Day 22 Admission Day 2 High-DAC Chemo

Dear friends and family,

Well, you have probably noticed the change in the title. We learned last night(2 days early) that the first round of chemo was not very effective. We won't be given percentages until Thursday, but the preliminary blood smears of the bone marrow showed very little change in the leukemia. So Bob was started on high dose Ara-C(hence, high-DAC) at midnight last night. This was not something unexpected...75-80% of AML pts. need a 2nd round of induction therapy chemo. It was a little surprising to get this news so quickly, however. ARA-C is another name for cytarabine, one of the original agents used 2 weeks ago. But this time around the dosage is 30 times greater. This is scarier, b/c the risks are obviously higher. The drs. expect Bobs' white count to fall quicker and stay down longer, so the chances of infection are much greater. This dosage can affect lots of other things too, one being your eyesight...so Bob has already been started on steroid eye drops. He's also back on the decadron(steroid)-zofran regime to prevent nausea, so he'll be getting the added benefit again of painless joints, increased appetite and elevated mood(gotta look for the silver lining, right?) In fact he had no fevers today and got 3 laps in before lunch. He was bushed however after washing up, and needs to rest after any exertion. He ate a good lunch(taste buds...who needs 'em?) and than started on The Two Towers. By the way, Istari6, Bob says to tell you he's reading the trilogy again. Bob is also back on IV fluids, so he lost some freedom, as he's always attached to the IV's and pump. The chemo is given twice a day over one hour, so he also needs to rest while that's infusing. He'll receive a total of 12 doses, so we're looking at another week to give the chemo, and than another 2 weeks for the counts to fall and rise. I don't know if I explained too clearly, but the goal is to wipe out the leukemic cells from the marrow. Unfortunately, the chemo also wipes out any good red or white cells and platelets. So we can expect many transfusions of blood and platelets to come. Our hem/onc MD, Dr. Luger and the attending, Dr. Perl both spoke w/ Bob today(I of course just missed them even though I got down there early) and told him that everything that's happened so far is exactly as expected. That is comfort of a sort, but it hurts me so to see Bob have to go through this. He is such a good man and so undeserving of this trial. Forgive me that maudlin moment, but anyone who knows Bob is certainly shaking their head in agreement. Thank goodness Bob himself does not dwell on that, but being his practical self says this is the hand we're dealt, and we have to play it. So, I take my cue from him and soldier on.

Honestly, this wasn't meant to be a depressing post. In fact, Bob was quite chipper today and had some more comments:

To sweet, little Kim, Bob says he's always prepared for a "blue" streak from your mouth. He remembers the old days in ICU.

To George and Aniko, Bob says it's very good to hear from you, and you should use more Amarone and less amiodarone.

To Hatfield Girl and Music Man(new moniker?), Bob loved the specially-tailored, check list get-well card. Very original.

To all the "elderly" bloggers out there having trouble w/ the small type, Bob gave me a hint for you. You can increase the size on your computer by going under VIEW on your toolbar, scroll to text size and choose large or larger. Whaddya know...this actually works, I tried it.

To Kate, Uncle Bob says hang in there kid...your braces will be on and off before you know it. And make sure you show those beautiful teeth when you smile, not like your sister.(Sorry Meg).

I'll sign off here, asking as usual to please remember us, but especially Bob, in your prayers. Also tonight, I'd like to ask you to add one more name to your prayer list...Kathy is my sis-in-laws' best friend who is undergoing colon surgery tomorrow. Anne sends her appreciation for your prayers for her.

Thank you one and all for all the support. It means more than I can say. Until you're actually in a position like Bob and I find ourselves right now, you have no idea of what it means to open a card,read a blog, or get a call from someone who says...just thinkin' about ya'. Believe me, it helps. Thank you too for letting me ventilate here tonight. We love you all.

All our love,
Bob and Mo