Dx and Tx of AML - Questions

Discussion in 'Health and medical' started by Kimba, Mar 12, 2004.

  1. Kimba

    Kimba Guest

    A friend of mine, who lives in VERY rural West Virginia,
    called me 3 weeks ago to tell me how rotten she was feeling.
    She'd had her period for nearly 2 weeks and was having an
    unusually heavy flow. She thought she might be anemic - she
    said she was very pale, that her lips were white, and that
    she had bruises all over.

    I urged her to go to the doctor right away. The nearest was
    over an hour away, but her husband put her in the car and
    took her. She was diagnosed with AML and transferred to a
    university hospital in Morgantown.

    Her platelet count was 12, so they transfused her with
    multiple units of platelets. She developed pulmonary edema
    and had a life-threatening reaction to phenergan, which
    included seizures.

    She received idarubicin initially and is now receiving ATRA,
    po. Her blood counts are much improved, but she's not in
    remission, yet.

    She was initially told that she'd be in the hospital for at
    least a month and that they were considering a bone marrow
    transplant. Yesterday, a new team of residents came in and
    told her that they were going to send her to a family
    residence on the hospital grounds for a few days, then send
    her home. She'll need to come in 4 times a week for follow
    ups - she lives over 3 hours away.

    Everything I've found about chemotherapy for AML strongly
    suggests 28 days of treatments, b.i.d., or until remission
    is achieved. The ATRA protocol that I found in my searches
    is IV, not PO - I found one study where it suggested that PO
    therapy is ineffective.

    She's got major nausea, which responds well to IV Zofran.
    They've told her that she's going to have to learn to deal
    with it, without the IV Zofran. She's concerned about re-
    starting the bleeding - they initially told her that her
    bleeding was secondary to the leukemia; now they're saying
    that it's a GYN problem.

    I'm really uncomfortable with what they're doing. Seems to
    me that she's sick enough to require more constant
    monitoring than she'll get if she follows this plan.

    I'm an R.N., but my specialty is surgical / telemetry, not
    oncology. I'm baffled. Am I off base, here?

    Kimba who is grateful as hell to live in a place with a
    good number of healthcare options --You did then what you
    knew how to do, and when you knew better, you did better.
    Maya Angelou
     
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  2. Kimba <[email protected]> wrote:

    >She was initially told that she'd be in the hospital for at
    >least a month and that they were considering a bone marrow
    >transplant. Yesterday, a new team of residents came in and
    >told her that they were going to send her to a family
    >residence on the hospital grounds for a few days, then send
    >her home. She'll need to come in 4 times a week for follow
    >ups - she lives over 3 hours away.

    That's 24 hours per week of travel. I would think that alone
    would make it clear their plan is completely non-viable.
     
  3. Kimba <[email protected]> wrote:

    >She was initially told that she'd be in the hospital for at
    >least a month and that they were considering a bone marrow
    >transplant. Yesterday, a new team of residents came in and
    >told her that they were going to send her to a family
    >residence on the hospital grounds for a few days, then send
    >her home. She'll need to come in 4 times a week for follow
    >ups - she lives over 3 hours away.

    That's 24 hours per week of travel. I would think that alone
    would make it clear their plan is completely non-viable.
     
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