Sunday, October 21, 2007

D +145

Bummer...we made a really funny video post for today, just to let everyone know that we are very pretty positive and upbeat, but MDA's wifi network has uploads to youtube firewalled. I have tried for the last hour or two to send it through proxies, and even using my Treo as a cellular modem and no-dice. Take my word for was funny and you would have laughed. So just go ahead and laugh, giggle or chuckle and then we can move on.

Done? OK then.

Seriously though as soon as I have a reliable Internet connection I'll post the video.

Here are Ann's labs for the day (plus some new values we might start including):

WBC 4.1 K/uL
RBC 2.84 M/uL
HGB 9.2 G/DL
PLT 343 K/uL
ANC 3.26 K/uL
LDH 579 IU/L

Overall things look good on the hematopoiesis front. Ann's WBCs have recovered from the little dip they had a couple of days ago. Her RBC numbers and HGB are starting to recover. Speculation on this is that the viral load in her blood may have been diminished by the Rituxan. I asked the attending doctor about this, but he just doesn't speculate on how treatment is going. Thats fine, but I feel like we go off on the wrong foot with him.

The last two numbers LDH and BUN have been of some concern to me over the last couple of days so I wanted to take a moment to talk about them. First Ann's BUN (Blood Urea Nitrogen) has been low since we came here to MDA. Most days it was 2 or 3 MG/DL, but today it has jumped up to 5 MG/DL. Since Ann wasn't eating due to cramps and diarrhea and BUN is a marker for malnutrition it makes sense that her levels would be low. Now that Ann has started to get her appetite back we are starting to see a gradual shift back towards normal. Which in this case is anything between 8 and 20 MG/DL.

Next LDH, which we've talked about before. It appears that her LDH levels have begun to fall. They started in the 400's and gradually began to rise after coming back to MDA. They spiked a bit after the 1st dose of Rituxan (600's). Now they appear to be falling back to the mid-high end of normal (313 - 618 IU/L). Because LDH is made when cells die off, the spike around the Rituxan infusion could mean that the PTLD is reactive to Rituxan.

We got a little news about Ann's last BMA from Friday. Her differential counts are back from pathology, but the attending doctor is hesitant to hand them to us until a full work up has been done. This is because he is worried that the PTLD could have gotten in Ann's new marrow. Not that it has, just that it could have. In the same was it is possible for you to get up and go into your kitchen and make yourself a ham sandwich, not that your going to or will. Anyway, the news he reluctantly parted with was that Ann has 1% blasts in her marrow. Which means that it looks like her baby stem cells are stable and doing their job. We will find out the final results from pathology Tuesday.

Ann's appetite continues to get better. She has gone from throwing up jello and soup for the 1st week we got here to eating almost an entire sandwich at a sitting. Her tummy still gets weird and I try to avoid eye contact or conversation while she's eating least I say something that sets it off. Right now I'm cautiously optimistic that the batter appetite and the apparently smaller node on her neck is a favorable sign.

Last but not least...

Ann and I have been through a lot in the past 10 months, but it's nothing compared to what others are going through. There is a little 9 year old boy in California named Dale Inouye who is suffering with ALL. He has been through chemo and relapsed. Then he underwent a transplant at UCLA using his brother's marrow, which allowed Dale several more months in remission from his disease. Unfortunately his family learned recently that Dale's leukemia has returned in a very aggressive way.

We really hope that Dale gets a chance to undergo another procedure that will bring about a durable remission for him and cure his leukemia. The big insitutions like M. D. Anderson are becoming much more aggressive in trying procedues like Double Cord Blood Transplants to treat relapsed resistant leukeima.

We were always struck by the commitment and love that Dale's parents and family showed for him and in reading the blog they kept for him. Ann and I would often draw strength from Dale's blog while we sat in the various waiting rooms of M. D. Anderson hoping we would get approval for her transplant. In those very dark and frightening times we were always encouraged to see the progress Dale was making on a daily basis. In addition we felt like we were allowed to share in the love and caring that his family has for him. I'm not sure we would have made it to where we are today if we didn't have Dale's story and pictures of his happy little face to brighten our lives.

Please visit their blog and let them know that other people are keeping them in their thoughts and wishing Dale well.


Anonymous said...

Hey Ann and Chris,
I am really sorry to hear about Dale, I am going to visit his blog and read it all, I find alot of strength in reading your blog every day, The strength and love, I honestly don't know how someone couldn't fell it. I showed my mom and my sister your blog and my family wanted me to tell you thet you are beautiful and they are going to start reading it now. I just want to say thank you because you are going through all this with your health and yet you focus on so many others and how sick they are, you guys are just AMAZING and we are looking forward to you coming to Florida one day.
Take care of yourselves and we will talk to you soon. My daughter Elaine sends her love, she wants to send a school picture, so i need to get ahold of you so i know where to send it!
Feel better.

Paige said...

That's it, Ann, just keep it up. You're going to feel better in no time!

Renee said...

Hi Ann & Chris,

I've been keeping up with the blog and hoping for the best for y'all. I just wanted to drop a little note to let you know that people are thinking of you! Also, I'm a first year LSU med student and I promise to NEVER be one of those over-eager scalpel wielding residents!!!