Month: September 2013

Drug Interaction – 2013 Style

My mom recently developed a blister at the location of the PICC line dressing. The nurse on call mentioned she may want to take Benadryl to help with what she believes to be an allergic reaction to the dressing. Since she was not sure if Benadryl would interact with any of my mom’s current drugs, she told me to call her pharmacist. While on call with the pharmacist, I decided to just do a quick Google search for drug interactions, since this is a problem that can easily be solved with a database. The internet comes through once again! Thanks Medscape. Before the CVS pharmacist came back on the line, I already had my answer about Benadryl.  I wonder if she used a similar site to look up the information she recited to me over the phone.  That said, I did not know about the other interactions!  Neither the doctor nor the pharmacy warned us about these other problems with an increase in OTc intervals.

http://reference.medscape.com/drug-interactionchecker

Drug Interactions

Blood samples from Vietnam have arrived!!!

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After much work and anticipation, coordinating with hospitals and shipping companies Vietnam, my mom’s five siblings were finally able to get their blood samples shipped in the kits provided by City of Hope!  According the FedEx tracking, the samples arrived safely at City of Hope today at 9:41am Pacific.  I am so incredibly excited that all eight of my mom’s siblings’ blood samples have arrived at the HLA typing lab at City of Hope.  Now we wait for the matching process!  Dr. Salhotra has indicated that each sibling is about a 25% chance of a match.  With eight siblings, that’s a chance of two matches!

PICC Line and Dressing

A PICC line is a Peripherally Inserted Central Catheter. Many chemotherapy patients have a PICC line put into their arm to make it easy to draw blood and give medicine without constantly pricking the patient. It’s great. The downsides include living with tubes sticking out of your arm and also the slight risk of infection at home. The PICC line dressing needs to be changed each week. The PICC Line even has its own sterilized cleaning it. It is serious business! There is nothing really holding the PICC line in besides the dressing so it is critical that the dressing is done properly. My mom has had a PICC line in her arm since her first admission into the hospital. They took it out when she left St. Josephs, but put it right back in again at City of Hope. She has never had any issues. This last time, however, she felt some irritation when the nurse cleaned it. The irritation just recently turned into a blister about the size of an inch. The triage nurse on call at City of Hope does not think it is a big deal, but since my mom’s white blood counts are dropping and infections are harder to cure, I emailed her doctor to check if we should do something about the blister. We went to a chemotherapy class a few weeks ago at City of Hope and the nurse emphasize that nothing is ever too small for chemo patients, so we are giving everything, even a 1 inch blister, attention!

Below is a photo of the PICC line and dressing right after my mom had it put in. They also gave her a waterproof arm cuff to wear in the shower. Apparently some people also take it swimming!
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Electronic Personal Health Record

Five years ago, I worked at Google on the Google Health team.  Google Health was a Personal Health Record product.  It was retired in 2012.  The Google Health team wanted to find a way to use its talents with information, connecting people and technology to empower users with electronic ways of managing their own personal health records.  There was as lot of healthcare and tech talent of the team, many who were very passionate about healthcare.  Some of this passion came from having to go through the healthcare system themselves and handed stacks and stacks of paper.  Today, five years later, we are still handed stacks of paper.  It is so easy for me to go electronic with  my credit card company and even my healthcare insurance company.  Everything is electronic – bills, insurance claims, notices, etc.  However, the medical record itself still lives in the world of paper.  While working at IBM on teams that build data warehouses for hospitals, I got to see first hand the plethora of data that hospitals store on their patients. This data is stored in systems like Epic and Meditech.  The major hospitals have Electronic Health Records.  However, the link between those electronic health records and patients’ access is still broken.  There are many start-ups now trying to solve this problem.

For now, I am trying various different Personal Health Record (PHR) tools.  The product of choice at the moment is No More Clipboard, recommended by an IBM colleague.  The user interface is not great, it is not intuitive or easy to add new medications and procedures, but is most certainly is better than nothing!  The entire time I am adding my mom’s medications, chemotherapy schedule and procedures, I can’t help but think: “All this stuff is already in a database!  Why can’t I just 1) have access to them directly on the provider sign or 2) have them pushed to my profile?!”

