"Right, ready to meet your medication for induction therapy Jess" Doctor Leighton said seeing Jess exit the bathroom carrying the pouch to put back in her bag
"I guess so" Jess responded as she went to sit on her bed to listen to Doctor Leighton
"Right, so your cycle from now on is going to be 1 and 3, treatment daily for 1 week, then you'll have 3 weeks of no medication at all, that will be consistent from now on, through your induction, consolidation and maintenance phase" said Doctor Leighton explaining the new schedule
"But, how can I manage IV's for 7 days consecutive and still be active duty" Jess asked concerned, a 1 of here and there was okay, but 7 consecutive days every 4 weeks wouldn't work
"You can manage it, because you won't be having the IV's when you get back to the maintenance therapy, purely injections and oral medication, the IV's will only be used during the induction and consolidation phase of treatment" Doctor Leighton said assuring Jess that she wouldn't have to be having medication through IV when she went to maintenance therapy
"So she can take it in the field" Eric asked Doctor Leighton
"It will be fully portable, and prepackaged so there won't be any need for special precautions while handling it, you'll just need to be aware of how hydrated she is, that way the drugs are easier on the kidneys, let's focus on getting Jess through the induction phase first however" Doctor Leighton told Eric
"Don't want to get to ahead of ourselves" Jess said
"Symptoms you can expect, you'll be receiving 13 different medications over the next 7 days, 8 through IV and 5 through injection, plus 2 biophosphate style medications" Doctor Leighton said giving Jess a list of potential side effects grouped into 3 categories based on chance of occuring, more than 10%, less than 10% and less than 1%
"I've never had biophosphates before" Jess said
"I know you didn't, they're being used to help manage the risk of developing osteoporosis, we had to stop your hormone replacement therapy remember as your leiomyosarcoma tested positive for estrogen receptors and once you've had one estrogen positive tumour, your chances of another one developing is a lot higher, combined with the LFS mutation, it's not worth the risk in Doctor Ambrose's opinion" Doctor Leighton said reminding Jess of the conversation they'd had just after her surgery
"Who's Doctor Ambrose, that seems like a lot of medication" Trent asked not familiar with the name
"New head of the oncology department here at Bethesda" said Jess
"He's dealt with LFS before, which means he's got more experience than me or Doctor Pratt when he was here, he's left me in charge of Jess's case, but I am seeking guidance from him in my treatment decisions, and yes I know it seems like a lot of medication, but we need to make sure we're covering all our bases here, I've reduced some of the doses to prevent toxicity, and we'll be taking extra precautions with the added fluids and leukapharesis while she's undergoing induction therapy, and we'll be monitoring her blood work every 12 hours for any signs of complications" Doctor Leighton said explaining the precautions they were taking
"He's not taking over, this Doctor Ambrose" Ray asked
"How else am I supposed to learn if he takes all the interesting cases from the residents, besides his people skills aren't fantastic, he's a surgeon after all, by time he does all the consults, paperwork, supervision of the other residents, he doesn't want to be taking on patients of his own" Doctor Leighton said
"Fair point" Jason said seeing the doctors point
"You'll also be having a medication administered after you've finished each 7 day cycle of treatment, to help stimulate the body's production of white blood cells, combined with the immunotherapy, you should find it easier to recover between cycles, and not be dealing with the problems associated with a low white blood cell count" Doctor Leighton said, this would be another new medication, Jess hadn't been able to have it last time due to the timing of her treatments
"So she'll have a reasonable immune system" Trent asked, the low immune system from regular treatment was a concern as Jess didn't have the best immune system to start with
"You'll probably find it better than what you had after you lost your spleen in Djibouti, it won't be like it was before then however" Doctor Leighton said, this was not a magic fix by any means and she'd still need to be careful about picking up infection
"Still sounds good to me" Jess said, the mono had really knocked her the most the last week and a bit
"Thought it would, now these 2 are another addition I think you'll like, you'll need to have this one twice daily for the next week, then you'll go 3 times a day for 4 weeks, if you handle it okay, Doctor Masterson will switch to a XR formula that you need to have once a month, help at least minimise the risk of diarrhoea developing and the subsequent risk of dehydration that follows, this one is straight up 3 times a day while you're having your induction and consolidation treatment cycles, help control your nausea, outside of those times it's as required, we'll store them in in here so you get use to using them yourself" Doctor Leighton said producing 2 different injectapens
"Why not have her stick to her other antiemetic she's use to" Clay asked
"Because this one is stronger and doesn't carry the risk of fatigue like the other one does" Doctor Leighton said to him
"So why didn't you give her this one when she was injured first up" Clay followed up with asking
"Because it's not FDA approved for use in short bowel syndrome over here, it is however FDA approved for use in patients undergoing chemotherapy, Jess can now have access to it long term thanks to her LFS and needing ongoing treatment once she's back in remission, it also comes in dissolvable form you can place under the tongue for minor bouts of nausea, hold you over till you can have an injection" Doctor Leighton said explaining the reason for the change
"She can use them together safely" Trent asked curiously
"They're different strengths, but to be safe, take them no closer than an hour apart, that will give you time to assess whether the medication has worked, she can however take up to 3 of the tablets in a dose to bring it under control, you want to take them 30 minutes apart however" Doctor Leighton said
"So take 1, if she's not feeling any relief after 30 minutes, she can take a second, then a third still if it's not improving 30 minutes after the second dose" Trent asked wanting to make sure he understood the dosage instructions
