It seemed to be amateur hour at MDACC yesterday. My brother's hemoglobin didn't even come close to holding steady. It plummeted from 8.7 g/dL down to 7.6 g/dL. The cutoff was 8.5 with at least 2 weeks since the last transfusion. He's not necessarily disqualified from the clinical trial. He needs to get some blood, wait 2 weeks, and be above the cutoff of 8.5. How that happens is where it gets more confusing and tricky, not mention irritating. I was ready to strangle 2 different nurses and 1 PA at their lack of any ability to think or do their basic job.
Step 1 is to get the 2 units of blood. Check. My brother's on his way to do that right now. Step 3 is to get into the clinical trial. What's Step 2? Step 2 is what's tricky. Prior experience tells us that 2 units ain't going to cut it. If he gets two units, the most we can hope for is that he jumps to mid 8's and then plummets back down into the 7's. Been there, done that. Not good enough. Simple logic would dictate to get more than 2 units. Apparently, the blood bank will only release them in 2 unit blocks in non-emergency situations. So we're not sure if family members (both me and my mom are O negative so it's not a problem) can donate and bank it for him. The PA basically said, I can get you 2 units and then you come back in 2 weeks. It was a bit like a parrot repeating itself. In my mind, Step 2 also needs to rule out the possibility of any hemolytic action going on. We need to know if he's having a problem with making Red Blood Cells, keeping them alive, or both. So we're trying to get back in to see his regular oncologist to address what's going on. His nurse tried to tell me we needed an order from the clinical trial group to see his regular oncologist. They then tried to pawn us off back on the clinical trial nurse. Yeah, that wasn't going to fly. So now we're waiting....
The MD Anderson doc cleared him to see an orthopedist about his back. Even though he has cancer, the back pain is far more debilitating and causing him severe pain. It turns out with good reason. He essentially broke his back. Three of his vertebrae were fractured as determined by the x-ray. Next step is to get an MRI today to see if there's any soft tissue damage (muscle, tendons, etc). From there, they'll make a decision about how to move forward. Options range from an outpatient procedure where they reinforce the fractures with a cement to full blown surgery if there's a lot of soft tissue damage complicating things. In the meantime, he's commiserating with my brother knowing pain and the rather nasty side effects that opiates induce.
So it's been a fun past couple of weeks with more entertainment to come. Through this, I somehow had exams and managed to not blow it. Microbiology had me miss High Pass by 2 points, Physiology has me right on the edge of High Pass, and my hands-on Clinical Physical Exam is next week. I guess I need to start practicing that one. Hey, it's only a 110-E-Z steps to memorize and go through in 45 minutes on a patient with someone looking over your shoulder. No sweat.