Progression on Neutrophil Count

Neutrophil - A mature white cell that protects the body from pathogens.

Erika's neutrophil count has risen again from the previous 100 to 300 this morning. When she reaches 500, her body would be able to protect itself from common bacteria. This means that blast cells are actually maturing properly. The goal is low ration of blast to neutrophil cells. At this point we will not know what the ratio is of blast cells (immature white cells which is the leukemia cell) to neutrophils (mature white cells) until another bone marrow biopsy is done. So the chemotherapy is working. I know I may sound like a quack but I think the green smoothie helped as well.

Green Smoothie Anyone?

When Erika and I were dating, we both were off and on with our diets. We would follow a particular program and dropped it to start a new one (we all  have done this I'm sure). The one diet that I've always believed in but stopped for some reason were consuming more green leafed plants and fresh fruits and vegetables. My father, being a village farmer and medicine man back in Cambodia, always preached to my brother and I to eat mostly green plants and anything that is bitter. "The more bitter the better," he would say. I remember my first attempt in making a green smoothie, back when I was 24 or 25, I blended mint, basil, Chinese broccoli, and kale with bananas. Freaking disgusting. Do not attempt to mix those ingredients unless you want to practice your gag reflex. When I was dating Erika, I improved the taste of the green smoothie, at least for me, but Erika could not take it down, so we stopped.

Back in 2010 I remember watching a documentary called "Food Matters" and it was an eye opener. We both started to make green smoothies and increased our fruits and vegetables portion of our diet. But when you have so much love for meats, you'll end up falling back to your old habits and them delicious sweet and tangy baby back ribs were sunken back into my teeth (dang just thinking about it my mouth is salivating). Early last year in 2012, we watched another documentary called "Forks Over Knives," about two doctors who have done their own separate studies throughout their lives, one clinical and the other scientific, about the correlation between diet and cancer. This was another eye opener. Yet, our eyes stayed opened for a short period as usual, until now.

Organic bananas, mandarin orange, lemon juice, parsley, kale, celery, apple, two cups of Naked Juice Green Machine, two scoops of Amazing Grass Berry Super Green, and a cup of ice.

Sitting in the hospital chair, tired, exhausted, and feeling helpless that I can't do anything to help Erika, the idea of food as medicine came back. Everything my father has taught me, things I've read, and those two documentaries started to flow back into my mind. I whipped out my phone and watched both "Food Matters" and "Forks Over Knives" on Netflix. I can do something to help. I can help Erika with her diet. In Erika's room we now have a Vitamix blender. This Wednesday the 23rd, Erika decreased the amounts of meats and dairy in her meals. Her portions of fresh fruits and vegetables have dramatically increased. I made Erika her first green smoothie that same night. Yesterday we followed the same diet plan. 

Erika's red cell was always at a slow decline, neutrophils (immunity cells/white cells) was at a 0, and her platelets were also at a slow decline. This morning, the doctor came in with an excited tone of voice, told us that Erika's red cells have maintained count, platelets have increased slightly, and her neutrophils is now 100. Is this related to the increased fresh fruits and vegetables? Is it the green drink? Either way, we will continue with the diet in hopes that her blood count improves.

Result of a Possible Match of Bone Marrow

Erika's brother, Paul, came in two weeks ago to get a test done on his blood for a possible match of bone marrow. The result came in today and he is not. Erika has a rare combination of antigens in her blood. No one in the donor database is a match at the moment. Currently, it's too early to say whether she needs a transplant or not. She will need to be on chemotherapy for another 3-4 more months to determine if she needs one. Let hope she doesn't.

Here is a link to FAQs of being a donor. Bone Marrow Donor Registry.

Spinal Tap at Noon and Chemo of Vincristine After

Erika is now preparing herself for the 3rd spinal tap in about an hour. Two hours after recovering from the spinal tap she will then be receiving her does of chemo (vincristine).

Spinal Tap Tomorrow

Erika will be getting a platelet transfusion right before her spinal tap tomorrow.

Erika's Immunity

Normal flora of the human body are referring to the microorganisms that live on our skin by outcompeting harmful pathogens.

Erika's ANC (immunity-white cells) is officially at a 0. So she has absolutely no immunity. The only thing that is helping her fight off pathogens or even her normal flora (the once good kind of bacteria that will now do her harm) would be her constant antibiotics, antifungal, and antiviral via her central line daily.

Please be aware before visiting her at the hospital. Children are still off limits at the moment.

Thank Yous

Visits From Friends and Family

Erika with her grandma

Our niece and nephew

My brother, Tone

Awesome caring employees of Wasatch OBGYN but mostly friends

Erika's best friend in Utah, Emily (aka "friend" or "Em" to a select few)

Room Change

Erika has been moved to room 801 East 8th floor. She was given the option to move to a different room while there were vacancies. She chose this room for the size of the bathroom, the room itself, and the double windows.

Low Hermatocrit

This morning Erika's hermatocrit and platelets were low. She will be getting a blood transfusion again today. Thanks all those who donate blood.

MLL Gene Test Result

Pic stolen from some random site

Dr. Mitchell came today and told us that Erika's test was negative for the MLL gene. Therefore, the mutation were not caused by the Philadelphia nor the MLL gene. This means the possibility of a marrow transplant may not be necessary if her body is able to produce cells on her own. So far, with some of the bone marrow sample taken on the 6th of January, they were only able to culture and produce a total of 11 healthy cells (22-24 is ideal for a normal person). So currently her body is not capable to fully produce the normal amount of cells yet. We hope that after the chemotherapy things will get better.

Regarding the MRI spot, Dr. Mitchell said the discussion of the radiation amount on the cranium is still in debate (1200mg or 1800mg). A decision will be made once she gets closer to the Central Nervous System treatment phase, 2-3 months from now.