I have always been very passionate about healthcare IT, but having a personal experience with something as involved as cancer, I now truly understand the urgency and passion from some of my past colleagues.

HLA Typing – Sending Blood Abroad!

Thank goodness for siblings!  My mom has 8 healthy brothers and sisters.  This means lots of blood tests and Human Leukocyte Antigen (HLA) typing to determine a stem cell match.  Each sibling is required to provide two very carefully labeled tubes of blood.  Each tube is 10cc, for a total of 20cc per person.  Since five of the siblings are in Vietnam, the HLA Typing lab in California sent five testing kits to Vietnam.   Each kit has 2 tubes, 1 Instruction Sheet and 1 “Return of Specimen” form.  The forms are included in this post.  If the tubes are not properly labeled, the blood is rejected. There are specific instructions to not cool or refrigerate the samples.  The samples are required to make it to the HLA typing office in less than 7 days. I called our family to translate all the instructions.  All five siblings met at the hospital to have their blood drawn but left to go home for the following reasons:

  • The clinic’s office said they need to go get cooling gel to keep in the packages to keep the blood cold.  This is incorrect.  Must be at room temperature!
  • The contacted the local post office and they refused to send any blood.  They then asked FedEx and DHL.  Both carriers only allow blood samples from one specific hospital in Ho Chi Minh City.  So the siblings would have to go there to get their blood drawn and FedEx would have to pick it up.

We cleared up all misunderstanding!  Tomorrow, my aunts and uncles will go to the main hospital in Ho Chi Minh City that has partnerships with FedEx and DHL.  After getting their blood drawn, they will label everything and return everything properly packaged via overnight mail back to the United States.  It has been a very interesting experience of translating and learning about localization and shipping rules in each country!

Mailing Instr – HLA Testing kit – Current-Blood Return of Specimen Form

Return of Specimen Form

CNS prophylaxis – preventative measures for the CNS and Brain

When my mom first got chemotherapy, we were told that at one point, a CNS prophylaxis would be done.  This is chemotherapy given to the central nervous system (CNS) as a preventative treatment.  A lumbar puncture (also known as a spinal tap) is performed and chemotherapy is inserted into her spine.  The reason they do this is because there is a barrier that prevents normal chemotherapy from entering the spine and brain.  I guess “Go Brain!” for protecting itself.  Our first doctor, Dr. Grant Lewis, indicated that most times with Adult Acute Lymphoblastic Leukemia patients, a CNS prophylaxis is done even if no cancer has been detected in the brain or spinal cord.  It is for preventative measure since cancer presence in the central nervous system is quite a critical affair.

My mom was originally scheduled to have the lumbar puncture and CNS prophylaxis tomorrow.  However, presence of blasts (bad white blood cells) in her peripheral blood stream has halted this procedure.  The team of doctors at City of Hope have “concern of seeding the CNS ( due to presence of leukemic blasts in Peripheral blood).”  Also, Hyper CVAD Part B includes two drugs, methotrexate and cytatabine, that enter the brain and CNS, so the CNS prophylaxis is not currently needed.  She will have her CT scan on Friday and will be admitted for her 2nd round of chemotherapy on Monday.  While all this happens, her siblings will be tested for stem cell match.  If there is a match, the transplant will probably happen in 2 months, after chemotherapy cycle 2 (called Hyper CVAD Part B) and satisfactory remission.

Heme and Non-Heme Iron

One of the many side effects of chemotherapy is anemia.  Since the chemo is killing all blood cells, good and bad, the body oftentimes does not have enough red blood cells (RBC).  When the hemoglobin level reaches below 8 g/dL, my mom needs a blood transfusion.  Therefore, I looked up foods that might help with keeping her hemoglobin at a somewhat normal level, which is 12-15 g/dL in adult females.  This was when I learned about Heme and Non-Heme iron.  There are many different kinds of food that contain iron.  The heme type is more easily absorbed by the body.  This type includes chicken liver, clams and beef.  The non-heme type includes the veggies, beans and cereal.  We have to balance this list out with what is actually good and not good for a chemotherapy, cancer patient!  No wonder the hospital provides dietitians.  There so many different factors to a chemo patient’s diet!

