Tuesday was another unexpectedly busy day. Dr. Riley called us early this morning and told me that Marye's hemoglobin was low, and she should come in for some bloodwork and probably a transfusion. So we headed to the cancer center and did just that. Once we got there, they took a blood sample and we waited for the results. In the meantime, we talked to Dr. Riley about what happened over the weekend and what is going on with Marye's blood.
The good news is, we shouldn't worry too much about the new lesions they saw over the weekend from the MRCP. Basically, since this was the first time Marye had this kind of scan, nothing we see can be compared to what we saw- or didn't see- before, because there's no baseline. Those lesions could have been there before, but just not picked up by the CT or PET scans. So, until and unless she gets another MRCP, there's no way of knowing their significance. Also, the onc says they look more like an infection than cancer. However, if they are infection, they would expect Marye to be much sicker than she actually is. But she's also getting IV antibiotics, which could be keeping the symptoms of infection at bay. So who knows? Again though, if it is infection, she's getting treatment with the antibiotics, and if it's cancer, the chemo should work on it. So unless these lesions do not shrink, there is no reason to biopsy them.
Ok, on to the blood work (aka "the bad news")... the blood they took from Marye showed better than expected hemoglobin levels, but a much worse than expected white blood cell count. It was really low (1.1 for you medical types). So, Dr. Riley still wanted to give her a blood tranfusion, which we did. But she was really alarmed at how low her white blood cell count was. Remember, chemotherapy attacks quick-dividing cells, including white blood cells, which help the body fight infection. Well, when Marye had chemo back in 2005, she was getting a Neulasta injection after each treatment. These injections cost $6,000 each. This drug stimulates the bone marrow to grow more white blood cells to counteract the effects of the chemo. It works well, and the only real side-effect is bone pain, like growing pains when you're a kid. Anyway, she's not getting Neulasta, but we now have a similar drug, Neupogen, that has to be injected once a day for five days. So, after a training session with the nurse, I performed my first-ever injection. We'll do this for four more days, and (probably) after each chemo treatment. As Michelango said (at age 88): "Ancora Imparo". Still, I learn.
So, moving forward, given Marye's reaction to the Abraxane, Dr. Riley has already decided to reduce the dosage in the future to reduce the side-effects. This is really where the art of oncology comes in. Since Marye had a fever last week (indicating some sort of infection), she's going to keep her on the antibiotics for the near future. Again, the oncologist is really concerned with how the chemo is going to affect her liver. But Marye needs the chemo in order to shrink the tumor, which is likely responsible for the pain and nausea that Marye is experiencing. She probably won't get a CT scan to measure the tumor until after the third treatment; then we'll know if the Abraxane is effective or not. If it's not, we'll have to look at another drug. In the meantime, we need to manage Marye's infections and keep an eye on her blood counts. Hopefully (there's that word, again), the transfusion will boost Marye's hemoglobin and ease her fatigue and weakness.
Barring some new catastrophe, we don't have to go back to the clinic until Friday for more bloodwork. This was a regularly scheduled appointment, and is the nadir of her chemo treatments... meaning it's halfway between treatments and when the bloodwork numbers are expected to be their worst. It's also a good time to follow up after these latest developments, so maybe we'll see some improvement in her numbers and how she feels. (I'm purposely trying to avoid using the word "hopefully".) Until then, no news is good news.
-Chris
