I hesitate to do a blog entry until the end of the day. Too many things can happen in a very short period of time.
Today is no different. My blood work shows an alarming decrease in hemoglobin levels over the past few days, especially since starting the blood thinners on Monday - from 128 to 78. Eighty triggers an automatic decision for a blood transfusion, which is exactly what transpired over the past few hours.
But before we did the transfusion, I had to get a stool sample for an occult blood test. I have seen no blood in my stool, but the test was unequivocal - there is blood. So where is it coming from? Back in April 2006, I was hospitalized for vomiting blood, but we never did an upper GI tract scope test to confirm the suspected peptic ulcer. Certainly peptic ulcers can cause blood to appear in the stool, even without any apparent pain.
Also in April 2006, I was hospitalized for what we discovered was pulmonary embolii, most likely caused by clots travelling from deep veins in the legs. Initially we treated that with blood thinners, only to have a serious bleeding episode in which I bled profusely from the anus. That was certainly one of the most anxious moments in my life. We stopped the blood thinners and inserted an IVC filter to block any possible blood clots from the lower half of the body migrating to the lungs. Since then, I've had no apparent problems with clots, until this week.
So tomorrow - Friday - I'll be doing the upper GI scope test (technically a esphogogastroduodenoscopy) to see if we can spot a peptic ulcer or some other underlying condition to explain the occult blood in the stool and, by inference, the drop in hemoglobin levels (anaemia). I will prefer to be as sedated as possible for this one, happy to see just the still photographs afterwards and get the results for my file. My hope is that we can continue with the chemotherapy afterwards and still be discharged by the end of the day. If not, what's another weekend in hospital?
My oncologist seems as mystified as I am. But to be cautious, we will not only decrease the dosage of the FOLFIRI by 20%, we will not even treat with Avastin tomorrow, since Avastin can be responsible for both clotting and bleeding in metastatic colorectal cancer patients. One less variable to consider, I guess.
One positive development today was another meeting with the CCAC coordinator who just wanted to reassure my wife and me about our plans for an occupational therapist to visit us at home. They will cover initial costs associated with additional equipment for the home and extend that coverage as required. Depending on what happens with the tests and treatment tomorrow, we may also need twice daily CCAC home care nursing to administer blood thinners sub-cutaneously, at least until I feel confident in doing so myself (my abdomen has a lot of "space", so it will be awhile before we run out of places to stick the needle).
One other thing to look forward to tomorrow is having a shower in the hospital. It will be the first time in my life that I've ever taken a shower sitting on a chair. Whoohoo!