Around 11 am on 29th Dr. Patel and her team came to visit us. She had 3 other doctors and 2 nurses with her. She was fast and impressive. She explained that we know its a B cell type ALL but there are tests currently underway to determine its sub-type, which might be available tomorrow, which will determine the treatment plan.
Hyper-CVAD treatment is the more traditional approach and is needed in most cases with older patients. By recent advancements have concluded that patients in the 18-40 age group respond more to quickly to CALGB treatment with 80% success rate. She also said that one of the tests will confirm if Rachana has an abnormality of chromosome 22 also called Philadelphia Chromosome which will direct the treatment towards using CALGB. Irrespective of which treatment plan, Dr.Patel said we’ll be here for the first 4 weeks. At the end of the first month they will check the bone marrow and will know if the cancer cells are all killed or they need do to more chemo.
She said the next two days of tests will also determine if we need to plan for a bone marrow transplant immediately or later. These tests will also give the data to make a prognosis on the rate of success and the treatment timeline. The initial treatment is all about how we can remove the cancer from the system, the body can then be in remission (no cancer) for any period of time and people can be cancer free forever or it might come back. There will be regular checks to determine this. She explained that she would prefer a bone marrow biopsy again as SW does some extra tests which North Hills might not have done. She asked the nurse the type of port Rachana already has and commented that they’ll add another catheter (pipe) from the arm into a vein near the chest as they cannot use the existing port for both blood and chemo. Dr. Patel will be our doctor of record but the 4 Leukemia specialist at the hospital take turn every two weeks. So today was the last say of Dr. Patel and Dr. Madhuri Vusrikala will be looking after us for the next 2 weeks.
A councilor came after that and gave us information on the resources we can use to cope with the issues. It was helpful. Then a TV technician came and showed us how the video conference system works. It’s basically like GotoMeeting but with a pretty nice video setting to talk to family and friends. We also requested and agreed to hook up our Roku to the TV. Trying to make things as comfortable as possible for the next 4-6 weeks.
A doctor then came in to put a catheter from the forearm to a vein near the heart. The first injection was very painful but the rest of the procedure was ok. Now Rachana has a pipe with three opening near the forearm going all the way to the heart. The doctor was very skilled and used some device that was like a combination of GPS and ultrasound. The ultrasound showed a grainy video of the movement of the pipe from the forearm to the heart and the GPS style device had a button moving through and you could see it move left-right-back-front as she moved the pipe. She was done in 45 mins.
After this Dr Azeem came to do the bone marrow biopsy. He did it bedside and I saw the whole process and did a video of the last attempt. He made about 4-6 attempts using 2 new holes and one existing hole but could not get any substantial bone marrow. He said it was very unusual but commented that she probably has either healthy think bones or the blast cells are clogging up the space. On the last attempt he got a tiny tiny bit and said the combination of the small marrow that North Hills got and the little bit he got should be enough. Looking at him work took me back to Rachana’s C-section for Rashi where I thought the surgeon was basically a skilled mechanic, butcher and carpenter with knowledge of the human body. Dr. Azeem basically poked a hole with a sharp screwdrive, to reach the bone, attached it to a drill to pass through the bone and used a syringe to pull out some marrow. The video is very telling.
After that a nurse came in with a mobile x-ray unit to x-ray the catheter going into the vein near the heart to make sure it was in the right place.
In the morning before Dr. Patel’s visit a ultrasound of the heart was performed to confirm if her heart is healthy for the treatment. We didn’t hear back about the results but they didn’t expect any issues. It was very cool to see the heart beating.
Rachana is now resting but in pain from the biopsy. She wanted to walk but felt a bit dizzy and so is just staying in bed. Today was a tough day with all the tests and the painful procedures. We are looking forward to tomorrow to hear about the test results and the treatment plan.