Wednesday, May 26, 2010

ER and Latest News

So in Sean's last post he mentioned that he was going to the ER for a bloody nose that wouldn't stop bleeding. We got to the ER at about 2 pm on Sunday and they drew some blood to run some tests to check his platelets. As we suspected, they were low and they decided that his red blood cell count was pretty low too so they decided to give him infusions of both. The ER doctor packed Sean's nose with something that can really only be best described as a nose-tampon. It was a thin tube of cotton that expands when it absorbs the blood and the idea is for it to put pressure on the vessels in the nose to stop the bleeding. The catch, of course, was that they wanted to admit Sean to give him the transfusion and keep him overnight because the process of ordering the blood, typing it, and making sure it had been checked for antibodies and all of that can take a long time and they didn't want him to keep taking up space in the ER. So he was admitted.

When we got up to the room, the on-call doctor, Dr. Samuelson who is one of Dr. Chandramouli's partners came in to see him. He told us that the pathologist who had looked at his cell counts had also noticed some abnormalities among the blood cells that looked very suspiciously like leukemia. He told us about a specific test they can run on the blood to determine whether or not the leukemia exists but that it would take a couple of days to get the results because they have to send the sample to another facility with the University of Utah to have it processed. He told us about the possibility of this occurring because of some of the chemotherapy drugs that Sean has had in the past, and didn't want us to worry yet because the suspicion of leukemia hadn't been confirmed in any way. So, after a good long scare, we got a phone call from Dr. Samuelson later that evening who told Sean that the test was an error and that the nurse from the ER had drawn his blood from his port which had been flushed with heparin the day before. Heparin is a blood-thinning agent so that explained why the pathologist saw cells that looked like they had clotting issues.

So we put that out of our minds and got on with the hospital stay. On Sunday evening, they gave Sean 2 units of platelets which took about an hour and a half to infuse, and 2 units of red blood cells which took 3 hours each to infuse. The infusions went on into the middle of the night and were finally over at about 3:30 am.

Early Monday morning at about 5:30 am Sean woke up suddenly and immediately paged his nurse to come in because he was having tightness in his chest and difficulty breathing. This turned into a huge ordeal for him. The chest pains/tightness and shortness of breath lasted for about 2 hours before they were able to get things under control. He said it was like someone was sitting on his chest and squeezing it making it hard to breathe, and that it came in waves. The waves lasted about 10-15 seconds each time and he went maybe 20-45 seconds in between each episode. The nurse and aid were great about staying in the room with him to make sure he didn't code, and Dr. Samuelson was paged immediately. Sean had a chest x-ray and an EKG done during all of this as well. The chest x-ray was to check to see if there was any fluid in his lungs, and the EKG monitors the heart. Both tests came back normal. Sean was being given IV morphine to help with the pain during all of this and once he had enough in his system the episodes eased up and became much less severe and much less frequent. They hooked him up to oxygen and monitored his vitals very consistently.

We were very stumped and confused as to why this had happened, as were his doctors. The oncology doctors ordered a cardiology consult, and the cardiologist looked at the results from his x-ray and EKG and ordered a cardiac sonogram which was also normal, and therefore ruled out that there was any connection between the chest pains/tightness and his heart. Sean also had another test to check to see if he had a blood clot in his lungs (pulmonary embolism), which he didn't. The only thing left that the doctors could think of was that it was a GI issue and so they started him on IV protonix and carafate which coats the lining of his esophagus and stomach to help prevent damage from acid reflux. With these medications, and his pain medications, he was able to make it through the rest of Monday and Tuesday. Wednesday Sean had a consult from the GI doctor on call which was Dr. Batista who works for the group that I am employed with -Mountain West Gastroenterology. It was nice having him be able to come by the room and go over the symptoms Sean was having with us. His recommendation was to increase his PPI medications (acid reflux meds) to twice a day and to take the carafate 4 times a day. He told Sean that if he was still experiencing problems, to let him know as an EGD, which is a scope that goes down your throat, might be necessary. He didn't see any reason for him to stay in the hospital for this since his medications seemed to have everything under control but said that he'd be happy to do the scope as an outpatient procedure if that's what Sean needed. So, happily, on Wednesday, the packing in his nose was removed and he was discharged and we went home.

So the good news with all of this is that the platelet infusion seemed to work well enough to get Sean's nose bleed under control, his chest pain/tightness was resolved with pain medications and acid reflux medications, and he is home and resting now until his next oxaliplatin treatment which is scheduled for this coming Friday with Dr. Chandramouli. Of course, they will check his blood counts to make sure he can receive treatment on Friday before they give him any chemo, but he also gets to meet with Dr. Chandramouli Friday morning before treatment begins.

The bad news is this: when we got home from the hospital, Sean got a call from Anne, who is a nurse practitioner who was working on the oncology floor at the hospital and is with Utah Cancer Specialists. She told Sean that the blood work that they drew today has them concerned again about the possibility of leukemia being present in his blood. She told him that his white blood cell counts are rising out of control to extremely high levels. She didn't say anything about the clotting factors of his blood. She told Sean to follow up with Dr. Chandramouli on Friday about the results, but wasn't extremely specific. The best we can tell is that they are going to send Sean's blood work to the University of Utah to be processed and that Dr. Chandramouli will be able to speak about the results at his appointment later this week. So, we're back to square one....wherever/whatever that is. It's not unheard of for patients in Sean's situation to develop leukemia from the treatments he's had, but this usually doesn't happen until years and years and years down the road so it's a bit startling that this could be happening to him so soon. We weren't ready for this, but we'll deal with it like we've dealt with everything else. If the tests confirm that he has leukemia, he will have to begin treatments for that cancer as well as continue to fight off his testicular cancer. We're not going to assume things yet, we're just going to wait to hear back on the blood test. Hopefully Dr. Chandramouli will have information to give Sean on Friday.

We'll update the blog again after his appointments on Friday and we'll let everyone know if we've heard anything and what we found out.


1 comment:

matt sewell said...

my thoughts are with you bro