Sunday, June 18, 2006

Day + 4 Happy Father's Day

Day 4

Jordan’s Levels Normal Range
Weight 52.2
WBC 0.05 3.84 to 9.84
Hemoglobin 10.7 10.8 to 13.3
Platelet Count 31 175 to 345

Today is Father’s Day. Jordan was feeling a little uneasy this morning when she got up to take a shower. After finishing the shower and relaxing for a bit, she felt much better and was able to eat some breakfast.

Saturday, June 17, 2006

Day + 3

Day 3

Jordan’s Levels Normal Range
Weight 52.8
WBC 0.09 3.84 to 9.84
Hemoglobin 10.5 10.8 to 13.3
Platelet Count 67 175 to 345

Jordan did fairly well today. I got here this morning around 9am, Donna had spent the last couple of days and nights with her. The Marinol helped her nausea quite a bit. She didn’t get sick at all today, and was in good spirits.

Friday, June 16, 2006

Day + 2

Day 2

Jordan’s Levels Normal Range
Weight 53.4
WBC 0.16 3.84 to 9.84
Hemoglobin 10.8 10.8 to 13.3
Platelet Count 32 175 to 345

Her blood pressure is fairly high today and Dr. Neider is going to give her Norvasc. She had this same problem during a previous chemo session when they gave her a steroid. Steriods seem to elevate her blood pressure, which is quite common.

She received a platelet transfusion today, the first of many to come until her counts recover.

Thursday, June 15, 2006

Day + 1

Day 1

Jordan’s Levels Normal Range
Weight 54.8
WBC 0.33 3.84 to 9.84
Hemoglobin 11 10.8 to 13.3
Platelet Count 40 175 to 345

Jordan was given Cefapine today and within a couple of hours broke out in red blotches on her knees and elbows. It does not itch, but they suspect it is an allergic reaction to the Cefapine, which she has had many times before now. They gave her Benadryl to correct the reaction. The transplant will cause changes in her bodies reaction to numerous things, including allergic reactions to things she might not have been allergic to in the past.

She has very bad diarrhea which is also common during transplant. She tested positive for C-Diff which is a normal bacteria that we all carry around, but when you don’t have an immune system, it causes diarrhea.

She is still feeling terrible, lots of nausea and vomiting. She can’t keep any food down no matter how hard she tries. She’s losing more weight and she is resigning herself to having an NG Tube inserted into her nose that will go down to her stomach. They push nutrition through the tube and even some of her medications that are typically in pill form. They get them in liquid and use the tube instead of having her swallow it.

She did get a massage today, which she seemed to enjoy quite a bit.

She also got her first dose of Methotrexate today. This is a chemo drug that she will receive on Day 1,3,6, and 11. It’s a very small dose of only 15 mg used to suppress both her and the donor’s T-Cells to help prevent rejection.

Wednesday, June 14, 2006

Day zero - TRANSPLANT DAY!



We have prayed a lot for this day and continue to have faith that this will cure Jordan's illness.

Jordan’s Levels Normal Range
Weight 54.5
WBC 0.74 3.84 to 9.84
Hemoglobin 9.2 10.8 to 13.3
Platelet Count 51 175 to 345

Jordan’s counts have really dropped quite a bit now. She doesn’t need any blood products today for platelets or red blood cells.

Dr. Neider came in this morning and told us her transplant will be sometime around 1 or 1:30 today. They got a good yield and will be infusing her with 575 million stem cells.
They are also going to freeze 94 million stem cells in case she needs them later.

She is feeling better with the nausea, but is really down in the dumps emotionally. She was crying a bit this morning because she really doesn’t want to spend another 5 to 6 weeks in the hospital. We have to keep her busy, create a schedule and stick to it, even if she doesn’t want to.

The doctors and nurses have all told us how important it is for her to be as normal as possible, even though she cannot leave her room. She brought lots of stuff to do and now we need to push her to do it.

