One round in

Today marks one month since this craziness started. Today was also a crazy long day of appointments at St. Luke's (Greg said it should count as an in-patient day since it was so long), but the best part is that today was day 7 of my first round of the Vidaza chemo. Although I still have frequent appointments (mostly for CBC blood tests), it won't be every single day.

Today started with an appointment in cardio-oncology. Since I have been on three known cardio-toxic meds (Adriamycin, Herceptin, and now Idarubacin), they will follow me closely to see if I look like I'm showing signs of heart failure. I had an echocardiogram done as my baseline before the Idarubacin, and everything looked good at that point (EF 57% and GLS -21, if you are interested in reading what the measurements mean).

So the plan is for me to have a repeat echocardiogram next week.
If there are no changes, then I'll repeat echos in six months and a year, and then annually for five years after treatment (with Idarubacin) is complete.

If there are small changes, then I will continue with echos every six months for a longer time and they will consider cardio-protective medications (ie: blood pressure meds)

If there are big changes, I'll need to do meds and be followed every three months.

The other thing we discussed relates to my QT interval. Three of the meds I'm currently on (fluconazole, the anti-fungal; levofloxacin, the antibiotic; and Zofran, the anti-nausea med) all can interact and impact the QT interval, which can cause an arrhythmia. I will have regular labs drawn to see if my salts are balanced, and I have to watch my symptoms, which are (of course) the same symptoms that are caused by my chemo and/or leukemia/low blood counts. Things like lightheadedness, shortness of breath, racing heart, fatigue.

BUT I did get good news--that I'm encouraged to keep exercising (biking!) and to just listen to my body and rest when it tells me to rest. Greg and I went biking yesterday (so he could try out his new fat tire bike) and a small hill was really, really tough. I had to stop at the top and catch my breath and slow my heart rate. But that's okay--and really due to the fact that my hemoglobin is still very low.

Next stop was labs. My WBCs are still at 0.8 (no neutrophil measures); hemoglobin still hovering around 8 (actually 7.8), and platelets down to 7K.

Then I met with Dr. Sana. He was surprised that I have not yet been able to start the Venetoclax, but it comes from a specialty pharmacy (in Michigan), and they were still working out the dosage earlier this week. Apparently the fluconazole that I have to take is a CYP 3A inhibitor and CYP 3A plays a major role in Venetoclax elimination, so if the two are given together, more Venetoclax is available and the dosage needs to be reduced to avoid over-dosing.

He also clarified a few things going forward.
1. He doesn't plan to do another bone marrow biopsy until 2-3 cycles of the Vidaza are completed.
2. I will be seen 3x/week between the Vidaza infusions for blood work and to determine if I will need blood or platelets.
3. I may not see a rebound in my blood cell counts ("hematological recovery") until three cycles of the chemo is completed.

After that appointment, I got my 7th Vidaza infusion in this first round. This also marks the end (fingers crossed) of needing Zofran, which makes me feel kind of fuzzy, until the next round of Vidaza at least.

And then I got platelets.

It was a long day, and I'm exhausted, but I'm pretty happy to not have to go back in until Monday, I hope!