Nurse Sam back in action

I leave for 3 days and come back to this! Nice way to welcome me back to Calgary.... with a snow storm. (Fyi- I didn't bring this weather with me)

A quick note:

I am currently enrolled in a private dental hygiene college in Hamilton Ontario (armpit of Canada or most beautiful city... if you like steel factories, downtown creatures and methadone clinics). As Friday January 28th was the last day of my 2nd semester, I felt it necessary to go back to Hamilton for a couple days to write a final and complete a couple clinical assessments, in order to be promoted to my 3rd and final semester. I am thankful that my school has been supportive and accommodating in regards to my father's situation, as we have managed to work together to put my 2nd semester behind me, and allow my primary focus to be my Dad. I am currently in a 2 week semester break, with my first day of classes for my 3rd semester beginning on Feb. 15th. My school has granted me these 2 weeks to decide if I am going to return to finish with my current classmates, or if I am going to defer, and finish when the next semester begins mid August.

Enough about me! Back to my main man....

As I mentioned in my last post, my Dad has finished his first round of chemo agents. This week his blood counts showed that his WBC, hemoglobin, and platelet levels have completely bottomed out. With his numbers reaching all time lows, he was given a couple platelet and blood transfusions. The doctor has informed us that his body will be dependent 1-2 transfusions per week until his marrow begins to produce enough of his own blood cells. (All blood cells -WBC, RBC, are produced in the bone marrow) With his platelet levels being as low as they are, he has experienced some gingiva bleeding while brushing...I guess that job should be left to the expert. At this point, my Dad is deemed immunocompromised, which makes him extremely susceptible to contracting any virus or infection. (This is where the bleach showers I discussed would come in handy) The counts should begin to go up around day 23-28, today is day 15. At that time they will test his bone marrow again to determine if he has attained remission. This has placed us in a sort of holding period, as we roll with the punches of no immune system.

On Thursday he was given his first 'pass' to leave the hospital for the afternoon. Kelly and my Dad went home and were able to have lunch with a real knife and fork and watch some golf. Today we were given another pass and have been lounging around... watching golf (it's winter, why is golf on), having lunch, being 'normal'. I think it was hard for my Dad to leave the safety of the hospital at first, but once home visits become more routine, I believe they will come to be therapeutic for him.

I wanted to send out a massive THANK YOU for the unconditional support we have received thus far. Kelly and I have brought all the cards to the hospital, read him the comments on the blog, and are working out way through the emails. I know it may not seem like your doing much, but every prayer, thought or word he has received will positively aid his journey towards complete remission.

Ding Ding Ding

The bell has rung... round 1 is over! He did it!

The last drop of chemotherapeutic agents went into my Dad's body at 1pm on Saturday.

In the last few days he has received a 2 bags of platelets and 2 bags of blood. The transfusions were necessary as his platelet and hemoglobin levels were coming back low.

He has lost all the fluid weight he has gained since being admitted. Now he must maintain his fluid and food consumption in order to not lose anymore weight. Chemo is not a diet.

The doctor was concerned with his central line (the main tube that delivered everything to his artery beside his heart), as the site was red and tender. There was speculation that the central line is the cause, or could potentially cause an infection. (About once a day my Dad has been running a fever; a fever is a sign of an infection) The doctor made the decision to take the central line out on Saturday. My dad and I watched the Flames game while the doctor removed the central line at his bedside with MUCH MORE ease then when it was being put in. You may be thinking, "but Sam, how will he be getting his medications now that his central line is out?" Let me tell you... Earlier that day the nurses put him through mini hell while they put a peripheral line in his arm. A peripheral line looks just like an IV line and is in the elbow crease of his right arm. All of his meds, and anything needed to be transfused will now be administered through this line. This is only a temporary situation. On Monday a pick line will be inserted into his arm, and the tubing will go up his arm and insert into that main artery by his heart again. The nurses will be able to draw blood from this line; something they cannot do with the current peripheral line. We haven't said goodbye to our friend central line quite yet. Another one will need to inserted into my Dad (this is a procedure done in the operating room- OR for all you Grey's/ER or people with actual medical designation), but not until the next round of chemo. He said the resident doing the last central line procedure looked more scared then he did, and after numerous attempts, ended up having the attending finish the procedure. As you can imagine, Jer requested that a student NOT do the next one.

Days 7-14 is a crucial time period. This is when his blood counts are at their lowest levels and he is at the most risk of getting an infection. Kelly and I have been very diligent with proper asepsis... if we could shower in bleach, I'm sure we would.

On a lighter note...

I think I have a pretty cool Dad. He sports trendy clothes (sometimes...sometimes he struggles). He knows of the 'hot' places to go in Calgary. His stampede party schedule is idolized by my friends. Well.... His LATEST fashion trend is none other then, the snuggie. MY pink snuggie my friends got me for Christmas. Jer Diddy...always keepin' it fresh.

