Monday, November 30, 2009

and the doc says...

We were a few minutes late to the doctor's office, but the place was crowded and, because one nurse was absent, the office was running behind. Mom was eventually called back; we rolled her to her exam room, where she had her blood drawn and her vitals taken. Dr. Meister came in not long after. He didn't have much to say, except that he felt Mom had actually improved, clinically, since the last time he'd seen her. He asked Mom a series of yes/no questions, to which Mom responded with nods. I mentioned that Mom sometimes tended to nod "yes" to everything, but in this case, she really did seem to be following what was happening (as was true yesterday and the day before). "On previous visits, she seemed to be somewhere else," the doc said. This is entirely possible; if he had seen Mom during a brain edema flareup, then she would have seemed unresponsive or somehow "off" in her behavior.

I asked Dr. Meister what he thought might have caused Mom to sleep all day several Tuesdays ago; he said he didn't know, but felt it wasn't worrisome since the behavior hadn't been repeated. I wasn't satisfied with this answer, and reminded the doc that Mom's behavior had changed noticeably for the worse on the Wednesday after her long sleep. The doc ventured that it might mean the carboplatin wasn't working, but that we'd have to await Mom's next MRI results to know more. That won't happen until early January, after she's finished her 8-week Avastin and carboplatin regimen.

While we were waiting for the doc to appear, Mom's blood work results came back, and we were given a copy. Of note: a low red blood cell count; a low hematocrit; a low lymphocyte count (LY#) and number (LY%); and a high granulocyte count.

When the above figures are compared to the normal ranges for these aspects of the CBC, what we see is that Mom is currently immunodepressed, and very vulnerable to infection. All the more reason to be careful around her.

The depressed blood count might be seen as evidence that the carboplatin is indeed in Mom's system, but the doc confirmed that the drug is often "processed by the kidneys"-- i.e., peed out, as I had read, thereby reducing its effectiveness. He didn't offer an opinion as to whether NCI had made the right choice in putting Mom on carboplatin.

The doctor also said, rather cryptically, that he had "absolutely no comment" on the treatment regimen that we're looking into for Mom. He wanted to know, instead, whether we'd gotten Dr. Fine's blessing to pursue this procedure; Dad said that he had contacted NCI several times, but hadn't heard back from anyone on Dr. Fine's team. We reassured Dr. Meister that we wouldn't be doing anything without communicating fully with all the offices that currently care for Mom. We're not crazy enough to act so cavalierly.

Sean accompanied us to the checkup, then went his own way when it was over. I'm glad he was there. When we got home, David was inside the house, napping away. The poor guy needs to catch up on his sleep. Mom was a trouper throughout the whole ordeal; she had trouble getting back into the van, under the cold and rain, but otherwise, she gamely endured all the tests, and walked up the wheelchair ramp to the house.


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