Today was more forward progress, but Chris' blood counts are taking their sweet time in getting started. The stem cells that have been finding their way to her bone marrow need to kick in and start producing the white blood cells, the red blood cells, hemoglobin, and platelettes. Here is how she compares to that range as of today:
Measurement / Chris / Normal Range / Result
WBC (white) /1.7 / 4.0 - 11.0 / LOW
RBC (red) / 3.2 / 4.2 - 5.4 / LOW
HGB (Hemoglobin) / 10.4 / 12 - 16 / LOW
Platelet / 14.0 / 150 - 400 / VERY LOW
This was "day 12" as they refer to it (12 days after replant) and most counts get back to normal between 9 and 14 days. So it seems like Chris is running behind but in reality she is still within the normal timeframe. We just want to sprint to the finish (get to normal) when in the long run, one or two days won't matter. In the scope of many years, whether her counts get up today, tomorrow, or Friday will not really matter. Of course the first question I asked was "is it possible that the stem cells don't get to the bone marrow and start producing as they are supposed to?" The answer is no, just be patient, they will come.
Chris had no breakfast today at all, but she had a fair lunch and a good dinner. For the first time in weeks I actually felt that she ate a decent meal.
It is interesting to see the shifting attitude today in the center. You can kind of tell that they are preparing for the long weekend and are trying to position themselves to ensure the patients are fully prepared. Chris did get two bags of platelets via an IV today, and they may very well add more tomorrow, along with some red blood cells. They are effectively stocking the pantry, with the hope that nobody has to run to the store over the three day holiday. This is true of both the medical team and the patients. Certainly the doctors deserve a long weekend and it would be nice for Chris to not have to go to the hospital for at leat one day. She and I have been there every single day since June 4th in one capacity or another. She could really use a day where she sleeps in, lays around the apartment, takes naps on her schedule, reads the many books she has been trying to read, etc. It's too bad the DVD isn't working (oops).
I did have a discussion today with the team on the rationale as to the stem cell transplant as an out-patient vs in-patient. They were very blunt, stating "our mortality rate with our out-patients is significantly better than others doing inpatient". It made we wonder about the focus on the "mortality statistic" in the medical field. In theory, a hospital could ensure it has a great mortality rate (i.e. low) by only accepting extraordinarily low risk patients. Yet this would obviously cause a bias against medium risk patients who could very well benefit, albeit with the higher risk. It must be a very difficult decision sometimes whether to accept a candidate for the risky stem cell transplant/high-dose chemo program if the candidate has a higher than average risk level. These doctors have an incredibly difficult decision to make that I did not fully appreciate. Do they accept a higher risk patient into a high risk program that has a greater success rate (high dose vs oral) along with a higher morbidity rate, or do they do the low risk, lesser success rate route. Not sure that all made sense but the point is these doctors make decisions everyday that we (or at least I) do not appreciate the magnitude. One could almost say that they have to play God everyday. This reinforces my belief that medicine is an art, not a science. There is no script to follow when it comes to final decision making like this.
Again, I meander off the true subject here - Chris. My wanderings are sometimes theraputic, as they help me appreciate the enormity of this. Most important, Chris is taking small steps forward. Tonight I will give her a back massage as a way to coax those shy stem cells to get to work. Enough vacationing, we need to step it up. But again, in the long run this is not a sprint, but a journey to long and healthy life.
RBC (red) / 3.2 / 4.2 - 5.4 / LOW
HGB (Hemoglobin) / 10.4 / 12 - 16 / LOW
Platelet / 14.0 / 150 - 400 / VERY LOW
This was "day 12" as they refer to it (12 days after replant) and most counts get back to normal between 9 and 14 days. So it seems like Chris is running behind but in reality she is still within the normal timeframe. We just want to sprint to the finish (get to normal) when in the long run, one or two days won't matter. In the scope of many years, whether her counts get up today, tomorrow, or Friday will not really matter. Of course the first question I asked was "is it possible that the stem cells don't get to the bone marrow and start producing as they are supposed to?" The answer is no, just be patient, they will come.
Chris had no breakfast today at all, but she had a fair lunch and a good dinner. For the first time in weeks I actually felt that she ate a decent meal.
It is interesting to see the shifting attitude today in the center. You can kind of tell that they are preparing for the long weekend and are trying to position themselves to ensure the patients are fully prepared. Chris did get two bags of platelets via an IV today, and they may very well add more tomorrow, along with some red blood cells. They are effectively stocking the pantry, with the hope that nobody has to run to the store over the three day holiday. This is true of both the medical team and the patients. Certainly the doctors deserve a long weekend and it would be nice for Chris to not have to go to the hospital for at leat one day. She and I have been there every single day since June 4th in one capacity or another. She could really use a day where she sleeps in, lays around the apartment, takes naps on her schedule, reads the many books she has been trying to read, etc. It's too bad the DVD isn't working (oops).
I did have a discussion today with the team on the rationale as to the stem cell transplant as an out-patient vs in-patient. They were very blunt, stating "our mortality rate with our out-patients is significantly better than others doing inpatient". It made we wonder about the focus on the "mortality statistic" in the medical field. In theory, a hospital could ensure it has a great mortality rate (i.e. low) by only accepting extraordinarily low risk patients. Yet this would obviously cause a bias against medium risk patients who could very well benefit, albeit with the higher risk. It must be a very difficult decision sometimes whether to accept a candidate for the risky stem cell transplant/high-dose chemo program if the candidate has a higher than average risk level. These doctors have an incredibly difficult decision to make that I did not fully appreciate. Do they accept a higher risk patient into a high risk program that has a greater success rate (high dose vs oral) along with a higher morbidity rate, or do they do the low risk, lesser success rate route. Not sure that all made sense but the point is these doctors make decisions everyday that we (or at least I) do not appreciate the magnitude. One could almost say that they have to play God everyday. This reinforces my belief that medicine is an art, not a science. There is no script to follow when it comes to final decision making like this.
Again, I meander off the true subject here - Chris. My wanderings are sometimes theraputic, as they help me appreciate the enormity of this. Most important, Chris is taking small steps forward. Tonight I will give her a back massage as a way to coax those shy stem cells to get to work. Enough vacationing, we need to step it up. But again, in the long run this is not a sprint, but a journey to long and healthy life.
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