Thursday, April 5, 2007

Midway through Round 5

Day 84

Two more people passed away on the wing that Ann was staying in today. The person on the other side of her and the person next to them. I know that the juxtaposition of those events to us is random, but the closeness of it is still un-nerving.

There are some other events from today to report. For the first time Ann had an accident with her central line catheter (CVC). She asked to take a shower and the patch that was constructed for her failed. This got her tegaderm bandage soaked and water actually managed to get to the hole penetrating into her chest cavity and artery. This could be extremely bad.

Up till now we have avoided any problems with her CVC and the infections that come along with it. Most patients who develop a CVC problem are sidelined for a week or more as the Doctors work on getting the infection under control. Because chemo screws up the patient's immune system, bugs that come in through the CVC line get a free ride right into the heart and can literally attack any part of the body in a few hours or minutes. Some patients die from something as simple as this.

I feel like the accident is my fault. I was talking on the phone, trying to get something done and I didn't check her shower patch made by the nurse closely enough. If I had I would have seen the problem and asked the nurse to make it again or get me some larger tape to fix it. Stupid! Just %&*#@ stupid of me!

This could be part of the reason for the new 875 mg "horse pill" antibiotic that she had to start taking.

We are still getting apologies for the state of the room we had to check into for this round for chemo. I'm happy to report that the problem has been dealt with completely and there is no hint of unpleasant smells anywhere. There has been one unintended side effect to the whole event though. Our charge nurse overheard a Doctor on rounds this morning speculate that Ann would be released Saturday and checked on it. It seems that the time we waited to move into the room delayed her getting her 1st bag of Cytoxin. So that in turn pushed her release back into Sunday night. So it looks like Ann will have to spend Easter Sunday tethered up to a IV pole.

The pathology report on Ann's last Bone Marrow Aspiration still has not come back. We are waiting on pins and needles for it. I know it showed 3% blast cells but the question is "what are those 3%"? Are they Leukemic, or normal?

Ultimately I suppose the answer to that question doesn't matter. The t(4;11)+ form of leukemia that has stricken Ann has been studied enough even though it is rare, for the Doctors to be almost 100% certain that there is a single Leukemia cell lurking somewhere in my beloved Wife silently learning how to avoid being killed by the drugs being pumped into her. Leukemia is a cancer of the human immune system and the immune system is after all adaptive. As soon as that single cell figures out how to survive the chemo drugs then the problem will simply begin all over again. But worse now the drugs will be an ineffective tool at keeping the monster at bay.

I wanted to answer a comment someone made on to a previous post. The owner of the New York Bagel Co. on Jefferson Hwy in Baton Rouge is a good friend by the name of Ann Tran. Ann Tran has kindly offered to promote our cause and run some specials in her store to help us. She is a very kind and generous woman, who runs a wonderful business. If you have time and are near Jefferson Hwy in south Baton Rouge, please stop in and visit the New York Bagel Co. you won't be sorry.

Finally we have had some interest from another TV station on a different angle on Ann's story. I'll keep everyone posted on this. Also the channel 2 story looks like it will run very soon.

Anyone know how to get in touch with Oprah?

Wednesday, April 4, 2007

Moment of Silence Please

Day 83

The patient in the room next to Ann passed away today.

It's easy to forget when you walk through MD Anderson that this happens. The smooth glossy surface of the hospital is a veneer that masks and subdues more basic human fears. They are still there lurking beneath the surface of perception. Invisible until confronted.

He had ALL just like Ann and although I don't know who he was, his passing leaves me evermore fearful for Ann's morality.

I hope he didn't suffer.

Urine Luck

First, I really hope Tommy Chong doesn't sue me for the title.
Second, I just thought it was appropriate considering what this posting is going to be about.
;)

Yesterday started out at 5AM and we knew it would be an extremely long day. I had lab and immediately after that I had a bone marrow aspiration immediately after that. I keep forgetting not to lean on the left side when I sit, but it's easier said than done. Immediately following that appointment, I had one with my new transplant doctor. Personality wise, he is on the opposite end of the spectrum from my original transplant doctor. He's got a demure demeanor and is rather soft spoken. I like him and appreciate that he forces you to ask questions. After this appointment, we had to hoof it back to see my Leukemia doctor. If you think that any of my appointments were on time, you'd be sorry. I was 1hour-30minutes late for my last appointment. We were told to go get lunch and come back at 2pm. So, we ended up having to do something else and ended up getting back to the Leukemia clinic around 2:30 PM. Shame on us, we made a doctor wait.
Here's the skinny on what we found out. My blood counts were good. They were almost normal, which would explain why I was able to walk half a mile without falling to pieces. My BMA came back good. I had 3% blasts, which is normal. This is a preliminary reading. We're waiting for the pathology report.
We had another interview with WBRZ, today. As always, it was a pleasure. We'll keep everyone posted on when the story will run.

