Who can say where the road goes
Where the day flows, only time
"Hello Mr. and Mrs. Salvatore. Please have a seat. I've had a chance to look over all of your labs and your biopsy results. You're a young man with no other medical problems. That's a very good thing. How are you feeling?"
Damon laces his fingers with mine, clearly needing purchase. "I feel much better actually. My breathing is back to normal. I did have another nosebleed this morning. Elena and I went for a walk yesterday. I was tired when we got home but I didn't feel too stressed. Can you talk to us about chemotherapy?" Damon asks, concern etched on his face.
"This first part of the chemotherapy is aimed at getting rid of all visible Leukemia. Age, health, and other factors clearly need to be taken into account when considering treatment options. In younger patients, such as yourself, induction chemo often involves treatment with two chemo drugs. Sometimes a third drug may need to given as well. Chemo is usually given in the hospital and lasts about a week. Induction chemo destroys most of the normal bone marrow cells as well as the Leukemia cells. Most patients develop dangerously low blood counts, and the patient may become very ill. Most need antibiotics and blood product transfusions. I know this is a lot to take in." She says before pausing.
Damon turns his attention to me, squeezes my hand, inhales deeply then turns his attention back to her. "Go on."
"There are drugs that can be used to raise your white blood cell counts. Blood counts tend to stay low for weeks. Usually, the patient stays in the hospital during this time. About one or two weeks after chemo is done, we'll do another bone marrow biopsy. It should show few bone marrow cells and only a few blasts. Over the next few weeks, normal bone marrow cells will return and start making new blood cells. We may need to check more bone marrow biopsies during that time. When your blood cell counts recover, we will check cells in a bone marrow sample to see if the Leukemia is in remission." She stops again letting Damon take it all in.
He's staring pointedly at the Dr. I can see traces of fear in his eyes. He closes his eyes and drops his head momentarily before raising his eyes to her once more.
"If the biopsy done a week or two after the chemo treatment shows that there are still Leukemia cells in the bone marrow, more chemo may be given. Sometimes a stem cell transplant is recommended at this point. When looking at the first bone marrow, if it isn't clear whether or not there are still leukemic cells, we will repeat the biopsy in another week or so. Induction chemo is considered successful if remission is achieved. Further treatment is then given to try to destroy any remaining Leukemia cells and help prevent a relapse. This is called consolidation. Consolidation chemo differs from Induction chemo in that only one drug is used but is given at very high doses. It's usually given over a five day period and repeated monthly for a total of three to four cycles," Dr. Mikaelson explained, matter of factly.
"This really is a lot to comprehend." He utters before repositioning himself in his chair.
"Another approach after successful induction therapy is a stem cell transplant. Patients receive very high doses of chemo drugs to destroy all of their bone marrow cells. This is followed by a stem cell transplant either with stem cells given by a donor or your own stem cells which in turn restore blood cell production. Stem cell transplants have been shown to reduce the risk of recurrence more than standard chemo. However, they are also more like to have serious complications including increased risk of death from the transplant itself," she elaborated. "Are your parents still alive? Do you have any siblings that would be willing to be tested for compatibility to be a donor for you?" she asks.
"My parents are still alive. They're in their early sixties and healthy as far as I know. I have an older sister and two older brothers. My brother Matt is a half brother. My Dad's first wife died very unexpectedly when he was still a baby."
"I'm going to schedule an outpatient surgery for you to have a port implanted. It's a thin, soft, hollow tube made of plastic. It's put into a vein in your chest. It has an opening just under the skin. This is called the port. The tube is usually is tunneled under the skin of your chest. One end of the tube goes into a large vein just above your heart. The other end connects with the port. You'll be able to see and feel a small bump underneath your skin. When you go into the hospital for your chemo, the nurse inserts a special needle into the port then aspirates or pulls back on the syringe to make sure we get a blood return. That will ensure the patency of the port. They'll infuse your chemo through that," she finishes. "Do you have any questions?"
"I think we're both kind of in shock right now, Dr. Mikaelson. Am I going to lose my hair? When I was a kid, a friend of my mom's was on chemo for lung cancer. I just remember her losing her hair and vomiting all the time? Is that pretty standard with chemotherapy in general? As you can see, Elena is pregnant. If treatment is successful, what about my fertility after chemotherapy and radiation? Is there any danger to the baby and what about sex?" Damon queries.
"Those are good questions. Yes, you will lose your hair. The good news is that it does grow back in most cases." She reassures.
"Elena should use a separate bathroom. It's important for Elena, other family members, even your nurses to avoid contact with body fluids during and for the first forty eight hours after treatment. This will help prevent accidental exposure to the chemotherapy medications. You should also avoid sexual activity or using condoms for that same time period. This will prevent potential medication exposure through semen and vaginal secretions."
"Chemotherapy and radiation can significantly affect your fertility. There is the option of freezing your sperm. It can be frozen and stored for future use in infertility treatment if you and Mrs. Salvatore desire more children in the future. These samples can be kept for twenty to thirty years. You might want to seriously think about this. I think it would be optimal to have some frozen before we start your cancer therapy. Should you decide you do want to do this. When you desire to use the sperm, Mrs. Salvatore would be artificially inseminated with your semen."
"I know this is a lot for the two of you to comprehend. I'm going to have my nurse schedule an outpatient surgery appointment for you to have that port placed. That is a relatively simple procedure. We'll get your first chemo scheduled as well. Do you have any other questions for me?" She says, eyes focusing on Damon.
"If I would need a stem cell transplant, what's the procedure for the donor? I wouldn't want to cause them any pain or disruption in their lives."
"This is another excellent question. We'll need to do blood work on them to check for compatibility. If your donor is approved, they will give themselves injections of Neupogen starting four days before the collection procedure. Neupogen is a drug that stimulates white blood cell production. That person will have to give themselves injections every day at the same time for five days in a row. The next step is the collection of the cells. They need to drink a lot of fluids. A central venous catheter will likely be placed. That is like the port you're going to receive but this is temporary whereas your port will be long term. The cell collection takes three to four hours for two to three days till the minimum number of cells is collected."
I glance at Damon as she's talking. I see him grip the chair tightly. I know he doesn't want to cause his family any pain or hardship. I also know that they wouldn't hesitate a moment to help him if they're able. I softly place my hand on his forearm, caressing gently. He looks at me for just a moment before turning his attention back to her.
"The collection process may take more than three days. We don't know. They may experience a decreased platelet count. Platelets help the clotting process. We'll check their blood each day while the procedure is ongoing to ensure it's safe to take the cells. They also may experience a tingling sensation due to fluctuation in their electrolytes. Those can easily be replaced by IV. Twenty four hours after the last collection, the central line will be removed. The collection department will follow up with them after all is said and done to make sure they're feeling well. Anything else you can think of right now?"
Damon shakes his head. "It's just all so overwhelming. I'm sure we'll have more questions but right now I can't think of any." Dr. Mikealson stands and offers her hand to shake.
"Come, I'll walk you out."
It's late in the evening by the time Damon and I finish discussing all the information Dr. Mikaelson laid on us. Damon, weary from the stress of the day, tells me he's going to take a shower and go to sleep. He's been in there a long time so I go to check on him. My heart breaks when I see him curled up at the bottom of the shower stall, sobbing uncontrollably. Without bothering to undress, I step under the hot water, wrap my arms around him and pull him tightly to my bosom. "I love you Damon." I whisper over and over.
A special thanks to Eva. Thank you for all your reviews, follows and favorites. Don't forget to push that review button. Have a lovely day, evening wherever you may be.