She has a stationary bike and yoga mat in her room. She did ride on the bike on Thursday and Friday, but hasn’t since then. Now that her nausea is under control, it’s time to get out of bed and get motivated. It’s easier said then done, but I think she will feel much better if she’s doing something and keeping busy.

We met another family last night that is a couple of doors down from Jordan. Their son Daniel Fernandez is getting his transplant today too. He is 19 and has ALL with the Philadelphia Chromosome. His donor is also un-related, it’s a 19 year old girl that came from the International Registry. I think Jordan’s donor must be in the U.S, because Mati never mentioned him being International. The only thing we know about her donor is that he is a 44 year old man with O Positive blood type.

The Marinol is really helping with her nausea. She also feels hungry which is a great sign. Making sure she eats well is also key to recovering from transplant. She doesn’t want to have an NG Tube inserted through her nose to her stomach and the only way to prevent that is to keep her nutrition up by eating regularly.

For some reason today, Jordan just is not excited about the transplant. She didn’t want her picture taken and just seemed like she didn’t want to participate in the excitement at all. I think she has a lot more anxiety than she will admit. She doesn’t really want to talk about it much and gives very short precise answers to all of us without any eye contact.

The infusion of the new marrow started at 2:15pm today. At 2:30 they slowed it down, because Jordan wasn’t feeling right. She started feeling warm and her throat felt like it had something stuck in it.

I talked more with Danny’s parents (Fernandez) today. We have so much in common with him and his family. He also presented with back pain prior to his diagnosis.

Donna stayed the night with Jordan tonight and will for the next couple of nights.

Tuesday, June 13, 2006

Day minus 1

Day -1

Jordan’s Levels Normal Range
Weight 55.6
WBC 3.07 3.84 to 9.84
Hemoglobin 9.2 10.8 to 13.3
Platelet Count 76 175 to 345


Today is Jordan’s last day of ATG. She started receiving FK506 today which helps prevent graft versus host disease. The FK506 will wipe out any T-cells she might still have and wipe out the donor’s as well so the new bone marrow doesn’t reject her body. There is still a big chance of getting GVH, but this drug helps minimize the chances.
She also started Diflucan today, which is an anti-fungal.

They gave her Marinol today for the nausea. It is a synthetic form of marijuana that prevents nausea and promotes appetite.

Monday, June 12, 2006

Day minus 2

Day -2

Jordan’s Levels Normal Range
Weight 56.2
WBC 8.77 3.84 to 9.84
Hemoglobin 10.2 10.8 to 13.3
Platelet Count 111 175 to 345

Jordan woke up this morning, feeling very tired. She had to get up every two hours last night, so she didn’t sleep very well. She is still feeling bad, but did finally drink some powerade and eat half a saltine cracker. They switched all her meds to IV if possible, but she still has about 4 or 5 pills that she has to take daily. They were concerned with her vomiting that she wouldn’t keep them in her system, especially the Dilantin to prevent any more seizures.

Sunday, June 11, 2006

Day minus 3

Day -3

Jordan’s Levels Normal Range
Weight 55.3
WBC 3.35 3.84 to 9.84
Hemoglobin 10.0 10.8 to 13.3
Platelet Count 173 175 to 345

Chemo day 5 – Cytoxan and ATG

Jordan is done with the Busulfan but will still take Dilantin for 48 hours afterwards, to continue to prevent seizures.

She had a rough day today, for the first time this hospital stay she is now feeling sick and throwing up. She did each lunch today, but didn’t eat anything else.

The Cytoxan requires her to get up every two hours and go pee. Cytoxan is known to cause bladder and kidney problems, so you cannot keep urine in your bladder, it must be expelled every two hours.

She will get Cytoxan for two days.

They also give her other meds to prevent bladder and kidney problems. It seems that all the chemo drugs have some possibility of bad side effects and yet they try to counteract them as much as they can with alternative drugs.