I'm sure most of you are wondering about the title, so I won't keep you in suspense anymore. I was readmitted into the hospital for round 5 of chemotherapy (Yippee!). We were told that the hospital was completely full and running in diversionary mode. I suppose this meant that they weren't taking any more patients for in patient treatment. I was all for that and had visions of going back to the apartment to veg out with my knitting. Oh, what a sad fantasy that turned out to be. I was one of the lucky few to snag the last available room (again, Yippee! with shades of Ben Stein). I'm housed on the tenth floor, which is the leukemia floor. As most of you will recall, I was here once before, but in the opposite wing. When Chris and I reached our room it was just after 5 PM. We dropped our bags and started checking out the layout when Chris asked me if I smelled something. I was wearing a mask, so it took me a minute but I did indeed smell something. I wasn't in a hospital room. I was standing in a men's urinal at the height of Mardi Gras, and we are not talking about in a bathroom at a 5 star establishment. We're talking about that shady gas station where the restroom key is tied to a shard of concrete block found in the parking lot. As an aside, who would knowingly steal the key to the bathroom of one of these places. Are your standards of hygiene so low that you would want carte blanche in one of these places. You have to use your foot to flush the toilet to avoid actually touching the commode handle with bare skin, if you actually cared about such a thing.
We immediately walked out and informed my nurse. She got the charge nurse involved and it all went on from there. After several phone calls, one of which was to the hospital administrator, who kept asking if there really was an unbearable odor, the room was cleaned twice more. After cleaning number three, we were asked to come back in and evaluate the smell. At first, you could only smell cleaning solvent, so it was on the tip of my tongue to accept the room when the smell of urine came back with a vengeance. We walked back out and waited for some other solution to be found.
In the meantime, I asked if we could leave and be readmitted in the morning. The charge nurse called my leukemia doctor at home who was paraphrased as saying, "Under no circumstances was I to leave." It seems that my chemo drugs had been mixed and were ready to go. By this time, the hospital administrator came up to investigate the smell herself. Once she caught a whiff she got building services up here to do something. They replaced the shower curtain and checked the drains, etc. Still, there was a distinct smell in the entire room. House keeping came back and cleaned twice more with a different set of chemicals and they left industrial strength room deodorizers. Last night, the room smelled like synthetic oranges--chemical makers will never get this right in my lifetime.

At the moment, there is the slight scent of urine. I'm sure it's not my imagination. I only worry that the people who come into my room think the smell is coming from me. I know I have bigger things to worry about, but who wants to smell like eau de pee-pee? I wonder if I should just bring up the smell to throw suspicion off of me, but that tactic always seems to make you seem even more suspicious.

I've been promised a room change when one becomes available. I don't think that it's going to happen since they've already roped me into the fragrant room. As a hospital employee, I wouldn't want to have to deal with the next patient complaining after I'd already dealt with it once.

To add fuel to the fire, I'm retaining fluids again, so I've been given lasix. This is only adding to the urine rumors. I will forever be remembered as "that girl" to the tenth floor staff. It's like being a Charlie Brown character. Watch out Pigpen!

On a personal note--no urine anecdotes involved:

Amy, you have to love Christopher. He's got such a great sense of humor. Definitely your child.

Mabyn, if anyone saw me in a backless gown right now, they'd think they were seeing a science experiment going horribly wrong. My back would have more creases than an accordion and I'd look like I was smuggling volleyballs from the front. You and I both know that I am smuggling volleyballs to the Backyard Sports Underground, but that's just between us. :)~

I had a visit from the attending physician this morning and he said that I'm doing very well. He did comment that I'm having opposite reactions to my chemo protocol than most other patients. It seems that other patients become nauseated during the even rounds and they do better on the odd rounds. I get nauseated on the odd rounds and had supporting physical evidence last night. If everything goes as history suggests, I'll have a present for the nurse every night between 8pm and midnight. The vomiting usually stops within a day of getting back to the apartment. I think the mesna has a lot to do with it. Here's an interesting fact that I only just found out. I get drugs to help with my nausea and for the entirety of my treatment, I thought that they worked to calm my stomach. Turns out, anti-emetics work on your nervous system. Stopping vomiting has more to do with your brain. Crazy.

