Progress Note Friday July 1st, 2011

Jodi is finishing up week 2 in the hospital. It was a great first week, but there have been some tougher days during this 2nd week. She and Ed and our entire family are grateful for all the blessings and loving care she has received from the doctors and staff on the Stem Cell Unit. 

Monday and Tuesday of last week she received her high dose chemo as discussed and did not have too many ill effects. She had some fatigue and tiredness but no expressed increase in fatigue. She did not experience any bone pain or much nausea and no vomiting. Then on Wednesday 6/22 she had her infusion of autologous stem cells (her transplant) as discussed in the previous posting.

Her first week went well and her 2^nd week has been good; however, she is finally starting to feel some of the negative side effects which are the results of both the cancer and the medications.

Tuesday of this week, 6/28, she awoke in the morning with a “sore throat” which was actually the beginning of her mouth sores  and other related symptoms. She has had some rough days this week but has continued to respond to the treatment as expected and in a positive way -- in fact, better than expected.   The side effects are not particularly dangerous or unexpected with her treatment, but they are uncomfortable.

I will explain: There are 3 real side effects from the high-dose chemotherapy Jodi received as preparation for her transplant. The major side effects are Stomatitis, Esophagitis, Mucositis.

·      Stomatitis refers to inflammation in the mouth

·      Esophagitis refers to inflammation of esophagus.

·      Mucositis refers to all mucous linings.

These are all caused by the same thing: the high dose chemotherapy which was given to rid Jodi’s body of all remaining cancerous cells prior to introducing here stem cell transplant. The medication works by attacking rapidly dividing cells which is exactly what cancerous cells are doing. The chemo is designed to target only rapidly dividing cells, so in theory, it attacks only the cancerous cells.

This is great, right? For the most part yes! The only problem is that we have several areas in our body where health cells divide rapidly.  For example any mucous membrane has rapidly dividing cells as a normal function of these linings. Our mouth, esophagus and intestines are all lined with a membrane of rapidly dividing cells. This allows these areas to rapidly turn over cells, heal quickly and provide a great layer to exchange nutrients and absorb things our body needs as well as rid the body of waste products and keep our body’s healthy.

Normally these cells rapidly divide without any issue, and we are unaware of the cells going about their jobs keeping us alive and healthy. However when high-dose chemotherapy is introduced, it targets all rapidly dividing cells including these normal mucosal cells. Many patients will have extreme side effects that can actually indirectly cause further complications making for a miserable patient and poor outcomes.

Fortunately Jodi has not had these extreme side effects; however, she has had some rough days including what was expected as discussed above. She has had painful mouth sores,  diarrhea, and general discomfort. She also has continued weakness and fatigue (which she has had since the time of diagnosis at varying degrees). It has been worse this week, and with the added pleasures of mouth sores and other symptoms, it has been a long week.

If you were to call Jodi or Ed or get the pleasure visit her, you would never known.  She is upbeat and always smiling. She has been a true champion throughout these tougher days.  Of course all the staff comment and express how much they enjoy and love Jodi. She has won all of them over and many have relayed to me that she is their favorite patient, but any of you who know Jodi would have predicted this. This is the Jodi we all know and love.

As far as her response to the treatments, everything is on point for a good outcome. She has responded well in everyway. Her old bone marrow is now gone and her transplanted stem cells are just now starting to generate new healthy bone marrow, so she is on her way to a full new and healthy bone marrow. Currently the doctors are waiting for the white blood cells WBC’s to flourish and go up in number. This can take some time but the labs are trending in the right direction.

Last, Ed and Jodi are grateful for all the prayers, kind thoughts, phone calls, emails, letters, love and support from those of you who love them most. Both have told me individually that they really do feel the support and love. Thank you and keep the good vibes flowing. It is much appreciated.