Making Excellent Progress

Marian was scheduled to see the nurse practitioner today, but we saw Dr. Flinn instead. I was glad. He said he is very pleased with Marian's recovery and her response to the CAL-101/Rituxan therapy. We will see him again Tuesday. And after that he will see her every two weeks in February. Once he is satisfied that she is fully recovered from the pneumonia, she will be able to resume four week intervals for office visits. After December 29, she was supposed to go from two week visits to four week visits. But then came pneumonia.

Dr. Flinn reduced her prednisone from 20 mg. to 8 mg. today, and said that he will probably discontinue it completely when he sees her Tuesday. She will continue on her current medications (anti-viral, anti-bacterials and anti-fungal) for two to three weeks, then discontinue some/continue others. But the number of prescriptions will definitely decrease over the next month. He said that nothing has grown from the cultures so far and he doesn't expect a fungal infection to be the cause of the pneumonia. He explained that the pneumonia could have resulted from a viral infection that made her vulnerable to a bacterial infection, resulting in the pneumonia. But there has been no positive result from any of the cultures thus far. Every result that has come back has been negative.

Marian seems a little stronger every day to me. She has lost about seven pounds since her hospital admission on the 6th and she was down two or three pounds from her normal weight prior to that. But her appetite is back and she's eating very well. So I expect her to be back to normal soon. On the way home from Nashville, we stopped and ate an early dinner at Fulin. And then we drove through Culver's and shared a hot fudge sundae. This was my first Culver's frozen custard, by the way, and I loved it. (I foresee more Culver's hot fudge sundaes in my future.) As we were eating the sundae, Marian said, "Their ice cream is so good in the summertime." And I said, "It's pretty good in the snow, too!"

I don't want to fail to mention the great results Marian has gotten from her treatment regimen. The CAL-101/Rituxan combination therapy has been very successful. Her lymph nodes responded first. And now her blood is showing more impressive results also.

Here are her numbers before treatment and four months into treatment.

September 21, 2010

WBC (White Blood Count):  53.8 (normal range: 3.8 - 10.8)
ALC (Absolute Lymphocytes):  43.3 (normal range: 0.85 - 4.1)
HGB (Hemoglobin): 11.5 (normal range: 13.8 - 17.2)
HCT (Hematocrit): 36.6 (normal range: 41 - 50)
Platelets: 92 (normal range: 130 - 400)


January 20, 2011

WBC:  20.8
ALC:  9.6
HGB:  13
HCT:  42.6
Platelets:  225

Dr. Flinn said today that he will probably have Marian resume CAL-101 at a lower dosage. Her clinical trial dosage is 150 mg. twice a day. But the attending physican does have some flexibility in adjusting individual doses over the course of therapy. John has had great results on the lowest dose of 50 mg. twice a day. But other patients have required higher doses. I believe the highest dose given has been 300 mg. twice a day (that's the highest dose I have personally read about). And, of course, one of the purposes of a clinical trial is to find the most effective dosage with the lowest toxicity. John's low dose is not effective for a lot of patients, but [thankfully] it has been for him.

I'm very excited about Marian's numbers. I told her tonight at dinner that I never thought she wasn't going to survive the pneumonia. I felt like she would pull through. But I DID wonder if this would be the beginning of a downward spiral for her. John and I talked about it because he had the same concerns. Dr. Flinn confirmed today that her condition was "scary" (when she told him that she had feared she was not going to get well). But she has made great strides in the last week, Dr. Flinn said he is very happy with her progress, and I believe she is going to have a full and complete recovery.

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