ATG is the rabbit serum. This drug has to be pre-medcated because it can cause a severe allegric reaction. They gave Jordan Benadryl, Tylenol, Atvian and Solu-Medrol (a steroid) prior to giving her the ATG. The ATG runs over an 8 hour period and during the first hour the nurse stays in her room and monitors her vitals every 15 minutes and titrates the does, speeding it up until it gets to the correct volume to run over the 8 hours.

Jordan’s vitals were stable and she didn’t have an allergic reaction to the ATG. She did spike a fever at around 9pm. Her fever was 102.8. The fever is a normal side effect from ATG. They did draw cultures per procedure, but don’t expect them to be positive for any bacteria.

Saturday, June 10, 2006

Day minus 4 - seizure

Day -4

Jordan’s Levels Normal Range
Weight 55.6
WBC 3.92 3.84 to 9.84
Hemoglobin 10.0 10.8 to 13.3
Platelet Count 185 175 to 345

Chemo day 4 – Busulfan (last day of Busulfan)

Jordan did pretty well today. She complained early on that she didn’t feel quite right. She felt a little dizzy when she would get up and at one point said she felt a little bit disoriented. Her stomach starting feeling sick this afternoon but she never became sick.

At about 12:30 tonight, Jordan got up to go to the bathroom. We had just settled in for the night after watching a movie. She was coming out of the bathroom and I was laying on my air mattress. I noticed she seemed to be getting closer and closer to the floor. It was hard to see, but there was just enough ambient light that I could see her. All of a sudden she fell to the floor. I jumped up and noticed she was having a seizure. I ran out of her room and there weren’t any nurses at the station. I ran to the other nurses station and found a single nurse entering a patient room. We ran back to Jordan’s room and found her nurse Denelle in the room too. Within about 20 seconds her room was completely filled with hospital staff.

The Busulfan commonly causes patients to have seizures. They give them a medicine called Dilantin to prevent seizures, but Jordan’s level of Dilantin was lower than it should be. They drew blood and determined her level was only 7.1. They gave her an IV injection of Dilantin of 500 mg and this brought up her level to 14.

She had been given 15 of her 16 doses of Busulfan when she had the seizure, so she only had one dose left this night at 3:45 a.m.

I didn’t go to sleep tonight I was so worried that she might have another seizure. Luckily, she did not.

Friday, June 9, 2006

Day minus 5

Day -5

Jordan’s Levels Normal Range
Weight 55.1 kg
WBC 3.35 3.84 to 9.84
Hemoglobin 8.6 10.8 to 13.3
Platelet Count 152 175 to 345

Chemo day 3 – Busulfan.

Today was uneventful. Jordan is still feeling very well. We got good news today. The PCR came back for the Philapdelpia Chromosome and it was negative. They were not able to detect the Philadelphia Chromosome in her bone marrow any longer. This means Jordan is in full remission, both from the Leukemia and the Philly Chromosome.

Thursday, June 8, 2006

Day minu 6

Day -6

Jordan’s Levels Normal Range
Weight 55.5 kg
WBC 4.56 3.84 to 9.84
Hemoglobin 9.7 10.8 to 13.3
Platelet Count 171 175 to 345

Chemo day 2 – Busulfan.

So far, so good. Jordan had an exercise bike added to her room today. She rode on it a little bit last night and did 2 miles on it this morning. The staff tells us that they have seen patients recover quicker if they are active and eating/drinking. They don’t want her laying in bed all day, doing nothing. She is determined to have a quick recovery, so she’s trying to get into good habits early.

The IV team came tonight and replaced her dressing and caps on the Broviac. This has to happen every 7 days as normal routine, but if the dressing comes off, gets wet, etc, it will be replaced sooner than 7 days. The nurse didn’t have the best bedside manner. The IV Team, does just that, places IV’s, changes dressings, etc. The nurses here do not do them, unless an IV Team member cannot be reached quick enough.