2nd test result of Spinal Tap

The result for the 2nd spinal tap, done on Monday, came back negative. So is the spot in the MRI of her brain evidence of leukemia? Will she still follow through with brain radiation treatment and risk the side effects, with the possibility of her not having any issues up there at all? Will she risk it by not having the treatment and it ends up being leukemia? We will see what the doctors conclude.

Very scary looking needle

This is not the exact x-ray machine, but a similar machine is used seconds before the needle goes in for an accurate placement

Shaolin Monk

Day 8 Chemo of Vincristine

Everything went well with her chemo treatment today (vincristine is the name of the chemo). There were no reactions or noticeable side effects.

Erika with her mom and dad

Taking a stroll before her chemo (Vincristine)

G.I. Erika and 2nd Spinal Tap

This morning Erika decided to buzz it all off with the help of her CNA.

The spinal tap was painful, but it had to be done. They put in another small dose of chemo into her spine. She said when they injected it, she felt tingling down her legs. Her spinal fluid looked like water. "I wanted to drink it" she said.

Day 8 & Haircut

Everyday for the next three weeks Erika will continue to take predisone three time a day. One of the side effects of taking predisone is high blood sugar. Two nights ago her blood sugar was 250. Last night it was up to 350. Today her highest was 450. She felt uneasy, jittery, and anxious. It's been rough for her because the nurse has to check her blood every two hours and inject insulin, to bring it down to a normal range (90-110). She can't get a good nights rest. Maybe tonight it'll be better after we do more walks in the hallway before she goes to bed.

Earlier today, her best friend Jennifer, from California, came out to give her a surprise visit. Jennifer assisted in braiding Erika's hair and chopping it. It was a good day.

Her Konkee playing with her hair

Day 7

Day 7

Today's chemo is asparaginase, given through intramuscular, four shots total, two on each side of her hip. To make sure her body doesn't reject it, they did a skin prick test of asparaginase an hour before they administer the chemo. She had no reaction. After they administered the full dose of the chemo she only felt a minor itch in her thighs. It subsided a few minutes later after walking it off.

Post Chemo of Day 6

It appears phenergan (aka promethazine), anti nausea, is doing its job well. After her does of chemo, she went straight to sleep. I'd rather it be like this then in pain.

Speaking of pain, so Erika was put on this pain pump when she was first admitted to the LDS hospital, where she holds a remote and pushes the button whenever she needs the medication dilaudid (aka hydromorphone). Today, for the first time, she was pain free for about an hour. The rest of the time today she was at a 2 or a 3 (scale from 0-10). So the pain Doc is going to take her off the pump today and put her on a pill three times a day so it's more consistent, since the IV version of the medication only stays in the system for 15 minutes. This is good news because that means the leukemia cells in the system is dying off fast. Hopefully she goes into remission very soon. Both Dr. Mitchell and Dr. Ash did say if she doesn't show any signs of leukemia they will follow through with the treatment as planned to make sure she doesn't relapse.

Day 5 & 6 of Chemo

I apologies for not having an update yesterday. I had to catch up on my sleep while Erika was asleep all through out the day yesterday. Her second day of chemo consisted of Prednisone (steroid for a total of 29 days) and Doxorubicin (just day 4 and 5). The side effect she felt mostly were from nausea. She was on a high does of anti-nausea medication which was why she was asleep all day. Other than that, she went through it all well.

Yesterday we got a visit from Dr. Ash. She is in charge of the Clinical Trial studied and organized by the Dana-Farber Cancer Institute (affiliated with Harvard Medical School), http://www.dana-farber.org. She gave us good news. After doing the second bone marrow biopsy, the lab found very low traces blast cells (the leukemia cells of ALL). Although, her concerns are the spot they found in the middle of her brain from the MRI over the weekend. The question is why did her spinal fluid show negative of leukemia when there is a spot in her brain? Normally, if there is leukemia up there, then there is leukemia down below in the spine. Because of this, they want to do another spinal tap next week on Monday to verify the data and throw in another small dose of chemo.

Dr. Ash  re-assured us that even though Erika opted in the clinical trial, she's in very good hands. Not only does she have all of the staffs support here at the LDS hospital, but she also has Doctors in Boston who are also watching her progress through the trial. There are a total of 114 spots for this trial. Erika was the 114th volunteer to take the last spot. http://en.wikipedia.org/wiki/Dana-Farber

Today, day 6 of chemo, she received a dose of Methotrexate along with another does of anti-nausea. We'll see how she does today.

"Hospital food sucks" Erika said.

The chemo in light sensitive bag.

RN, Nataliya, injecting the chemo.

Chemo going into the central line.

RN, forgetting to cover the chemo. It was only exposed for less than a minute.

Spinal tap test result

The fluids tested negative. There were no signs of leukemia in her spine.

Because her brain showed a small sign of leukemia from last weeks MRI, Dr. Mitchell will need to consult with her colleauges, out in Boston at Dana Farber, for a treatment plan of the brain.

Bone marrow biopsy

Erika was nervous for the biopsy today due to her experience at McKay Dee hospital done by Dr. Johnson last week. Her biopsy experience here at the LDS hospital, done by a PA, was so much better. She didnt feel any pain besides the initial poke for numbness. All went well. Next is chemo.

Hair or no hair

Erika will be losing her hair in about two weeks. She wants to know if she should keep her hair until a bunch falls off or should she just shave it off now?

Bone Marrow Biopsy and Chemo

My Sleeping Beauty resting with her buddy Konkee on her chest before the battle

Dr. Mitchell has ordered another bone marrow biopsy to be done this morning and Erika's first does of chemo into her blood system via the central line later in the afternoon.

Heading down for the spinal tap