Day 6

As I mentioned in one of my early posts, when my Dad arrived to the hospital, his care was taken over by one of Kelly's friends, a hematologist specialist. Now that a week has passed, the initial shock has worn away and we are almost through our first round of chemo, the doctor, my Dad, Kelly and I have reached a collective decision that my Dad's care be handed over to another doctor; one with no personal connection. His care will now be in the capable hands of another hematologist at the Foothills, one who also specializes in bone marrow transplant; something my Dad may be needing in the future. Our original doctor will now be able to act as our 'friend on the inside'... visiting with my Dad, checking in on his care, offering further clarifications and opinions, and being there for our family if we ever need to talk. Our family and the Jer Diddy army would like to send out our most sincere 'THANKS' to our original doctor, and friend, for all the work she has done to get my Dad to the point he has reached so far, and know that her diligence and passion has been acknowledged and very appreciated by us.

I am excited to report that my Dad has slowly been acquiring his appetite back , and is eating solid foods at most meals. Every morning we watch our peeps Regis & Kelly, and there is always this commercial for KFC (fyi- coupons are not necessary, they have everyday low prices on buckets)...today he turns to me and says "for some reason, I am craving KFC". I'm not exactly sure if the Colonel's recipe is in the immune boosting/cancer fighting diet plan?

My Dad says he wants to have more followers then Ashton Kutcher.... so sign up and be a follower

Day 5- Big Day

Today we got back the bone marrow results. It is kind of confusing, so try and stay with me as I use my "Samensese" to explain it.

Multiple tests were ran using the sample bone marrow that was taken from my Dad's back when he was admitted. The pathology of the disease was confirmed: Acute Myeloid Leukemia (AML).

The cytogenetic test results were the main results we had been waiting in anticipation for. It turns out my Dad has Normal Cytogenetics. This means that my Dad does not carry any genetic markers that would indicate a poor prognosis to the doctors, BUT, he doesn't have any markers that would offer a stellar prognosis. The doctors classify my Dad as being at an "intermediate risk with his cytogenetic results". If his genetics indicated he had "good" markers, chemotherapy would be a sufficient treatment option. If they found certain markers that indicated a "poor" prognosis, he would be getting a bone marrow transplant ASAP, as chemo would not be effective. As he considered to be in the intermittent group, chemo is the first method of treatment. If chemo is found to be ineffective, or if the doctors feel he could positively benefit from a transplant, that would be the next course of treatment.

Now for the bone marrow discussion. The transplant specialist would be looking at a person's HLA type (don't ask me what that stands for, just go with it). This can now be done with a simple blood test. To be a match to my Dad, the donor would have to meet a minimum of 8 out of the 10 criteria. A 10/10 match would be ideal, but not necessary. The transplant team will be contacting his 3 brothers within the next few weeks to test them, as they have a 1/4 chance to match my Dad because they share the same parents. I would be a 5/10 match because I am only half my Dad... allegedly. I still think I am adopted. Yes, I look exactly like both my Mom and Dad, BUT... where I got this attitude from, that is a question no body can seem to answer. Back to bone marrow. Once his brothers are tested, it will take 4-6 weeks for the results to come back. If a match is not found within his siblings, the doctor will do a search of the world bone marrow bank to see if his HLA type matches with an anonymous donor. The results will come within a few hours of the search.

The first question that comes to mind is, "can I be tested to see if I match Jer?" The answer to that is unfortunately, no. You can donate bone marrow, which will go into the world bank allowing any patient needing marrow to use it if they are a match; but they are unable to test you for a specific patient. To be honest, I don't really get it, but we have to accept it. Another option is to donate blood. Patients undergoing chemo, especially leukemia patients, will receive multiple blood and platelet transfusions over the course of their treatment. While I can't guarantee that your specific blood will go into my Dad (I know some of his friends would think its cool to be "blood brothers" with him), I can guarantee that you would be helping to extend or possibly save someone's life.

After receiving the FFP the other day, I am pleased to report that my Dad's platelet levels are within normal limits.

He had another chest x-ray to check the progress of the pneumonia. Pneumonia is clearing up!

Lastly....Jer's quote of the day "Don't trust a fart"

*Knock Knock*... "Housekeeping"

I just wanted to thank you for the enormous amount of support and unconditional love we have received so far!

Just a couple things I/we wanted to share with you:

- At this time, my Dad is not accepting visitors. We realize that everyone wants to offer their love and support and wants to be Jerry's personal cheerleader, but we have to think bigger then ourselves right now. Chemo is knocking my Dad's immune system to zero; therefore, he is extremely susceptible to catching ANY and ALL viruses or bacteria that may be lingering on your person. My Dad makes everyone in his life feel as though they are VIP, but at this time, the only people on the VIP list are Kelly and I. Kelly is stronger then she looks...she will tackle you. Something you can do is send cards, posters or love notes to our house and we will bring them to the hospital. Positive words of encouragement go a long way!

- We have enough magazine to start our own news stand. In a month from now, maybe we'll need a refresh on the magazine front as I will need to know if Kim has adopted a baby, if Kendra has divorced Hank, and who broke up and is available for me.

Keep the love, positive energy and prayers coming :)

Meet the team: Nurse Kelly, Nurse Sam, Captain Jerry

Days 2-4

Since being admitted, my Dad has been battling pneumonia, as confirmed by the chest x-ray. We believe he had this prior to being admitted to the hospital, as the pain of it on his ribs is what prompted him to seek medical attention in the first place. He was treated with antibiotics and is slowly recovering from it.