Enough of the delightful workings of my gastrointestinal tract. I could continue to rhapsodize about my inner workings, but I'll spare you for now. Chris is off campaigning to keep me around for a while more and I think I'll have a nap. As soon as we get some good news, we'll post it. I also want to apologize for not having the fun thing done. The build up has been ridiculous, and I know that when you see it now, you'll think, "All of this for that?". These past few days have been so hectic, that when we get to the place with the fun stuff, it's closed.

Everyone take care.

Tuesday, April 3, 2007

Letter to the Government

To My Honorable Government Representative:

I am writing this to you to draw your attention to the great personal difficulty of my Wife and me. My Wife Ann has been diagnosed with a very rare form of Acute Lymphoblastic Leukemia. We left our home, family and jobs in Baton Rouge Louisiana so that she can receive treatment at M.D. Anderson Cancer Center in Houston, Texas. Her physicians have stated that she must receive an unrelated blood/bone marrow stem cell transplant, for any chance of a cure. Due to Ann’s heritage, which is mixed race Asian and Caucasian, locating a suitable donor for her is problematic and has thus far been unsuccessful. Therefore, the recommended treatment for her is to receive an umbilical cord blood transplant as soon as possible before her leukemia relapses and kills her. This is expected to happen in the next few months.

Her employer, Harolds Stores Inc. (Harolds), provides her health insurance through Private Healthcare Systems (PHCS). This is in turn administered by The EPOCH Group. Both have agreed that her condition qualifies her for an unrelated or allogeneic stem cell transplant. However, they are denying her claim because they state that allogeneic cord blood transplants are experimental. In addition they may have violated her rights by not permitting her to file more than one appeal on this matter, or seek independent medical review.

Harolds is a clothier and is not qualified to make medical decisions or determine the necessity of medical procedures. Harolds and EPOCH are refusing her plea for service on the grounds that they are unable to pass the cost of the transplant onto the reinsurer. By doing so, they are forcing Ann into lesser treatments which the Doctors at M.D. Anderson estimate have only the slimmest chance of survival.

While Ann has not found a donor through the National Marrow Donor Program or a foreign country, it does not mean her condition is hopeless. Cord blood has proved to be as efficacious as Bone Marrow and is a well-regarded option for treating leukemia. In addition, Cord blood transplantation with adults is a growing practice within medical centers in the United States. Cord blood can prove to be a life saving miracle for those people, especially for minorities like my Wife, who are critically under represented among marrow donors.

The contact information for Harolds management is:

Harolds Stores Inc. (Corporate Office)
5919 Maple Avenue
Dallas, TX 75273
(214)-366-0600

Harolds Stores Inc. (Financial Office)
765 Asp Avenue
Norman, OK 73069
(405)-329-4045
Day 82

I know we promised some good news today, but things didn't turn out quite the way that we had anticipated. We had a meeting at the stem cell clinic, and it was an opportunity to meet my new transplant doctor. All of the stem cell doctors met to discuss my case and he relayed what they had concluded. Unfortunately, we are still tangled up in the insurance debacle. Please be patient, and we may be able to share some good news depending on the outcome of some things. It's frustrating, I know, but imagine how I feel.

I'm going to be going into the hospital today for round 5 of chemo. I'll admit that I can feel a tantrum brewing, because I don't want to go back into the hospital. I started going stir crazy in round 4. It's just that you go from living a somewhat normal existence, all things considered, and then you go to wearing a backless gown, eating off of a restricted menu, with people coming in to check on you every two hours 24 hours a day. I've had a nurse's assistant wake me up at 4AM to weigh me. Imagine waking up and being faced with a scale, with the expectation that you're coordinated enough to get out of a bed with guard rails and manage to stand on a platform for 60 seconds while your weight is being taken. The only plus that I've discovered about having your weight taken in the wee hours of the morning is that you don't weigh as much. That's the only recompense that I can think of.

I find that I'm impatient for things to move forward. I'm absolutely sick to pieces of being told that without a transplant that I'll die. Got it. Trust me, the first time I heard it, it was imprinted permanently on my brain. I know that I need to have a BMT or an umbilical cord stem cell transplant in order to survive. I'd love for the people in charge of green lighting my insurance to pull their heads out of certain orifices and see the light.

