Chemo #2 + very low platelet counts

Although Garrett has been feeling better every day since the first dose of gemcitabine as his antibiotics take hold, he developed a rash this week that had no symptoms other than small purple pinpoint bruises on his arm and abdomen.  They are in fact tiny bruises that show up when your platelet counts (blood cells that help clotting) are low, called thrombocytopenia.  Platelets have occasionally dropped from chemo before, but this last chemo dose got him unusually low while the other blood counts (red and white) were strong!  For whatever reason gemcitabine seems to be extra hard on platelets so we started today an injection called Neumega to boost the bone marrow's production, but it can take three weeks to raise counts so we'll call the hospital tomorrow to see when they can fit us in for an outpatient platelet transfusion (takes a fraction of the time it takes to get red blood cell transfusion!). Then we stop by our doctor's office the next three days for the same Neumega shot.  Next week we have off from chemo, but we'll have to keep an eye on blood counts and take it easy enjoying the sun we have planned here! 

Here's some recent relaxation in good weather (not from this cloudy week!) hopefully we'll be doing more of this over the weekend!

Dinner and a movie!

While Garrett is on the mend, I had a wonderful day turning 28 years old!  We've been partying while Tommy is visiting us and last night we all three made it out to Garrett's first in-theater movie in years... I can't even remember the last movie we saw in the theater... maybe it was before his diagnosis in 2006!  We saw The Other Guys this time and thought it was pretty funny. Good times.

On the topic of mending Garrett... we did get a call last Friday with results of the skin culture and started on an oral antibiotic and topical antibiotic cream to fight an infection going on, but luckiy it was not MRSA this time!

Infections

Cancer patients usually are at greater risk for infection because some chemotherapy drugs, cancers in bone marrow and radiation treatments cause neutropinia - low white blood cell counts - that means fewer immune system fighters.  Luckily during Garrett's adria treatments his white cell count remained strong.  We try not to let infection risks keep us from spending time with friends and family, especially when  his counts are so strong, but instead we try to remember the common sense ways to reduce spreading bacteria and viruses - hand washing and sanitizers, covering coughs and not sharing food...  ways that everyone can behave to avoid the cold and flu season!  Amazingly, Garrett does not seem to catch much even when I have something, but when he does it is usually a doozy or multiple issues compounding his symptoms.

The last time we dealt with infection was December 2009 when Garrett was very low on red blood cells and had to be hospitalized for three days.  At the hospital his skin ulcer was cultured and it came back with two strains of bacteria, one of them (we found out much later) was methicillin resistant staphylococcus aureus (MRSA) which has been discussed in the media lately for spreading in hospitals.  Although it is a tough bacteria that is resistant to some antibiotics and disinfectants, it can live on our skin or in our nasal passage without causing any trouble for years even.  When someone is neutropinic and/or has an open wound the bacteria can get in and cause real trouble.  Luckily hand washing is one of the most effective ways to not share the bug.  In December Garrett got several days in a row of Vancomycin, a powerful antibiotic that is used when bacteria is found resistant to others.  This cleared up Garrett's symptoms, along with blood transfusions, got him back on his feet. 

During our inpatient transfusion last Friday we learned more about MRSA and how nurses are supposed to wear disposable gowns and gloves when in a patients room with a history of MRSA...  some nurses did, some didn't...  and in all the times we've been in the hospital for transfusions since December this was the first time they tried to address it.  On the 3rd floor where cancer patients check-in it should be a high priority since many are neutropenic, but the night shift wasn't so concerned this time.  I followed up with the infection control department and they gave us a lot of information about getting cultures, washing hands and giving feedback to hospital staff on how to better educate patients like us.

When we discussed Garrett's current symptoms with his doctor this Wednesday he took a new culture of his skin ulcer and saw signs of thrush (a fungus) in his throat.  With a prescription to treat the throat and waiting to hear results of the skin culture, Garrett should start feeling much better and be able to eat and drink without the discomfort he has had the last few weeks.  Hopefully that will get us back on track, gaining weight, feeling good. 

Also, we got a call with the echo results - his heart looks as good as ever!

Chemo #1 Gemcitabine + inpatient transfusion

Over the last few weeks Garrett’s energy was diminishing, his appetite along with it. A sore throat led him to believe it was a virus, but when he started feeling winded walking to the kitchen we figured his blood counts were down. We got in last Friday to see a doc and have blood drawn and sure enough his red blood cells and platelets were low enough to need a blood transfusion. Although we’d had good blood counts the previous week, it seemed like the cold just brought him down faster than we expected. After trying to get an outpatient transfusion appointment with no luck, Garrett agreed to check-in to the hospital that night and get it over with. We went straight over at 5pm and didn’t get done with the transfusion until 5am!  It was a very long night with several quirky night nurses and no sleep.

After being pumped up with new blood, Garrett still had a sore throat which kept him from enjoying drinks and food again this week, argh!  Today our oncologist selected a new chemotherapy that our insurance had already approved, so we went ahead with the first treatment of gemcitabine and a bag of fluid to combat dehydration. He will get a low dose once a week for two weeks, then have one week off. Most of the side effects listed for gemcitabine (aka gemzar) happen when you are getting a higher dose; Garrett should only feel some of them mildly, if any. It is supposed to be as easy or easier on his body compared to adria!

Echocardiogram results were not in, but that should be a good sign because any irregularities would have been immediately relayed to our doctor.

Chemo #13 + Echocardiogram

Last week Garrett had another great blood count result, gained weight (!), got a dose of adria and zometta (bone strengthener) and scheduled the echocardiogram. The echo is also called cardiac ultrasound. It will check on the strength of Garrett's heart to be sure he is healthy enough for another dose or two of adria. I am looking forward to the echo because I get to sit off to the side watching the images and hear the swoosh of Garrett's heart pumping blood, very cool stuff to me!

While Garrett was finishing up his chemo last week I took a little walk around the medical park and their super green retention pond. The weather here has been keeping up with summer and we deserve it after such a cold and rainy spring!

Homemade crab dip, yum

Delicious date at Hearthfire!

Last Friday we made it out to my favorite local fare, Anthony’s Hearthfire Grill. At the last peninsula, on the very southern point of the puget sound, between East Bay and West Bay in Olympia, Hearthfire has a nice twist on Anthony’s well known northwest cuisine and it’s a place Garrett and I can reliably enjoy! It is a bit fancy, but the view and food are worth it to me. We had great seafood and good company as you can see, Garrett didn't let one bite of crab dip go to waste :)