This morning Rachana went from 2 days of constipation to 10 hrs of diarrhea. They had given fiber supplements and two other meds to handle constipation and then Rachana asked for a suppository, which triggered the diarrhea. In talking to another nurse, she said usually they don’t give suppositories to patients who have low neutrophils (ANC), which is exactly what Rachana has. Any treatment, especially complicated ones, are just a series of judgement calls that the doctor makes. They are mostly right, but sometimes they aren’t.
Not sure if I should be relieved or frustrated every time I hear the doctors say ‘Oh ya that happens sometimes’. Yesterday, when Rachana was constipated she had a little blood in her stool, obviously we were worried. In fact I was more worried, she was unfortunately too tired to care. When we explained this to the doctors, they asked a few questions and then basically said – ya that happens sometime, chemo is very powerful, we’ll track it but it’s a known side effect. Relieved that the doctors were not surprised; Frustrated because when it’s a ‘known side effect’ it means you just have to suck it up and move along.
Because of the extremes her stomach has been through, they did some tests to make sure her Pancreas are healthy and found that they are. Remember the PEG-asparaginase chemo from day 4? That was a potent chemo and can have huge side effects even after a while. So they are checking to make sure things that didn’t cause the issue. In speaking with another Oncologist, who I connected with through a friend, I learnt that most cancer centers follow Hyper CVAD treatment plan rather than CALGB because they don’t have the facilities or experience to deal with PEG-asparaginase. It seems you need to be able to do tests more quickly and react to the test even more quickly when dealing with this drug.
They also did tests to confirm that her diarrhea was not a viral infection. For about 5 hours till they completed the tests, we were isolated. They had signs for everyone entering our room to suit up in extra protective gowns. I was told to stay put and not wander around till the test results came back. Thankfully, the test were came out negative These guys are super careful about infection control.
Today was not a good day. Dr.Patel assured Rachana that she is very close to the end of this phase. She asked Rachana to manage the next 5-6 days and this will be behind her. She was about 80-90% sure that Rachana will be in remission by next Wednesday/Thursday. If that happens and her ANCs are up, she’ll be sent home and the next phase will be much easier than this.
Finally, thanks to everyone who have signed up with the bone marrow registry. If you haven’t yet, please do, Rachana might need your help.