"Exactly, now these 3 medications Jess, think of them as advanced recon scouts or whatever you call them these days, leukaemia and lymphoma cells are known to produce certain proteins, which your biopsies all tested positive for, this medication will work its way around the body and look for those proteins, when it finds any sign of any of the proteins in your cells, it will attach a marker so your immune system can easily find the cells and destroy them" Doctor Leighton said showing Jess another 3 injections
"I thought Bookworm couldn't do that, that's why she gets the cancer" Sonny said confused
"Her body has the ability to fight the damage, the problem is the tumour suppressor gene she's missing means there's nothing stopping the cells from multiplying out of control, and because of that her body can't recognise that it's faulty" Doctor Leighton told the Texan
"Because the gene that should be doing the job of telling my body what's going on doesn't work, but by leaving the markers it's telling my immune system that they need to be destroyed, right" Jess said looking at Doctor Leighton wanting to make sure she understood how the medication was supposed to work
"Right, then for good effect, we'll also be administering the drugs to seek out any cells that's fast growing, and deal with it by making it so it can't repair itself or function properly, leaving it with no choice but to die, we're throwing everything including the kitchen sink at this, get you back on track Jess" said Doctor Leighton, glad that Jess had some understanding of how her medications were designed to work
"So how long are those for" Luca asked looking at Doctor Leighton, Trent had been right, there were a lot more medications this time around
"This one is for the next 7 days, 5 days for these 2, this is 24 hours, we're going to keep the fluids going for 24 hours over the next 7 days, the other IV's that are due first day of your cycle, we'll run your TPN for the 12 hours, then we'll run the other 4 medications will only take 3 hours to run, so we'll run them as soon as the TPN is finished, then we'll reconnect the TPN, the other days we'll have a spare port, now you've also got to inject this one every 24 hours for the next week, and this one is for the first 5 days only, the other injections are once of only" Doctor Leighton said pointing to the various medications
"So I'm going to be dragging the IV pole everywhere I go for the next 7 days" Jess said looking slightly disheartened, last time she had induction therapy, her longest hooked up to the IV pole was 27 hours before she could disconnect and take a break
"Can't be helped I'm afraid this time, you'll still be able to shower and change, just get one of the nurses to help you, should take a few hours before the side effects kick in if you want to get some decent sleep" Doctor Leighton said
"Wouldn't hurt to do that cuddle bug, I've got the emesis bags on standby already, as soon as any nausea hits" Luca said, side effects usually started 6 hours after treatment started last time, this time being different circumstances, the timeframe could be different
"Now, before I hook up the IV pole, do you want to change your top, something that either buttons up at the front, or go for a singlet top with adjustable shoulder straps, so it's easier to change if you have a accident, just why you're having the continuous treatment" Doctor Leighton said making the suggestion, if she had a top with adjustable straps, she could push it down over her abdominal area to get out of it if she needed to change her top
"That's not a bad idea Jess, you're going to be feeling miserable by the looks of this, might pay to put on a bag as well, in case the diarrhoea medication doesn't work straight away" Trent said making the suggestion to ensure Jess wouldn't have to move to much unless she absolutely wanted to
"Trent's right with this cuddle bug, moving around is going to be hard for you the next few days while this kicks in, so the less you are moving around, the more comfortable you'll be, you can't hide under the baggy tops forever, your brother's are going to see the scars eventually" Luca said making it clear he supported Trent's suggestion
"You can always wrap your robe around if you're not comfortable with the fact we could possibly see them" Trent said guessing the scars that Luca was referring to the scars that had been left where Jess had had her breasts removed
"Or keep a blanket covering your shoulders, you've got extras" Luca said pleased to have them on hand now
"No, it's fine, don't want to many layers on" Jess said finding a singlet in her bag that had adjustable spaghetti straps to put on, she also grabbed what looked like a toiletry bag to take in with her
"You worried about getting to warm" Luca asked his wife
"Little bit" Jess said as she went to change top in private
"Won't the medication stop her from getting sick and the diarrhoea" Brock asked looking at Doctor Leighton
"Medication isn't always guaranteed to work unfortunately and it can take time to work, it's trial and error, that's why we're keeping her put for the moment, and why she'll be having her consolidation therapy in here as well" Doctor Leighton said explaining that Jess would be having both phases of treatment in the hospital
"So she's here till then" Brock asked again, that would put her in hospital for Zah's swimming competition
"No, we plan to discharge her in 2 weeks probably, or just before, let her have 2 weeks at home in her own bed, providing there's been no serious complications develop, then we'll bring her back in for the next round of treatment, all goes well it will be a round of consolidation treatment, discharge her again a few days after she's finished, then she should be able to return to duty when she feels ready" Doctor Leighton said explaining the timetable she had in mind
"So potentially we could see her back before we head to Australia to run the training course" Clay asked hopefully looking at Eric
"Which would also mean having Bookworm back for deployment if that happens" Sonny added also looking at Eric hopefully
"What's the chances of that happening Doctor Leighton" asked Eric looking at Doctor Leighton for an answer
"If we get remission first try, which I'm confident that is what will happen, extremely high" Doctor Leighton said confidentiality, hearing Doctor Leighton say she was confident that Jess could be back on duty quicker than they all realised, had put a spring in all their steps
"Alright Jess, let's get you back in bed, get this show started" Jason said pulling the blanket back so Jess could get in, once she was settled in Doctor Leighton handed Jess a tub containing all the injections she was supposed to have for the first day of her treatment why she set all the IV's up on the pole with the appropriate pumps, as well as the feeding pump, ready to hook everything up as soon as Jess finished administering the injections
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