Saturday, October 6, 2012

Day 112 - mean marrow tricks

Today opened with my nurse telling me that my ANC had gone DOWN, not up overnight. It was now 200. These things happen and, it turns out, the doctors were not entirely surprised, but no one had warned me so I sure was! Two days ago we were at 60 and if it had gone 60, 120, 150, 200 I would have been perfectly happy, but because it went higher than 200 and then came down, I was quite disappointed. I keep telling people that I expect tomorrow's ANC to be "G" or a small squirrel because that makes as much sense as it going down this morning.

At any rate, that meant I didn't get to go home today, but Terry and Emily came to visit me so that was nice. We just sat around and chatted and then they took me for a little walk. I used to be able to stride up and down the fifth floor really as many times as I wanted. Now I was able to do half of the usual cycle with a rest in the middle and that was about it. I could have pushed it further, but I don't think pushing myself is a good plan right now. I'm not training for the leukemic olympics anyway.

They went home and I read the Sept 26 JAMA which has a really good article in it on COPD that mentions prominently the importance of palliative care and the full range of treatments for breathlessness. Eva has been getting a lot of push back from primary care docs about using opioids for dyspnea which is actually not at all controversial among those who are up to date. It is nice to have a very recent mainstream journal supporting our POV.

The other article was really interesting except that it felt like it was missing a page. It is about a different way of aggregating clinical trials so that you can make comparisons between two agents that were not necessarily compared in any real trial (Multiple Treatment Comparison meta-analysis). Kind of like meta analyses, but cutting the data differently. It spent all this time in explaining how to tell if the conglomerate studies were valid, coherent, etc. but then I never could figure out how to tell the treatment effect sizes. You may be smarter than me, have better luck with it or maybe have a page my JAMA doesn't. I'd recommend both articles.

A tiny factoid that I realized a couple days ago and again today is how happy I am that I boarded two years ago in Hospice and Palliative Medicine when I had my first chance to board. If I had waited, I would have been scheduled to take the boards Thursday and Friday. I am not sure who would have been easier to convince: Dr. Hill that I needed to go take the test or the board that I couldn't possibly take the test and needed to be allowed to take it with the people who need special accomodations in Nov. I am glad I had to convince neither. I wish I had thought of it in time, but retroactive good luck to all the boarders.

I am really hoping for a big ANC jump tomorrow so I can go home! I am not sure what to hope for you. So, once again, I will hope you get something you have been wishing for for yourself.

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