From: "Dr. D. Kossove" <doctordee@telkomsa.net>
To: <RchrdGrrsn@NETSCAPE.NET>
Subject: Update on blood clot in calf
Date: Monday, December 01, 2003 3:44 PM

Date:    Sun, 30 Nov 2003 13:47:56 -0500
From:    Richard Garrison <RchrdGrrsn@NETSCAPE.NET>
Subject: Update on blood clot in calf

Thanks again for everyone's help.

Began third round of AIM at 4 pm today.  Doctor's orders showed dose
of doxorubicin is 85 mg/m2, up from 75 mg/m2 during second course,
and 60 mg/m2 first course.  Also taking Ifex (up 10%), Mesna
to protect bladder), D5W, NaAcetate, KAcetate, Mgsulfate, Zofran by IV
for nausea, Decadron by IV for ? (several purposes listed on data
sheet, not obvious which purpose for me).  IV's were delivered in NS solution.  On Day 5 will get 6 mg Neulasta to promote neutrophils.
This round vs last round, moved 300 mcg SQ Aranesp (the red blood cell promoter, anemia preventer, clot promoter) from the last day after
chemo to the first day before chemo.  How does this help my
clot situation to move the Aranesp from last to first, from Day 5
to Day 1  ?.  Or maybe that's to decrease my fatigue during Days 2
to Day 7, when I have been brain dead, no energy, and feel poisoned.

When I showed my clot to Dr. Burgess, he did not mention the blood
clot is a side effect of Aranesp, or that he was moving Aranesp from
last to first.  Gee whiz doc, am I a pansy that can't stand heat?

I arrived an hour early so I could review Dr. Burgess' orders BEFORE
start of the infusion, and check the infusion quantities as suggested
by Dr D.   That's when I also read the Aransep side effects sheet
again. The warning about blood clots jumped out at me.   So it could
be a combo of the Aransep anemia drug (as Dr. D and others clued me)
plus inactivity of the leg (due to inflammation due to overdose of neutrophils caused by the Neulasta, in combo with tendency for
arthritis in the knee, and maybe I should drink more than 6
quarts of water per day).

In the time left from arriving an hour early, I walked a bit to
exercise the leg.   Then I got in the wheelchair and got more exercise
(than the leg can take) by exploring the labyrinth of hallways in M.D. Anderson.

Thanks again for your help.
Richard
    Sep 2001- May 2002 several paths taken, 3 benign path reports
   June 2002 diagnosed malignant larngeal tumor, possibly spindle cell
   carcinoma
   July 2002 diagnosed "most likely spindle cell carcinoma"
   July 2002 removed larynx, diagnosed spindle cell sarcoma "consistent
   with" leiomyosarcoma"
   August 2003  0.5, 1, 1.5 cm mets in lungs, suspicions in other organs
   Sept 2003 diagnosed prostate primary, medium grade, ignoring for now
   Sep 2003  Resliced wax from July 2002 -- "pleomorphic rhabdomyosarcoma is favored".
   Sep 2003  lung needle biopsy, "spindle cell suspicious for sarcoma"
   Oct 2003 0.5, 1.5, 2.5 cm mets in lungs, new 3 cm hilar lymph node
   Oct 13,2003 Began AIM (Adriamycin, Ifasfamide, mesna)
   Nov 2003 2.5 cm tumor disappeared; other lungs, and hilar lymph node, unchanged
   Nov 29, 2003  begin third cycle of  AIM chemo



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