  Heme iron Non-heme iron
What is it? Heme iron is found in foods that contained hemoglobin – animal foods including red meats, fish and poultry.

 

Non-heme iron is the form of iron found in all other, non-meat based foods.
Iron sources in food

 

A serving of chicken livers, clams, or roasted beef tenderloin contains all the iron you need for a day.

 

 

Non-heme iron can be found in vegetables, grains, iron-fortified breakfast cereal, lentils and beans.

 

Iron absorption

 

One of the biggest benefits is that heme iron is absorbed better than non-heme iron, andits absorption isn’t affected by anything else you eat. We absorb approximately 15-35% of the heme iron we eat, which is a lot!

 

Non-heme iron is not absorbed by the body as well as heme iron. Only 2 – 20% of non-heme iron is absorbed.

 

City of Hope Day!

It is the long awaited day of our City of Hope appointment!  City of Hope is ranked as the #15 best Cancer Center in the United States by U.S. News Rankings and is also one of the NCCN’s 23 hospitals.

To get to this day, my mom went through 25 days of inpatient at St. Joseph’s in Savannah, braved nadir during her first round of chemotherapy without getting sick, got successfully discharged and flew the 4 hour flight (like a rock star) from Georgia to California!  She will have some lab work, we will meet with the doctor and explore the facility.  Our discussions will include the following:

  • Future chemotherapy
  • Autologous vs Allogeneic stem cell transplant – most likely Allogeneic.  More about this in another most.  Auto is from your own stem cells; Allo is from another person’s stem cells
  • CNS Prophylaxis
  • Treatment at a local hospital in partnership with City of Hope
  • Complete Blood Counts

Wish us luck!  Thank you for all the support thus far.

We will get there a little early and hopefully get to explore some of their beautiful healing gardens!  Here’s to a healthy mind, spirit and body!

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T-Cell Therapy to fight Acute Lymphoblastic Leukemia

Several weeks ago, I was sent an article about T Cell Therapy for the treatment of Acute Lymphoblastic Leukemia (ALL).  Coincidently, City of Hope, my mom’s new center, was also at the forefront of testing this type of therapy!  I was very excited to see this interview.  Below is a blurb about this new form of therapy:

The experimental treatment involves isolating infection-fighting T cells from the bloodstream, genetically altering them with a disabled virus, then re-injecting the cells into the body. The virus essentially reprograms the T cells to recognize and attack cancer cells. Unlike traditional chemotherapy, which kills both healthy and harmful cells, this new technology allows the immune system to seek out and destroy cancer cells, without damaging the body’s healthy cells.

Here is a direct link to the interview with the CEO of City of Hope, Dr. Michael Friedman:

http://www.thedoctorstv.com/main/content/T_Cell_Therapy

We will talk to our doctor today about treatment types.  It will probably NOT be this new T Cell Therapy, but it was very exciting to me to learn that my mom’s new cancer home is at the forefront of ALL treatment!

Sally the Adventure Dog

Sally flew to California to live with my aunt a few weeks before my mom was discharged.  When we arrived Wednesday, we were excited to be greeted by Sally.  However, when we arrived, we realized that right after taking a bath and not having a collar, Sally decided to sneak out and go on a tour of her new California neighborhood!  Maybe she’s having a mid-life crisis.  Since pets are known to leave their new homes for their old homes, we were a little concerned.  We checked local shelters and put up signs.  The next morning, a neighbor called and said he picked her up after he saw her crossing the street, braving the traffic and hanging out at a house that wasn’t hers.   Turns out she just felt like going on a little unannounced adventure.

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