Hi! It's been a big day for me: I had my first blood transfusion! : ) As I mentioned in my previous email, fatigue has been nagging me since I had my most recent ipilimumab infusion. And the fatigue has increased significantly in the last week. I was so tired last night that I had to prop my arm up on a pillow just to read a book. After two hours of sleep last night--which probably sounds quite indulgent to Kelly, who didn't get any sleep at all because of my tossing and turning all night (sorry honey!)--I felt even weaker this morning.
Fortunately, I had my appointment with the palliative care team this morning. After explaining my medical history to them, they said they thought my problem was anemia. The doctors performed a few old school tests for anemia--pinching my fingernails, taking my blood pressure while sitting and standing and laying down--and then ordered a blood count. A normal, healthy male will have a hemoglobin count between 15 and 18. Mine was 7.5. The solution to this deficiency is a blood transfusion. Thankfully, Froedtert Hospital is equipped to handle such a situation, and I was admitted to the hospital for an in-patient blood transfusion.
I didn't know what to expect from the transfusion. Blood transfusions get a lot of bad press and do carry some risk, but generally speaking my transfusion was more or less just like all of the other infusions I've had. They put me in a chemo suite (a three-sided room that opens to a central nurses station), tapped in an IV, hung the first of two bags of blood I received, and gave me the remote control to the tiny TV hanging in the corner. A nurse checked my blood pressure every 15 minutes or so to make sure I didn't have an allergic reaction. Otherwise, I just sat there in my recliner and rested. After about four hours, the transfusion was complete and I was released to come home.
According to the doctors and nurses, the transfusion should have an immediate effect on my fatigue. I think they were right. I certainly feel better tonight than I did last night or this morning. I will go in for blood tests tomorrow and have my counts checked. A nurse said my hemoglobin count could be as high as 9 by tomorrow, which is still quite low but a marked improvement nevertheless.
The doctors could not say for certain why I have anemia, but the likely culprit is my clinical trial medication: ipilimumab, aka antiCTLA-4. Hopefully the transfusion will alleviate some of the fatigue. Most of the pain I had been feeling lately is gone, and I can sleep on my sides and stomach again. I take that as a good sign. Dr. Richards, who I meet with on Monday in Chicago, will probably be able to provide more information about all of this stuff. The doctors today couldn't offer much help because they are not familiar with my clinical trial and therefore do not know much about how it works. I'll post another blog after meeting with him.
Before I end this blog, though, I need to give a big THANKS to Grace, one of our babysitters, for watching the kids all day on short notice. And to the kids themselves for being so patient and helpful to me during all this. And to Kelly, for everything she has to bear and endure because of my melanoma. I'm continuously amazed by her ability keep our lives as normal as possible in the middle of a cancer war zone. A blood transfusion seems easy in comparison.