shortness of breath was because my cardiac output suddenly decreased, and I could no longer exert myself to the same extent.  And my pulse rate was 100 (should be more like 70), my blood pressure was 99/50 (120/70 would be more like it), and my hematocrit had dropped from 27 to 21.

  I should also say that blood in the GI tract acts as a laxative, causing not only diarrhea, but when digested results in black, tarry-looking stools.  And if the bleeding is brisk, bright red blood is not uncommon.

  So, the priority now is to get whatever spot is irritated to clot over and heal, and avoid any more of these incidents.  Lisa has been with me continuously, and we’re tentatively scheduled to be at Hopkins every day this week to watch my hematocrit closely and give any needed transfusions.

  Good news (we could use some, huh?) is that my white cells and neutrophils continue to climb.  My red cells would be climbing, too, if I’d just quit managing to lose them!

Love to all,

-Bruce

August 21, 2010

8-21-10 Saturday

Status: 8.25/10. Feeling a little better each day.

Events:  Got up early for a quick trip to Hopkins for some platelets so I won’t have to worry about any incident happening over the weekend.  Next visit Monday for labs.

 Comments:   These bumps in the road aside, right now, still on course for the goal of a transplant.  A parallel course of evaluating the matching donors, and me healing from the courses of chemotherapy.

  Besides hair follicles, the other sensitive cells are the lining of the GI tract (not grammatically correct but you get the idea).  Although you might think of the gastro-intestinal tract as inside your body – it’s not.  It’s on the outside.  Imagine taking a magic marker, and without picking it up, drawing a continuous line from your belly button up to your mouth, down the entire GI tract, exiting the other end, and coming back to where you started.  Topologically, you are a donut.  If you want to get inside the donut you’d have to poke through it, not just go around. 

  So, just as your skin protects you on the exterior, the GI tract lining is your protector on the interior.  If it gets damaged, which it does from chemotherapy, bacteria can get into the bloodstream, and you can have breakdown of tissues and bleeding (especially when compounded with low platelet counts).  So my episode of bacteria in the bloodstream and two GI bleeds weren’t unexpected, but probably preventable.

  My job is to heal without any more incidents and move on.  Think the kids, Lisa, and I will have a movie night and rest tomorrow.  Back to you on Monday.

 Have a restful weekend.

Love,

-Bruce

August 21, 2010

8-20-10 Friday

Love the comments!

Status: 8.0/10. An OK day, although it seems like it’s been a week since yesterday morning.

Events:  At Hopkins most of the day for red cells.  Lab results were great!  My marrow is kicking into gear – white cells at 1,000, neutrophils at 500.  Given my previous experience that should accelerate over the next week.  If we can keep my platelets up, I’ll be in good shape.

Comments:   Yes, I’ve been over a few bumps in the road, but as they say, failure isn’t getting knocked down, it’s not getting back up.  Even my oncologist said, “You keep bouncing back.”  I look forward to feeling well again (takes a while to start feeling good after being poisoned).  Back to Hopkins early in the morning for protective platelets and then hopefully a quiet weekend.  Hope you have one, too.

Love,

-Bruce

August 20, 2010

8-19-10 Thursday

Status: 6.0-8.0/10. An eventful day.

Events:  Had to get up very early for lab work at Hopkins.  As I was gathering my morning meds, I was suddenly overcome by a heavy curtain of weakness and was forced to sit down.  I became faint, short of breath,  and began to sweat profusely (called diaphoresis in medical lingo) then followed by nausea, vomiting, and diarrhea. Lisa said I looked as white as a sheet, and was about to call 911.  If I had any chest pain with it, I would have said I was having a heart attack. 

  I was able to get into the car and get to Hopkins.  Had my labs drawn, and luckily we had an early appt with our oncologist.  I told him what had happened, he looked at my labs and saw my hematocrit had dropped 5 points, and said I probably had an acute GI bleed (perhaps not surprising with platelets of 9,000).   So I spent the day getting 3 units of blood, and two large bags of platelets.  If had not rallied from the transfusions they were prepared to keep me overnight.  Fortunately, Lisa and I were able to leave around 4 PM.

Comments:  Both GI bleeds occurred when my platelets were less than 10,000.  They have now set my minimum number at 20,000, which simply means they will keep them greater than 20,000.  Also set my hematocrit at 30.  Platelets work better at higher hematocrits; don’t think anyone knows why.  So I’m back tomorrow and Saturday for transfusions to keep me safe over the weekend.   Some good news – my white count is continuing to increase.

   And just to end on a lighter note, when they call down for platelets they talk to “Dr. Platelets” as in, “Dr. Platelets says he’ll send a bag up in 30 minutes.”  This of course is just too good to be true.  In fact, the lab is populated by a number of staff who go under that generic name and all the doctors and nurses talk about “him” as if he’s a real person.

   Hoping for a quiet weekend, hope you have one, too.

Love as always,

-Bruce

August 19, 2010

8-18-10 Wednesday

Status:  8.0/10.  Easy day at home.  My appetite is getting better every day, which in the past went along with my white count, so I’m curious to see what it is tomorrow at Hopkins.

Events:  Tomorrowwill get some platelets, check some issues with my Hickman catheter, and have a consult with our lead oncologist.

Comments: Hopefully we’re on track, as we were after the first chemotherapy, of getting counts back up to normal and gaining weight. Lisa, of course, has been keeping it all together.

Love,

-Bruce

August 18, 2010

8-17-10 Tuesday

Status:  8.0/10.  Restful day, slept late, had a nap.  Trying to follow the old Zen instruction, “Eat when you are hungry, sleep when you are tired.”

Events:    Had a massage today to work out some kinks in my shoulder after days in a hospital bed.

Comments:  Gaining strength and weight, feel like I’m on an upward slope.  Hope you’re on a upward slope as well.

Love,

-Bruce