Sunday, October 11th, 2009

Sunday Morning



Looks like another big gap - sorry all. It has been quite busy around here. The last time I wrote down something in the blog, Lynn was about half way through the chemo, and things were going well. As far as the impact on the heart is concerned, that is still the case. So far, the RICE combination has not done anything to her heart. All her vitals are good. Unfortunately, she had a side effect that was the result of the "I" in RICE. Basically, she suffered from a condition called "Neuro-toxicity". It sounds pretty bad, and it is while it lasts, but it does not cause permanent damage. Basically, as the "I" chemical breaks down (the chemotherapy chemical is called "Ifosmaide" or "Ifex"), it creates a toxic substance. If there is not enough protein in the body, specifically albumin, which binds to the chemical and allows the body to flush it out, it works its way into the nervous system. The toxic substance, chloral hydrate, incidentally, was used as a sedative years ago during surgery or as a pain blocker. The result is confusion, disorientation, and, in some cases dizziness. It has the effect of alcohol on the body. In Lynn's case, the effect was profound....I'd have to say that it was pretty much as if she had consumed about a fifth of tequila.



Yes, you can say that it hit her very hard. As the Ifex dosage continued, she got more and more confused. Eventually, she was able to tell the doctors what her name was, but that was just about it. They pointed to me, and asked her who I was, and she just gave a goofy smile. I guess it could have been worse - she could have spit at me. Sometimes, a patient's motor skills also get affected. Fortunately, that was not the case here. However, she was extremely confused and disoriented mentally. One problem associated with this was that her heart doctor, Dr. Jordan, prescribed Lasix late in the day. Lasix is a powerful fluid reduction chemical, and it makes her body flush out lots and lots of fluid...in the form of urine. That meant that she had to go to the bathroom just about every 15 minutes. And, since she really had no idea on where she was or where the bathroom was, it was quite a challenge getting her lined up properly. I got there around 2:30 PM on Wednesday, and my time from then until midnight was pretty much taken up with steering her towards the right door (she made a couple of bee-lines for the hall), making sure that she didn't bolt up and dash for the bathroom without taking her IV stand with her, or just basically giving her the proper navigational assistance needed to find the right part of the room. To her credit, she did great until right around 11PM. At that point, she made it to the bathroom, but mistook the trash can for the toilet. Not good, and here is why. As the chemotherapy chemicals work their way out of the body, they exit via, well, the urine. These chemicals are considered to be toxic substances for 48 hours after the last chemotherapy infusion...that means that the URINE is considered to be a toxic substance. Therefore, if there is a "spill", there are all kinds of strict rules in place governing how they will be cleaned up. As soon as Lynn had her difficulties, four nurses and nurse's aids descended on her room. They immediately donned haz mat style gowns, and got to work cleaning up the spill as if it was the worst nerve agent known to man. I decided, at that point, to go out and see what the night life was like near Riverside. No, actually, I stayed in the room, but retreated to the other side...no sense in getting in the way as the people who get PAID to handle this stuff went to work!



One other interesting observation - at one point, Lynn had just gone to the bathroom. However, when she was done, she made no move towards heading back to bed. She just stood in the middle of the bathroom. I said "Lynn, time to go back to bed!". She said, "I know." And, she, again, just stood there, staring at me. I waited a minute, and said, "Lynn, time to go back to sleep". She said "I KNOW!". And, yet again, stood there staring at me. Well, we went through this cycle a couple of times...she acknowledging that, indeed, it WAS time to go to bed, but that the motor activity required to make this happen was not, at that point, not an option. Finally, I grabbed her arm and said, "C'mon! Let's get to bed!" She shook herself loose and said "Get your hands off me! I KNOW!" I gather that something about the physical contact broke the spell. She gave me a look like I had just eaten the last chocolate chip cookie in the house, snarled once, and got back in bed



Around 12:00 AM, staff at the hospital told me that the worst was over, that, with the Lasix out of her system, she would probably sleep the rest of the night. I got her to go to the bathroom one last time, and then headed home. I went to work the next morning really early, then called the nurse's station. Turns out that things did NOT go as smoothly as I thought after I left...she had continued to sit up on the side of her bed, refusing to lay down. I scurried over that morning and stayed with her. She settled down some, and we managed to get her to rest. Susan, along with Gary and Sharon also came by and visited for a bit, which also helped out a lot. As the day went on, Lynn got better and better. Finally, around 4 PM, Dr. Blair told her that she could go home that night. It was a day later than we wanted, but we jumped on it. After we got done with all the details. we ended up being able to get her home by around 6:30 PM. She was still a little groggy and all, but was much better than 24 hours before.

Lynn slept OK that night, but was still restless...same story the next night. Even though she is home, she still has to deal with the periodic times she has to get up in the middle of the night to go to the bathroom. Of course, it is much better than the hospital...after all, I do not try to clean the floor at 3AM with a motorized, and very loud, floor sweeper, like they do at Riverside. However, she is still prone to getting up, at least till the Lasix is done. All in all, things are much better. Of course, we still have the prospect of having to deal with the next round of Ifex, which is scary. On the positive side, Dr. Blair has said that he will take steps to keep her albumin levels up before she gets the next hit of Ifex, and he might back off on the level of the Ifex a bit. However, we'll still want to keep it as high as possible - even though the Ifex is hard to deal with from a side effect basis, it really does a number on the nasty Lymphoma cells. The harder we can nail those guys, the better chance she has of recovering.