Kidneys, Gut, and Blood Counts (ICU Day 7)
Mike’s still in the ICU. Incrementally improving, but still here. There are lots of things that still need to improve so that he can get strong enough to receive further treatment. The featured image for this post shows a sample of what his IV pole has looked like most of the week.
Kidneys and Gut
Mike was admitted to the hospital on July 31st. If you’ve been following, at that time, he had reduced kidney function due to vascular dehydration. That really hasn’t improved for any significant length of time because he had to start chemo 5 days after admission and the type of chemo he’s on is kidney toxic. His kidneys always take a temporary hit for about a week post-chemo. That combined with the already angry kidneys has given his body a bit of a hard time. It was a necessary hit, though, because the cancer was growing, and something needed to be done.
He’s still internally dry and needs lots of IV support with fluids, electrolytes, and intravenous nutrition. The IV nutrition is necessary because he’s currently unable to ingest food due to severe nausea and vomiting. He has a suction tube in his stomach to siphon off all the gross stuff so he can remain nausea-free. All that leads to basically just losing all fluids he’s getting until his body starts absorbing everything properly again.
Blood Counts
The TIP chemotherapy regimen is a bit more intense than his original BEP regimen and, therefore, hits the bone marrow a little harder. That’s a good thing because germ cells are itty-bitty and can travel to unwanted places, so having the drug hit the bloodstream and bone marrow will theoretically catch any pesky cells playing hide-and-seek. However, this means a couple of things:
The regimen has to be done inpatient for closer monitoring of side effects and blood counts.
Blood counts are hit harder and infection is more likely.
Anemia is a larger problem, which requires blood and platelet transfusions to correct.
That is where we are today with the blood counts. Mike is on Day 7 since his last chemo treatment and this is the day blood counts start to bottom out on a 21-day cycle. He is quite anemic and his white blood count and platelets are very low, so he’s more susceptible to infection and bleeding. Today, he has received 2 units of blood and an IV drip of platelets. He’s also getting shots to stimulate his bone marrow to produce more white blood cells so they can fight infection. While all of that is going he’s also getting IV antibiotics to prevent any infections that might arise. The blood counts should hit a plateau and then start to rise again in the next couple of days, then be back to normal (except for his red blood cells) before he receives any more treatment.
Word from Duke
It goes without saying that this chemotherapy regimen has kicked Mike’s butt with a steel-toed boot. Mike’s local oncologist said that any further treatment—including standard dose regimens—should be done at Duke where they do more high volume of salvage therapy for germ-cell tumors. We agree wholeheartedly and appreciate his doctor’s humility and care to make sure he gets the best possible treatment, no matter where that happens.
Yesterday, we heard back from the medical oncologist at Duke. He discussed Mike at their tumor board yesterday morning and made a recommendation that he move to a less aggressive regimen and do one to two cycles to prepare him for transplant. We are planning to have a video call with him sometime next week to see how strong Mike is at that point and plan the timeline accordingly. Please, PLEASE pray that Mike continues to improve so that he can receive the treatments he needs and kick this monster to the curb. His kidneys are crucial in that decision as well as his gut.
Celebrating the Bright Spots
Although I’m weary and anxious about the unknown elements of all of these variables, I’m trying hard to look for bright spots in the midst of all the darkness surrounding us. I want to list some of them below as a way of counting our blessings. It helps so much to focus on these moments!
Mike was brought to a tumor board at Duke less than 12 hours after I reached out to him for input. For those of you who haven’t walked this road before, it is virtually unheard of to get discussed at a tumor board that quickly. Most people have to wait at least a week to get put on the schedule at major hospitals. The fact that Dr. Ramalingam made that happen encourages us that he has a vested interest in Mike’s restored health.
We had some amazing friends from North Carolina drop everything and bring their dogs to an AirBnB nearby to just be here in support of us this week. They grocery-shopped, did my laundry, made a bunch of freezer meals, and just generally offered the ministry of presence. I’m speechless with gratitude at this kindness from friends.
