No chemo yet (10/25)

Talked to Daniella last night...
Stefan was checked in on Monday morning, around 8am. And then he waited. And waited some more. Stefan did NOT start his chemotherapy yesterday, as was planned. And he’s still waiting…

So, I called and talked to Stefan just a short while ago.
There’s a minor hold-up, in the paperwork and procedures. It’s not all that complicated – Dr. Olga, Stefan’s oncologist, can’t get a hold of hospital personnel in Florida, due to their being evacuated because of Hurricane Wilma. Stefan started his AML treatment last month as part of a nationwide study, where many hospitals around the nation treat AML patients with the same procedures and same drugs, but using differing doses of the chemo drugs. The purpose of the study is to find what dosage brings the best results with the least amount of side effects, to find just how aggressively to treat AML without being too aggressive.

Now, everything with Stefan is fine and proceeding as expected. He continues to meet all the requirements for the study. However, NMH has a new test they are starting to run to check bone marrow. Stefan’s bone marrow is clean – meaning it has a very minute percentage of leukemic cells – which works for the study, and as he’s going for his next round of chemo, those few cells will be wiped out. The new test that’s just been developed is more sensitive, which is why it detected the small trace of leukemic cells. But, other hospitals in the study aren’t all using this newer, more sensitive test, so Dr. Olga has to contact the other hospitals to let them know that with the “standard” test, Stefan still qualifies, just that NMH’s newer test detected some leukemic cells. So it’s simply a matter of protocol that’s holding things up. As soon as Dr. Olga is able to notify her contacts in Florida of Stefan’s test results, they can start his chemo.

Stefan’s chemotherapy this time around will be a little different from his last round. He will be getting cytarabine, just like last time, but instead of having it on a 24hour drip, he will receive a one hour IV twice a day. This round of chemo will last five days – three days of chemo, with a day’s rest in between each time. After the chemo, he’ll stay in the hospital for a day or two for observation. And then it’s back home for two weeks to wait, before the next bone marrow biopsy.

You read in Daniella’s posts that Stefan has qualified for a clinical trial drug, Posaconazole, to replace his antifungal IV med, Ambisome. He was supposed to start that this week. However, Dr. Ison, the Infectious Diseases doctor that prescribes Stefan’s antifungal meds (including the clinical trial drug) has put a hold on things. Dr. Ison said the drug manufacturer recommends not to start Posaconazole prior to starting chemo due to possible drug interaction, but rather to wait until the first dose of chemo has been administered. So, Dr. Ison is waiting until the day after Stefan starts his chemo to start him on Posaconazole. Until then, Stefan will continue to get his antifungal meds the same way he’s had for the past 6 weeks – via IV, where the whole procedure takes about 5-6 hours. Once he goes back home, it’s very likely that he won’t be seeing his girlfriend, Ivy Pole, anymore. The Posaconazole will be in oral suspension form (liquid meds taken orally, not injected), which Stefan will take either twice a day or four times a day, depending on the dosage he’s prescribed. I forgot to ask if that means that Stefan won’t need a PICC line anymore once he goes home… Though he might… Even though he won’t be getting IV meds, they’ll still need to come draw blood 3x a week, so they might leave his PICC line in for that.

For all practical purposes, Stefan could have been home these last 24+hours. He says he could have gone to work, but what can you do… can’t control the weather now, can we? So, he’s had his blood drawn, had a CT scan, and gotten his IV Ambisome (just like at home). So far, the hospital food hasn’t gotten to him. He’s not confined to his bed or his room, so he’s gone walking around 15 West. I asked him if he’s allowed off his floor (thought I’d go take him out to lunch), but he said he wasn’t sure about that. The only “meds” he’s on right now is saline, via IV, which he unplugs when he goes out.

For now, Stefan is in his room, waiting. He said he’s caught a few naps here and there since he was checked in. Which is good – when he was in the hospital for four weeks, he was able to nap during the days, and that’s something he’s been missing these past two weeks. So it’ll be good for him to catch up on his sleep, by taking naps during the day. When he’s not napping, he says he’s reading… or checking out the view out his windows. Stefan was lucky enough to get a corner room this time, with windows facing both East and South. From his room, he gets a very nice view of Lakeshore Drive and Navy Pier. He says he’s watched the big Ferris Wheel slowly going around. And he’s watched clouds move over Lake Michigan. The weather was clear enough this morning before dawn that Stefan saw lights on the other side of the lake. I’m sure the view will grow old in a day or two, but it’s got to be a better view than the construction he watched for four weeks during his last stay at NMH!

Daniella isn’t planning on staying overnight with Stefan during this stay. Although she’d like to because it makes her feel helpful to Stefan, he said that he’s quite capable of taking care of himself. Very true… this time he’s not sick, feverish, and battling pneumonia. So until I hear different, he’s on his own this week, at least while Daniella’s at work.

Just thought you’d all like an update, since everyone was expecting him to have started his chemo yesterday…