The Alimta is not working as well as it should and is discontinued. Her CA125 level has been slowly increasing and the PET scan showed signs of increased growth. Her blood clots and the anticoagulation factor discovered in a previous blood test are a direct result of her cancer. The hope is to find a drug or drug combination that will stop her cancer from progressing. Lucy still has chemotherapy options available.
The new drug is Hexalen, an oral chemotherapy drug. Lucy will be taking it every day for two weeks, then get two weeks off. She will need weekly blood tests because of her clotting problem and the fact her blood counts were generally low because of the previous rounds of chemo. Her next blood test is a week from today, and it can be a port draw. That will give her arms a chance to recover from all the pokes she received in the hospital.
Her hemoglobin was still at 8.1, so that was a good sign. Her white count and platelet count were in the normal range. Her legs are slowly getting less swollen, she is having less discomfort, and she has not had a fever spike since leaving the hospital.
We still don’t know if the Pradaxa is working. There is no slam-dunk blood test that will help. The drug waiting in the wings is Arixtra, the injection drug mentioned a few posts back. The challenge will be trying to figure out if she has a clot forming. Both legs are still pink and have peeling skin on them. It will be tough to spot the tell-tale erythema (rash) or streaks from a forming blood clot. As I have mentioned, Homans’ sign is wrong a lot, and Pratt’s sign is not any better. If Lucy’s leg pain starts increasing or if she starts having fever spikes, we’re going to get her in for an ultrasound.
We’re both frustrated and disappointed at this time. It’s been hard trying to find the bright spots in today’s events. The biggest bright spot we have is your compassion. Thank you for that, it helps us through these rough patches.
She still hasn’t had the giant leap towards going home. Dr. Rousey (hematologist) stopped by this morning. He and Dr. Thurmes are still digging though research studies to see if Pradaxa will be the drug of choice, with Arixtra as the runner-up. Pradaxa apparently has a shorter half-life, which is helpful in case of a complication. Lucy likes the fact that it is oral and not an injection (OK, so do I!). Neither drug will need as frequent blood testing as Coumadin requires. I think it is because both drugs manage specific coagulation factors while Coumadin takes more of a “scorched earth” approach.
The IV antibiotics are still going. Right now, she gets Vancocin (vancomycin) and ampicillin, and both are available orally. While the hematologists are researching Pradaxa, Lucy is still on IV heparin. She has not needed a blood test because she hit the therapeutic range.
Julie stopped by this afternoon and really made Lucy’s day! It was nice having nearly no interruptions while Julie was here.
Lucy took two walks today. The first was about 50 feet. Her second was close to 150 feet. She would go farther when they finally disconnect the damned IVs. Her left ankle is loosening up a little. On her second walk, she was able to get her heel on the floor while walking, at least for a few steps. There was still discomfort walking, but she was not wiped out afterwards. Like last time, her pain started decreasing when she sat down.
Dr. Thurmes will be on rounds tomorrow and said he will stop by. He’s been so good to Lucy through this ordeal. He might have the home care anticoagulant and antibiotic choices tomorrow. If so, she could be released tomorrow.
Diane visited Lucy this morning. She always manages to cheer Lucy up and today was no different.
Lucy received some good news today. The Infectious Disease group is very comfortable that the fever spikes and redness in her leg are both clot related. She is still on antibiotics. Her Heparin Factor X is at 0.29. Therapeutic range starts at 0.30.
Dr. Thurmes came by and gave her some better news. She will be going on either Arixtra (injection) or Pradaxa (oral), so her heparin level can be close to therapeutic range. Her IV heparin will be stopping soon, and she will switch to oral antibiotics. He mentioned Sunday as a possible release date. Lucy must be off the IVs before going home.
Lucy’s left ankle is still extremely stiff. She has not tried walking with her walker yet. Maneuvering is interesting enough without having to coordinate with someone pushing the IV stand. If she gets rid of her IVs tomorrow, she will start walking around and get used to being on her feet again.