Others have called, texted, shown up physically, sent meals, gift cards, get-well cards, and probably a host of other support measures I’m forgetting. I’ve been so surrounded by the love of our community, both near and far, and it’s humbling.
This might seem small to some, but I’m thankful for the baristas in the Thomas Hospital coffee shop. They see me so much, they know my standard orders (a hot one in the morning and a cold one in the afternoon). They’re always asking me how things are and they’re encouraging every single time I see them. Plus, they make beautiful, tasty coffee!
So many fantastic nurses and other medical staff. I can’t even list all the names of the amazing staff that has ministered to us, but I do want to take a moment and mention a few:
Dezzy, Clinical Associate on 4P. When I found out they were moving Mike to ICU and returned to his regular room to gather all our stuff, I came back to find four post-it notes on my Bible with incredibly encouraging Scriptures handwritten for me. I can’t describe to you how those verses have ministered to me this past week. Thank you, Dezzy! (She wanted to remain anonymous but one of her co-workers spilled the beans.)
Ashley D., Charge Nurse on 4P. She’s always a delight, but when I came back to the room to get Mike moved, she asked me if I knew the update. After I replied “yes,” in snot-crying tears, she just held me and let me sob uncontrollably. I needed that so much. She is precious to me.
Peyton, Allison, Jarrod, Valerie, Amanda, Sam, Jessi, Robert, and Cedric on 4P. These are all nursing staff (nurses or techs) who have impacted our lives in such positive ways that we can’t imagine life at the hospital without them. They see us in the hospital and stop to ask how Mike is, whether he’s admitted to their floor or not. Several of them have walked over to the ICU to check on him more than once.
Speaking of the 4P staff, I can’t forget Drew, the Nurse Manager of the unit. Drew is worth far more than they’re paying him. I don’t actually know how much they’re paying him, but given his level of care and the amazing team spirit he has managed to foster throughout his staff, I know it’s not enough. If there’s someone from the Thomas Hosptial administration reading this post, give that man a raise! Actually, give EVERYONE on 4P a raise!
Dr. Mark Tarakji. Dr. Tarakji has followed Mike’s case and cared for our whole family for years. He has been personally invested in Mike’s health and, even though he’s a general surgeon and not always part of Mike’s care team while he’s here, he comes and checks on Mike, just to encourage him. He’s become a family friend throughout all this and we’re so grateful for his concern and prayers.
ICU day nurse Megan. Megan was Mike’s ICU nurse for his first 5 days in the unit and she couldn’t have been more of a blessing. Through some sort of magical powers, she was able to comfort Mike through a much-needed MRI of his head. Mike has never successfully completed an MRI and Megan worked with him patiently, not taking “no” for an answer and encouraging him through the anxiety. This was a priceless gift.
ICU night nurse Shawn. Shawn was a blessing to me, personally. I was an exhausted basket case most evenings and he let me cry, consoled me, encouraged me in my faith, and just generally was awesome. In addition to caring for my soul, he truly treated Mike like one of his own family. He clearly loves caring for the sick and he is excellent at it. He has a wealth of wisdom from 40 years of nursing experience and WVU Thomas is lucky to have him. He told me that his contract was ending here at the end of August. I think they should also pay him more to keep him around. He’s worth it. I’m not sure hospital administration understands how much nurses care for the caretakers. Caretakers have lots of needs, too, and all the nurses I have mentioned have understood that well and extended their attention beyond the patient in the bed.
We have more stories to tell about this experience. Some funny, some miraculous, and others just wacky! Because Mike was out of it for several days, we’ve been playing a game I like to call Dream or Reality? lately. It’s been interesting! There will be more stories coming soon. I also need to do an update about my mom’s treatment plan. One step at a time, y’all. I’m trying to tell all the chaos in my world to sit down and shut up for just a minute so I can breathe and think! Thanks for the prayers! We’re desperate for them!