Wednesday, June 7, 2006

Day minus 7

Day -7

Jordan’s Levels Normal Range
Weight 55.1 kg
WBC 4.35 3.84 to 9.84
Hemoglobin 9.6 10.8 to 13.3
Platelet Count 158 175 to 345

Chemo Day 1 - Bulsulfan. Dr. Petrovic came in this morning and checked Jordan out before allowing the chemo to start. Jordan is in great spirits, feels great physically and is ready to get the show on the road. She’s happy it’s all taking place during the summer when she doesn’t have any classes to attend for school. However, she did bring 4 self study Advance Placement books to keep her occupied. She brought lots of other fun stuff to the hospital too, video games, laptop, ipod, books, gameboy, etc. She definitely is not technology challenged.

Dr. Petrovic gave us a little history lesson today on the BMTU. Apparently the first BMT ever done was in 1968 by a doctor named Goode. He performed this transplant on a child who was having immune problems. (bubble boy is how she said people recognize his illness). He gave the child a BMT and that person is still alive and well today, almost 40 years later.

Dr. Goode began the BMTU at All Children’s Hospital many years ago. Other hospitals have used the BMTU at ACH as a model on how to set up their units because this one has been so successful.

We also learned some sad news today. One of the other patients from St. Joseph’s that we knew, passed away recently. His name was Ovi Mendez and he actually came to ACH for a Bone Marrow Transplant (sometime in May I think). He started his treatment for the BMT (his brother was a perfect match) but he died on Day 8. I’m not clear if he died on his 8th day in the hospital of Day 8 after transplant. He died of multiple organ failure. He body could not withstand the treatment. He had developed Cancer when he was a young child, and was in remission but relapsed after 8 years. This was his second round and he had been through a lot of chemo, radiation and had encountered many awful side effects prior to preparing for transplant.

His dad was the Chief of Pediatric Medicine at St. Joseph’s several years ago, but has since been in private practice. We had spoken to him and his mom Donna many times during clinic visits.

I wasn’t completely surprised to hear Ovi had passed away. I knew something must have happened because when we toured the BMTU as part of our preparation, Ovi did not have a room up here. This seemed odd to me since I knew patients spent at least 4 weeks in the transplant room and it had only been about 2 weeks since Ovi had started treatment. I thought maybe he was in ICU, but didn’t find out what really happened until I talked to a nurse at St. Joseph’s today. We will pray for Ovi's family.

Jordan started the Bulsulfan today. This is the first chemo drug during transplant and it lasts for 4 days. This drug does not make you sick or have any other side effects. You basically don’t notice any difference when you receive it.

They are measuring everything she eats and drinks. It’s critical during transplant to keep hydrated and keep your nutrition levels as normal as possible. She doesn’t want to get a NG Tube in her nose, so she is focusing on eating every meal to keep her nutrition and hydration levels up.

Tuesday, June 6, 2006

Transplant Process begins

Jordan was admitted tonight to All Children’s Hopsital Bone Marrow Transplant Unit. (BMTU) She will spend at least the next 4 weeks here. Depending on how well her transplant goes, she could get released as early as 4 weeks after transplant, or some patients have spent as long as 3 months in the hospital.

She is not allowed to leave her room. The room is a specialized clean room with positive pressure on the door to prevent outside air from entering.

She was admitted tonight so she can start her chemo first thing in the morning tomorrow. She has 6 days of chemo, a day of rest and then transplant day.

The count down for transplant is measured in days. We begin at Day -7 and then go through for the first year. Day 0 is actual transplant day and Day 100 is a huge milestone.

Her pre-transplant drugs are Busulfan, Cytoxan and ATG.

She will be taking many other drugs to counter the possible side effects for these three as well as many drugs to prevent infection, etc.

Friday, June 2, 2006

Broviac surgery

Jordan was admitted to All Children’s Hospital today for short stay to have the Broviac placed in her right side. She still has a double lumen broviac which means it has two lines that can run different medications or products at the same time without interfering with each other. The surgery went well, but she was quite weepy afterwards. She said when she woke up, she was disoriented and I wasn’t in the room. They made me wait in the short stay area and I didn’t get to see her until she was fully recovered from the anesthesia.