Monday, May 28, 2007

Memorial Day 2007

By Mark A. Wright, HMC(SS)
22 June, 2000

I first saw him on a park bench
I've seen him every day
Sitting in a shady grove
Where my children come to play

Sometimes he feeds the birds and squirrels
Or whittles little toys
Sometimes he just sits and smiles
At the laughing girls and boys
And I never paid him any mind
'Till one day just this year
I noticed that he wore a frown
And on his cheek ... a tear.

Well I asked him why he seemed so down
He looked up, began to say
I lost half my friends 60 years ago today
He told me of the terror
As he fought to reach dry land
By the time the beachhead was secure
Half his friends lay in the sand

That was just in one long day
He fought on for 4 years more
And the 60 years from then to now
Have not dimmed His sights of war

He said they have reunions
Just to keep in touch and share
And for each comrade who has gone on
They leave an empty chair

Well, His park bench has been empty now
About 6 months or so
And if I'd never took the time
Then I never would've known
That sitting on that simple bench
With bread crumbs and little toys
Was a man who gave his all
To guarantee my daily joys

So give thanks to all the men and women
Who're still here or have gone before
And made the highest sacrifice
In both Peace time and in War
Because they bought our freedom
Paid their own blood, sweat, and tears
Then endured the heartache of those empty chairs
For all these years

So please do not ignore them
Or speed by without a care
'Cause you never know
When you might pass by
A hero, unaware

We owe a debt of gratitude to all the men and women who paid the ultimate price to secure our freedom and the freedom of others in different places in our world in many different wars. Originally this day was set aside to honor those who died in our Civil War. Now we honor all our war dead.

Since last Memorial Day, nearly 1,000 more men and women have lost thier lives in Iraq. No matter what your political beliefs or what you think of the war itself, we need to remember the mothers, fathers, brothers, sisters, children and other loved ones who are grieving for the loss of that precious life.

Unlearned Lesson

Memorial Day
Of every year
The little valiant
Flags appear
On every fallen
Soldier's grave--
Symbol of what
Each died to save.
And we who see
And still have breath--
Are we no wiser
For their death?

~Dorothy Brown Thompson~

Tuesday, May 15, 2007

Gee, IVIg for IgG

I had my oncology appointment last week and got all my blood test results. The CBC wasn’t changed too much from last month. Platelets dropped back down, and the lymphocytes went above normal. Here are the highlights with normal range in parentheses:

  • Absolute neutrophils 2.0 Low (3.0-7.0) (infection fighter)
  • Percent neutrophils 27.5 Low (40.0 – 74.0%)
  • Absolute lymph 4.5 High (1.0 – 4.0) (First time since chemo this is above normal)
  • Percent lymphs 62.4% High (19.0 – 48.0%)
  • RBC 4.46 Low (4.7 – 6.1) (This one got quite a bit better)
  • MCHC 36.8 High (32.0 – 36.0)
  • RDW 10.6 Low (11.0 – 15.0%)
  • Plts 106 Low (150 – 400) (good news is they are still above 100)

However, the big surprise was that my Immunoglobulin G (IgG or gamma globulin) level has dropped way out of normal range. My number was 438 and the normal range for my lab’s test is 723 – 1685. So what is IgG? Glad you asked. Here is an explanation from WebMD:

“IgG antibodies are found in all body fluids. They are the smallest but most abundant of the antibodies, normally comprising about 75% to 80% of all the antibodies in the body. IgG antibodies are considered the most important antibodies for fighting bacterial and viral infections.”

There are other antibodies such as IgA and IgM. However, I think IgG is the only one we can boost through medical intervention. Since this means that I am at quite an increased risk for infection because my immune system is quite compromised, the doctor has to decide when to intervene. The standard criteria for intervention are that the IgG level is below normal and the patient has had two or more infections in the last year. Hmm, guess I fit those criteria. Just since January I have had bronchitis, pneumonia, ear infection and a cold.

So, what is the treatment? Again, so glad you asked. The following is compiled from Wikipedia:

It is infusion of a product called IVIg, which just means intravenous immunoglobulin g. IVIG is an infusion of IgG antibodies only. Therefore, peripheral tissues that are defended mainly by IgA antibodies, such as the eyes, lungs, gut and urinary tract are not fully protected by the IVIG treatment.

FDA guidelines for IVIG state the product should be:

  • Prepared out of at least 10,000 different human donors.
  • All four IgG subgroups (1-4) should be present.
  • The IgG should maintain biological activity and lifetime of at least 21 days.
  • Does not contain samples which are HIV, hepatitis B, hepatitis C positive.
  • Screened and treated in a manner that destroys viruses.

Well, that all sounds just wonderful, so let’s go do it. Hold on, not so fast. There are some things to consider. First of all, it is VERY expensive. It is taken from plasma from donors and if you read above, 10,000 donors is a lot. (I have read elsewhere that it is taken from between 3,000 and 10,000 plasma donors.) Dr. Netaji said it is about $10,000 for the treatment. It can cost up to $90 per gram! However, Dr. Netaji said the insurance company reimburses him $15 per gram less than what it costs him. That means it would cost him a couple thousand dollars to treat me in his clinic. In order to get around this, he would send me to the hospital because the insurance company reimburses hospitals at a higher rate….sheesh!

The treatment is given over several hours and repeated for 2 to 5 days and then often repeated again at one to three month intervals until a satisfactory response is gained. So that means I could be in the hospital up to five days! The “common dose regime” is .2 to .4 grams of IVIg per kilogram of weight for four consecutive days to a total of 2 grams/kilogram. So, for my weight that would be 140 grams total, if I did my math right.

Also, there is a chance of adverse reaction, especially the first time, and that is why it is given very slowly. What are the adverse reactions? You are a curious reader, aren’t you?

Mild-to-moderate headache, chills, chest discomfort may develop in the first hour of the infusion and usually respond to cessation of the infusion for 30 minutes and resumption of it at a slower rate. Fatigue, fever, or nausea may occur after infusion and may last as long as 24 hours. Other side effects include, dizziness, leg cramps, muscle aches and pains and pain and tenderness at the injection site, difficulty breathing, shortness of breath, wheezing, chest pain or tightness, seizures or convulsions. A severe anaphylactic reaction may occur but this reaction is rare occurring in about 1 out of 1000 people. I also found a bunch of other rare reactions such as renal failure and even skin falling off the hands and feet – what a lovely thought.

I do have to be careful because some brands are made with a fairly heavy sucrose base and that would adversely affect my diabetes. IVIg is in short supply now and this is a recurring problem.

So what did we decide to do? Alright, I’ll answer one more question. We are holding off for right now. BUT ONLY FOR RIGHT NOW!! (I sent an email to my SS class last week and a few people thought I was refusing treatment for good – nope!) If my level drops more next month, or if I get another infection, we will do the treatment. Because it is in short supply, I believe other folks need it much worse than I do right now. My ear infection finally cleared up a week or two ago and I haven’t had any new infections since January or February.

And now class is dismissed. So glad you could join me for this month’s lesson on your way to an honorary medical degree. Oh, one more thing before you leave. Please keep me in your prayers and pray that my level doesn’t drop any further and that I don’t get another infection. My daughter, Cheri, is going to a wedding in Las Vegas next week and I am going to fly out with her on Monday so that she isn’t traveling alone to Sin City. We will come back Thursday night. I need to stay well for her sake. Since I don’t gamble, and don’t even like it, in addition to site seeing around the city, we are going to drive out to Hoover Dam and do the tourists bit there.