Spring/Summer Hospital Stay Day 10 Comment #4

May 26, 2016

In spite of the announced arrival of the matched platelets Angela Burslerexperienced a very tough day today. The quick and short of it is that the three big symptoms fever, headaches and elevated blood pressure returned with a vengeance. Most of the day she was non-responsive and in obvious pain. Doctors were in and out of her room often but none could provide a quick fix to her problems. In fact, at one point, she reached her max dosage of Tylenol so headaches were treated by icing her head and main arteries. Poor woman suffered mightily but never gave in.

Contributing to her pain is the ever deteriorating lung capacity caused by fluid in the lungs resulting in shortness of breath. Mid-day today she was told that if the volume of Oxygen used to assist with her breathing had to be increased consideration would be given to putting her in ICU. She struggled, especially when getting up to urinate, but the Oxygen was never increased and she remained in the general care unit.

She was visited today by the infectious disease and neurologist teams neither of which had solutions to her problems. Tomorrow we expect a visit from the Nephrology team to report on the condition of her kidneys. In preparation for that visit an ultrasound of the kidneys and bladder was done today. Antibiotics and other medicines have reduced kidney functionality below normal so this team has been called to do an exam.

Lots of suffering today but we are hopeful that the infusion tonight of the matched platelets will spark a dramatic improvement. If the platelets have the desired effect than fluid can be removed from her lungs allowing her to breathe freely.

The symptoms are beating her down but she has the heart of a lion and is holding her own.

Spring/Summer Hospital Stay Day 10 Comment #3

May 26, 2016

Matching platelets have been found and will be infused tonight!!! The news brought a magnificent ray of sunshine in to an otherwise cloudy, tough day.

Love you Angela Bursler

Spring/Summer Hospital Stay Day 10 Comment #2

May 26, 2016

Walked in on Angela Bursler in the middle of an emotional breakdown. The doctor just told her that there is a possibility that she may be released for Kyle's graduation only to have to return immediately thereafter. Her only thought is of her in a wheelchair connected to Oxygen which is certainly not the look she wants for either herself or her son. We need to stay focused on best case scenario which is that the HLA matched platelets are found and infused by tomorrow allowing for the water from her lungs to be removed the following day. If it plays out that way than she could possibly be discharged this weekend. A more realistic release date falls somewhere in between best and worst case. The good news is that the platelet count held steady at eight (target is eleven) over the last twenty-four hours which is an indication that the bone marrow is restoring itself.

Spring/Summer Hospital Stay Day #10

May 26, 2016

A day that started out in dramatic fashion turned out to be pretty uneventful. The drama started when the resident physician preliminarily reported that the CAT scan of Angela Bursler head showed what appeared to be a spot on her brain. Unfortunately this information was conveyed to Angela before I arrived at the hospital so she was forced to digest it on her own. Unshaken by the news she went about her way until I arrived. When she told me of the report my jaw dropped to the floor but we both did our best to stay composed. We discussed it a bit but eventually let it go by the wayside. It wasn't long after I arrived that we were told by the doctor that a final analysis of the scan by the radiologist and attending physician indicated that the scan was negative and there were no spots. Big sigh of relief!

After this bit of excitement the rest of the day was calm and as I said before somewhat uneventful.

The majority of her symptoms that prompted her visit to the ER last Tuesday have been successfully treated. i.e. fevers have subsided, blood pressure is controlled and headaches are few and far between. She is, however, still experiencing shortness of breath and bloating caused by the introduction of IV fluids. unfortunately hydrating her body is a necessary evil to keep her kidneys healthy. In spite of her level of discomfort (weight gain 20 lbs) doctors will not approve the use of a diuretic as it could negatively impact kidney functionality. Angela is expected to manage through these issues until her platelet count is restored at which time the use of Lasix will be approved and a pleural aspiration will be performed to remove water from her lungs.

The source of the majority of her symptoms (low platelet count) has not yet been treated however a plan is in place. Testing of the blood confirmed that her system has developed anti-bodies preventing the use of random platelets to spark bone marrow activity. The treatment moving forward is to specifically identify Angela's platelet type and with the assistance of the Red Cross attempt to find a match in blood banks across the Country. This process could take upwards of a couple of days to complete.

While we are playing the waiting game doctors will continue to do complete blood count tests and monitor her vitals. In fact, today, testing showed that her red blood cell count was less than seven prompting doctors to infuse another unit of red blood. The negative reaction she experienced with the infusion of the platelets has left her fearful of any type of infusion including red blood which has never caused a problem. After a long discussion it was agreed that she would accept the infusion if loaded up first with Benedryl, Zofran,Ativan and Tylenol first. The plan was executed to perfection and the infusion was completed with no ill effects.

A path out of the hospital is in clear view but timing really depends on how quickly the platelet compatibility study can be completed and her type located.

Her mood today was outstanding. She remains upbeat and confident that she will conquer this minor setback.

Spring/Summer Hospital Stay Day #9

May 25, 2016

After being told this morning by the resident physician that the CAT scan of Angela's head showed a spot on her brain the radiologist and attending physician said it was actually normal. Big sigh of relief. Now waiting for HLA matched platelets to be located. Testing confirmed that her system did indeed develop anti-bodies preventing just any old platelet from having an effect. Things are looking up!