Our night nurse for the last few days, Krista, made us a calendar to chart the results from the daily blood work and his weight. We follow his Neutrophils, White Blood Cells (WBC), Hemoglobin, Platelets, Potassium, Creatinine and weight in Kilograms. My Dad came into this hospital with 100 WBC (avg. is between 4.0-11.0), and as of yesterday he is down to 0.6! What this means is that the chemo is doing its job... killing everything. HOPEFULLY killing the cancer! On day 3 his platelets were low, meaning, the ability to form clots was low, as platelets give blood its "stickiness" (that's a real medical term by the way). To treat this, they gave him Fresh Frozen Plasma (FFP) through his central line, and Vitamin K orally, to get his platelets back to a level we'd like to see them at.

The doctors and nurses stress the importance of good oral health, as that is one of the main routes of infection. I guess Jer's investment in my schooling is paying off for once. (For those of you who don't know, I am just about to start my last semester in dental hygiene college) I wonder if my school will give me extra credit for this?

Another important daily routine is walking. One nurse had suggested a goal of 3 walks a day. With Kelly or I walking by his side, he is meeting this goal.

Still waiting for the bone marrow results to come back.

Diagnosis & Day 1

My dad wasn't feeling well on and off for a few months. It was getting worse last week, so Kelly made him go to the doctor on Thursday (Go kelly!). His doc took blood work and received the results Friday morning. She said that his white blood cell(WBC) counts were alarmingly high and suspected leukemia, and that my dad had to go to the hospital for tests to confirm. Thirty minutes later they had a bed ready for him and was in the hospital. As it turns out, a lifelong friend of Kelly's sister-in-law is a hematologist at the Foothills hospital and is now my dad's doctor. She was on the ball as soon as they arrived, conducting multiple tests, including the bone marrow test. As Friday evening approached they were prepping his body for chemo by doing a bicarbonate flush.

Kelly called me at 330pm eastern time (Friday) to inform me of my Dad's status, and I booked on the next flight out of Hamilton, which had me into Calgary at 930am on Saturday morning. Later that evening, to my surprise, I received a call from my Dad. Not a call he probably ever imagined making, nor was it a call I ever wanted to receive. He informed me that they confirmed the diagnosis... we are battling Acute Myeloid Leukemia.

Saturday was Day 1.

He will be receiving chemo meds for 7 days, 24 hrs a day via this tube they have inserted on the right side of his chest. There about 3-4 different tubes from the IV stand that all meet up, and empyty into the central tube that was inserted just above his nipple; this goes up towards the collar bone, and then U-turns down towards his heart, where it empties into an artery that feed directly into his heart. As leukemia is a cancer of the blood cells, this entry is the most efficient way for the drugs to get distributed to the rest of the body. (The nurses also use this entry to administer other non chemotherapeutic drugs such as anti-nausea, anti-biotics). For the first 3 days, he received an injection of a different (more potent) chemo med in the morning, but otherwise its a drip that goes into him constantly. After the 7 days, he will be off the chemotherapeutic agents and the goal to make healthy blood cells begins! He will be in the hospital for another 15-20 days, where he will be receiving platelets and blood transfusions, which will hopefully help with the healthy cell replication. On day 25, they will re-test his bone marrow to determine how effective the chemo was and if he is in remission (THATS THE GOAL!). The doctor said what will likely happen is at that point, she will give him 2 weeks 'off' in order to relax and basically mentally build himself up again... and then we will go for round 2 of chemo.

Currently we are waiting for the results of the bone marrow sample. Those results will offer a definitive diagnosis and give us a prognosis. Acute Myeloid Leukemia has a few subgroups, which are only determined through the bone marrow test, which tells the doctors the genetics of his specific disease. This result will also determine if he needs a bone marrow transplant. As it stands, my dad is an "intermittent" patient, which means, he is being treated with chemo, but may need bone marrow if the chemo does not take effect like we hope. His siblings have the best chance to match him, so I told my Grandma that I'm glad she had 4 kids. What the doctor is looking for is a 10/10 match (which someone of the same parents would likely have). I am only a 5/10 match for him, so they likely wont test me. Jer is going into this with a healthy heart, liver, kidney.. basically healthy body. He had a physical in September, and was of perfect health. Hopefully that means we caught it early.

Welcome

To say the least... the last few days have been a whirlwind. Everything has happened so fast, that communicating with our loved ones, and everyone that loves my Dad has been few and far between. When I received the call from Kelly that my Dad was diagnosed with Leukemia, my whole world turned upside down. I had so many questions and wanted to know everything, but ultimately, I wanted to be with my Dad. As being with him is not possible for many of you, and by many of you, I mean everyone but Kelly and I; I feel it necessary to start from the beginning so we are all on the same page, and fighting the same fight.

This will be the story of the patient you may know by the name of Mr. Albert, Gerald, GRA, Gerry, Jerry, Jer, Jer Bear, Jer Diddy, G, Uncle Jerry, D, Papa G... but to me...he's my Dad.