Discharge and Departure

After a three-and-a-half day stay in the hospital, Dad was discharged from Seton Medical Center on Monday (May 4) in the early afternoon. Over the weekend he received a total of four units of whole blood and at least one unit of platelets. By Sunday, all of his blood numbers were acceptable with the exception of his platelets, which were still well below normal. Drs. Moskowitz and Weber both expressed satisfaction with his condition and explained that his platelet count was moving in the right direction and his body would continue to regenerate platelets as time goes on. They also both condoned his discharge from the hospital as well as his planned trip to Missouri on May 5.

Even though his blood numbers are OK, he continues to feel very fatigued and his appetite was almost nonexistent until Monday afternoon. He has been experiencing a strange sensation when starting to eat, with hot flashes, flushing, clamminess, etc. either after the first bite or even when seeing food. This sensation has been decreasing and he has been able to work through it when eating. He also has some pain in his lower back that appears to be muscular in nature.

His fatigue and appetite have been slowly improving and after much consideration, the decision was made for him to travel to Missouri on Tuesday, as scheduled. After a delay of several hours, his flight left SFO for St. Louis at 4:51 PM Pacific time, projected to land at about 10:12 PM Central.

Readmission

Dad has been readmitted to the hospital at Seton Medical Center. Starting in the early evening of Thursday, April 30, he became extremely fatigued. We consulted with Dr. Weber on the phone and after checking his temperature and finding it to be 101.9 degrees Fahrenheit, Dr. Weber prompted us to take him to the ER at Seton. He was admitted to the 10th floor of the hospital sometime around 5:00 AM on Friday, May 1.

Blood tests showed that several of his blood counts were significantly out of the normal range (on the low side), including his white blood count and platelets. He was given a unit of platelets and two units of whole blood on Friday with another two units of whole blood being given to him today (Saturday).

The high fever was explained as being neutropenic in origin, stemming from the low white blood count. His temperature was back to normal shortly after arriving at the ER where they gave him a strong antibiotic. His temperature has been normal ever since.

Dad is currently scheduled to fly direct from San Francisco to St. Louis on Tuesday, May 5. We expect him to be in the hospital until at least Monday, so there is a chance his travel may need to be delayed, but we continue to work with his doctors and monitor his condition.

Update for April 24, 2009

I am happy to report that Dad has tolerated the third chemo (administered on April 16) much better than the first two. Many of the same symptoms appeared around day four or five after the treatment (most notably fatigue) but since then he has been gradually improving. There are three reasons that come to mind to possibly explain his improved response:

• Dr. Weber lowered the dosage of two of the drugs (see this blog post for details)
• His body may be "getting used to" the treatments somewhat
• The radiation treatments for his hip has made the pain he was feeling there much less of an issue

He has been taking short walks most days and his appetite is also gradually improving again. He hasn't experienced any mouth sores yet. Sleeplessness has been somewhat worse that before the treatment, but better than the first two treatments.

Third Chemo Treatment

Dad is having his third chemo treatment as I type this, a day earlier than scheduled to accommodate family schedules.

Dr. Weber adjusted the dosages of two of the drugs: Alimpta from 900 to 700 and Carboplatin from 600 to 400 (not sure of units, but the relative change is what's significant). This reduction will hopefully result in fewer complications in the weeks following the treatment.

[Posted with iBlogger from my iPhone]

Update for April 14, 2009

Since Dad was discharged from the hospital on Tuesday, April 7, he has been feeling quite well overall. The highlight of the past week has been a visit from his sister, Emma, brother, Sonny, and nephew Rick visiting from Connecticut and Maine. He was even up for a three day trip north to Redwood National Park that included a short jaunt into Oregon.

Here is a summary of his present condition, in no particular order:

• Pain (head/neck/shoulders and the hip) still continues to be an issue. He is using Fentanyl patches (total of 150 mcg/hr), changed every two days and also taking acetaminophen and liquid morphine as needed for breakthrough pain. The headaches don't seem to have much correlation with anything (activity level, fatigue, time of day, hunger, etc.) although sleeping at night does seem to have a positive effect. Likewise, the pain medicine is sometimes very effective and other times not at all. We are continuing in our efforts to manage his pain effectively.
• Edema in his feet and lower legs has been much less pronounced. He has been wearing compression socks intermittently to help control it.
• Fatigue has been much better than prior to his most recent hospitalization, but he still gets tired at different times during the day and generally takes at least one or two naps a day. When napping, he doesn't necessarily go to sleep but the rest seems to help. As the hip pain improves, he has been able to walk quite well and he goes for walks most days. He has not needed to use his cane much when walking; he has not yet gotten a walker, although he has a prescription for one.
• His mouth sores seem to have healed almost completely, which is consistent with the timing after the first round of chemo.
• Constipation is an ongoing problem, most likely a result of the pain medications. He is taking several forms of laxative and stool softeners and also eating prunes, etc. He has complained of some external bleeding, most likely from a fissure.
• His appetite has been fair since leaving the hospital, with several smaller meals or snacks throughout the day.
• While in the hospital, he stopped taking Ambien as a sleep aid and switched to Restoril. He is currently taking 22.5 mg nightly with fairly good results. He is also taking a melatonin tablet each night (available over the counter).

Dad's next chemotherapy treatment is scheduled for this coming Friday, April 17. As I mentioned before, Dr. Weber plans to reduce the dosages by about 20% in an attempt to reduce the side effects.

Chemotherapy Results

The original chemotherapy plan called for three treatments to be followed by a CT scan to assess its effectiveness. This would have resulted in the scan taking place around April 24th.

Due to Dad's negative reaction to the second treatment, Dr. Weber ordered a CT scan on Wednesday, April 1. On April 2, Dr. Weber shared the results, which indicate that the primary tumor has shrunk. This is very promising news and indicates that the chemotherapy is working.

Dr. Weber would like to continue with the treatment with three more to be administered before checking again and possibly two or three more after that. He is aware of Dad's negative reaction and is considering adjustments to the drugs. He has also changed the date of Dad's third treatment from April 9 to April 17.

Dad will remain in the hospital for the time being, most likely until his radiation treatment concludes next Tuesday, April 7. Blood tests also show that some of his counts are low, so they will continue to monitor his blood and assist him with other symptoms he's experiencing, including mouth sores, pain, and fatigue.

Blood

The doctors ordered a blood test early this morning and discovered that his blood count (both red and white) are low. Therefore, they are in the process of giving him two units of blood, which will take about six hours to complete. He should be feeling somewhat better this evening with the full affect being realized by tomorrow.

At this point, we are unsure of when they will discharge him, but he may end up staying until the radiation therapy concludes on April 7.

[Posted with iBlogger from my iPhone]