Spring/Summer Hospital Stay Day #8

May 24th, 2016

As days go this was a good one. Angela Bursler was very alert today and for the most part in little pain. Fevers have essentially subsided and it appears as though that doctors have found a way to control her blood pressure through the use of another medication. That being said both temperature and pressure elevate during or immediately after platelets are transfused. My understanding is that it is not uncommon for this to happen during
this period of time so it is less of a concern for us.

Her headaches have continued prompting the doctors to to do a scan of her head. The infectious disease doctors had already ordered a scan of her sinuses so it was not a hard decision to make to check her entire head. The ID doctors theorize that the sinuses could potentially be infected as a result of damage to the soft tissue from the Chemo. Examination of her body also revealed a swollen, rigid left forearm. Some concern was expressed by the doctors of the potential for a blood clot to reside in that area. An ultrasound of the left arm was ordered to rule out that condition. The exam, otherwise, with the infectious disease doctors revealed nothing significant.

Angela also received a visit today from Dr. Burger's (Oncologist) assistant. She explained in detail the plan that was/has been developed to treat the condition preventing platelets from being produced. Unfortunately the plan included transfusions of two additional units of platelets a process that resulted in violent nausea and vomiting the last two attempts. The staff tweaked the pre-meds to include higher doses of anti-nausea medications and Benedryl and also extended the feed from one hour to two hours. The higher concentrations of pre-meds and the slower feed would prevent the violent reaction that she experienced previously. Once the two units of platelets are infused into her bloodstream samples will be taken to determine if her system is rejecting the platelets. As I mentioned before if testing reveals antibodies are present than a compatibility study will be performed. Platelets matching her type will be located somewhere in the country and infused. If antibodies are not present (which doctors suspect) than the source of the problem is damaged bone marrow the cure for which is plain old time.

The issue with her lungs can not be addressed until her platelet count is restored to a normal value. There is too much risk of a bleedout by inserting a needle into the body of a person with low platelet counts. We are hopefully optimistic that the two units of platelets infused tonight will restore her count enough for the procedure to be done tomorrow.

She is very tired however her mood was very optimistic and upbeat today. Doctors may never find a cure for cancer but in the case of Angela pure 

Spring/Summer Hospital Stay Comment #6

May 23, 2016

Angela continues to be on a roller coaster ride of good days and bad with today being a bad day. She did not sleep well last night despite being give a dose of Ativan. Symptoms were not the source of her restlessness but instead just an inability to get comfortable. Six days of lying in a hospital bed can certainly contribute if not cause that effect.
Doctors are still attempting to determine if there is an underlying cause, aside from damage to her bone marrow that is preventing platelets from being produced. An objective today was to transfuse two units of platelets testing her counts one hour after each transfusion was complete. If there was movement in her platelet count or at least evidence of stabilization than there would be no need to deviate from the current plan however if the platelet count were to drop doctors would proceed with HLA testing (platelet compatibility study)
That was the plan however Angela’s body did not want to cooperate. Approximately thirty minutes into the first one hour transfusion she was overcome by severe nausea leading to a serious bout of vomiting. Once reported the transfusion was immediately stopped and Angela was treated with the best of care.

Unfortunately the entire unit of platelets had to be transfused to validate the study so the exercise proved to be unsuccessful. As the doctors regrouped in an attempt to understand why the transfusion resulted in such a violent reaction Angela was able to recall that she typically receives Benedryl prior to a transfusion of this type. When brought to the attention of the doctors they concurred that this could or would have prevented the nausea. A second attempt at introducing platelets into her blood stream is scheduled to occur later this evening/night with a plan to administer Benedryl.

The most bothersome symptoms are still shortness of breath and headache. Shortness of breath is attributed to pleural effusion (water on the lungs) and the headache is most likely a symptom of high blood pressure.

A CAT scan w/contrast revealed a moderate amount of fluid on both lungs confirmed by an ultrasound. The ultrasound also confirmed that there are pockets on both sides of the lungs where a needle can be safely inserted to remove the fluid. This procedure is scheduled to occur tomorrow pending a safe level of platelets can be maintained overnight. There is some concern that there could be an underlying factor causing the fluid buildup so once removed the fluid will be thoroughly tested.

Her blood pressure is a source of concern (at least to me) but the staff appears to be satisfied that it is stable even though high. Her BP remains stable at 155/93 however it peaked at 178/113 during her vomiting episode.

Headaches are being treated with Tylenol however when I brought it to the attention of the staff that it didn’t seem to be working they administered Oxycodone.

The most revealing comment of the day that describes Angela’s current mood is “I want this nightmare to be over”. Unfortunately we were told this morning that her stay in the hospital could extend another five to seven days. She is getting the best treatment in the world but she has had enough and I don’t blame her. She’s tough but even the toughest need a break.

Not whining about my feelings but observing her battle is the most difficult thing I have ever done in my life. I can’t fix this Angela Bursler but I love you very much we will get through this!