Today, I learned that a certain person in charge of managing my file at a place that shall go unnamed was getting testy with my stem cell social worker and the woman in charge of the business office at MDA. Let's call the testy person Kitty, since I don't think she'd appreciate being named outright. As it was told to me, she was adamant that my advocates at MDA were pushing me into the decision for a stem cell transplant using umbilical cord blood. Let me set the record straight right now. I am absolutely insulted that she thought that I would be stupid enough to let people tell me that I needed this procedure without doing quite a bit of research on my own. Kitty, I have met you and until this insurance nightmare, I had the highest respect for you. I am quite versed in the difference between a BMT and a stem cell transplant using umbilical cord blood. I can quote statistics and potential outcomes until you pass out from boredom. Chris is so versed in the topic, he can finish the doctor's sentences. I would never let a person tell me that I needed to do something without doing a little research first. How dare you. I am far from an idiot and don't appreciate being spoken of as one. Raising your voice to speak over someone doesn't make you right, it just shows that you don't have a valid argument to refute what you're being told. I know from experience that Kitty is intelligent and thoughtful and quick to solve a problem. I'm just surprised at her reactions to my situation.

As things stand, I have my orders to be admitted to the hospital. I'm tempted to burn them and go back to the apartment. I won't, because Chris would just wheel me up to the twelfth floor and tell them to set me up. He's the best thing that's ever happened to me and I don't know what I did to deserve him. I'm glad I did whatever it was. He's quit his job and uprooted his life to take care of me 24/7, and he hasn't complained. He's got quite a few more gray hairs as a result of this experience and I'm sorry for it. He didn't deserve to be put through this and I regret it.

Update

Very long and bad day...funny stuff is on hold until round 5 is over.

Monday, April 2, 2007

Grand Day Out...sort of

Day 81

Sorry about the lack of substantial update yesterday. Many gears are turning and many things are happening.

Today was a unique day for Ann all around. She slept late for a change and wanted to run some errands with me out of the apartment. The sleeping late is unusual because ever since her 1st round of chemo she is on "hospital time". That's measured in the span of time between a nurse waking you up to take your vitals and you being able to get back to sleep. Also, Ann tries to stay as hydrated as she possibly can, so that doesn't help with peaceful rest much.

After waking up I needed to run to Target (one of the only stores in Houston I can reliably get to and then back from) and Ann wanted to come with me. Her last CBC (Complete Blood Count) said she was no longer neutropenic so I agreed. Proper precautions still needed to be taken however. She would still have to wear a mask in public, there would be no touching anyone, no standing near groups of more than three people and if there were children around she had to get away from them immediately.

Target wasn't very busy before lunch and we didn't see many people at all (except for near the Easter candy). Ann said she felt alien walking around in a new place. Target may seem mundane to you or me, but Ann has seen nothing except the inside of MD Anderson or our charity apartment for 80 days. People by and large reacted to her as an alien presence also. People would go out of their way to give her a very, very wide berth and most didn't make direct eye contact or even smile.

Ann has been reading Charlaine Harris' book "Definitely Dead" (not crazy about the title) for the past two days and went back to reading it while I set up our new HP 5600 fax/printer/copier. I am sick and tired of having to go to MDA and pay to park if I want to fax something. So the HP should take care of that and allow us to send Ann's story to new corners of the media.

Tomorrow Ann is going back in for round 5. To bring you up to speed if you are new, right now we would be going in to start her transplant if her Employer Funded Health Plan could understand that "Medical Necessity" means "Service or treatment deemed absolutely necessary in treating a patient and the omission of such could adversely affect the patient's condition". Or that "Necessity" is an imperative defined as "essential, inevitable, inescapable, predetermined, compulsory, absolutely needed, required" by Webster's dictionary. I digress...

Tomorrow Ann will be restaged before being readmitted into the hospital for another round of Doxorubicin. A restaging is essentially what they do to new patients when they first come in to MD Anderson. Blood work and lots of it. Bone Marrow Aspirations. Lumbar Punctures. X-rays looking for solid leukemia tumors in the body cavity and breasts (yes it's creepy that leukemia can do that in addition to all the rotten things it can do already). Lumbar Punctures looking for leukemia cells in the central nervous system (this one scares me to death).

After all that we have a very special meeting. I know I have teased it, but everyone will need to be patient for a day or so more.

Plus, Ann has something funny planned to take the edge off, and hopefully make a few of you chuckle or at least smile a little.

See you tomorrow.

Sunday, April 1, 2007

Family Photos

Ann and her Ba Ngoai (Grandmother)

Ann with some of her family in San Jose

Ann's Uncle Binh, Ba Ngoai and a friend of the Family

Ba Ngoai , Ann, Ma Hai, and Ann's cousin

Ann and her Uncle Loi at Fisherman's Warf

Aunt Kim and Ann