Posted by Becky
Leif got a red blood cell scan today, in an attempt to determine where the blood leakage is in his abdomen. They injected him with some red blood cells tagged with an isotope, and then scanned to see where the blood went. However, while they checked him in the machine for over an hour, they did not see anything that provided useful information. This was not a completely unexpected result; the technique is most effective for somewhat rapid bleeding.
So in a way, the inconclusive results are good news; the leak must be quite slow, or has possibly clotted. His blood counts (plasma and hemoglobin) were up during the check he got right before the scan. They now look good enough that the nurses are no longer going to automatically give him platelets every 6 hours; instead they will check his blood levels every 8 hours, and transfuse blood/platelets only as needed.
It also means that the contraindication for radiation treatment - bleeding from his spleen - is not a concern. Therefore, starting tomorrow, they are going to do radiation therapy on his spleen. The goal of this is twofold; first, to knock back the lymphoma in his spleen (lymphoma is sensitive to radiation) and second, to halt some of the suspected sequestration of healthy blood cells in the spleen. The risk is that the radiation could actually lower his blood counts if it takes out a lot of these healthy cells. Although, as the doctor pointed out, his counts are so low already, they don't have that far to drop.
Anyway, early tomorrow morning they will do a scan to target exactly where they should send the radiation, in order to hit his spleen but minimize radiation to his nearby organs, such as his lung and kidney. Then in the late afternoon/early evening, he will get his first dose of radiation therapy. Tomorrow and Sunday they will check his blood levels and see how things look. If he looks good, they'll give him another dose on Monday. The doctor thinks that a couple of doses, maybe a few more, will be sufficient since lymphoma is so responsive to radiation. The dose they will be giving him is relatively low compared to typical radiation cancer therapy.
Leif is feeling better and has more energy today. He went for a nice long walk (20 minutes or so) around the hospital this morning, and did a gentle workout on the exercise bike this afternoon. His appetite is increasing - food doesn't taste very good to him, but it doesn't taste bad either, which is a real improvement. He continues to make a good effort to eat, even when he doesn't feel like it. He has lost quite a bit of fluid weight, which is a good thing; the swelling in his legs has just about gone away. He is methodical and diligent about following all doctor's orders; keeping moving, wearing his Sequential Compression leg wraps, keeping a warm compress on his sore butt to encourage healing, etc. Said butt is looking good - the redness is gone, and the soreness is diminishing.
I started back to work yesterday (I had been on leave for the move etc.); it is nice to get back into a normal routine. Three of my friends from Texas arrived this evening for a weekend visit, which I have been looking forward to very much.
Leif got a red blood cell scan today, in an attempt to determine where the blood leakage is in his abdomen. They injected him with some red blood cells tagged with an isotope, and then scanned to see where the blood went. However, while they checked him in the machine for over an hour, they did not see anything that provided useful information. This was not a completely unexpected result; the technique is most effective for somewhat rapid bleeding.
So in a way, the inconclusive results are good news; the leak must be quite slow, or has possibly clotted. His blood counts (plasma and hemoglobin) were up during the check he got right before the scan. They now look good enough that the nurses are no longer going to automatically give him platelets every 6 hours; instead they will check his blood levels every 8 hours, and transfuse blood/platelets only as needed.
It also means that the contraindication for radiation treatment - bleeding from his spleen - is not a concern. Therefore, starting tomorrow, they are going to do radiation therapy on his spleen. The goal of this is twofold; first, to knock back the lymphoma in his spleen (lymphoma is sensitive to radiation) and second, to halt some of the suspected sequestration of healthy blood cells in the spleen. The risk is that the radiation could actually lower his blood counts if it takes out a lot of these healthy cells. Although, as the doctor pointed out, his counts are so low already, they don't have that far to drop.
Anyway, early tomorrow morning they will do a scan to target exactly where they should send the radiation, in order to hit his spleen but minimize radiation to his nearby organs, such as his lung and kidney. Then in the late afternoon/early evening, he will get his first dose of radiation therapy. Tomorrow and Sunday they will check his blood levels and see how things look. If he looks good, they'll give him another dose on Monday. The doctor thinks that a couple of doses, maybe a few more, will be sufficient since lymphoma is so responsive to radiation. The dose they will be giving him is relatively low compared to typical radiation cancer therapy.
Leif is feeling better and has more energy today. He went for a nice long walk (20 minutes or so) around the hospital this morning, and did a gentle workout on the exercise bike this afternoon. His appetite is increasing - food doesn't taste very good to him, but it doesn't taste bad either, which is a real improvement. He continues to make a good effort to eat, even when he doesn't feel like it. He has lost quite a bit of fluid weight, which is a good thing; the swelling in his legs has just about gone away. He is methodical and diligent about following all doctor's orders; keeping moving, wearing his Sequential Compression leg wraps, keeping a warm compress on his sore butt to encourage healing, etc. Said butt is looking good - the redness is gone, and the soreness is diminishing.
I started back to work yesterday (I had been on leave for the move etc.); it is nice to get back into a normal routine. Three of my friends from Texas arrived this evening for a weekend visit, which I have been looking forward to very much.
I'm very curious about the radiation therapy source they're using...it's been 13 years since I've even browsed a Health Physics journal. What isotope are they using for the gamma source? (or are they using a high-energy X-ray source instead? - that would be new.) How are they targeting the beam in 3D? The old gamma knives had multiple stationary gamma sources, each separately collimated by holes drilled into a big hemispherical lead block, all pointing to the center. With that you have to move the patient to the exact right spot to put the target organ in the center where all the beams converge, then open the shutters on the gamna source. I've heard about a relatively new device using a single source that's moved around constantly during the irradiation by a robotic arm which keeps the source aimed at the target organ. Lots more programming involved, but more freedom & precision about what gets irradiated and what doesn't.
ReplyDeleteI will ask. Getting the treatment is little scary since they are SO serious about it. They photograph your face and get your consent with a witness and timestamp. They record everything. I assume that it is because of people's general fear of radiation, because I am getting a "low" dose (although I do not know exactly what that means, or how it correlates to long-term risk - something else that I would like to find out, although long term risk is a bit of a non-issue unless I get through this current illness).
ReplyDeleteYeah, I think the biggest reason for all the consent forms is general fear of radiation. It can cause long-term problems, but then so can the chemo drugs. I think if something does go wrong later, people are more likely to blame the radiation. One good thing about it is that unlike chemo, its direct effects are local to the targeted organ, not whole-body (which of course is why they use it in the first place.)
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