https://www.amljourney.com/course daily 1.0 2021-11-06 https://www.amljourney.com/course/beforediagnosis monthly 0.5 2019-12-29 https://www.amljourney.com/course/induction-chemotherapy-week-one monthly 0.5 2020-01-25 https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5dfedafc5a4eb35ea7759503/1576983358775/WBC Course - Induction Chemotherapy — Week 1 - White Blood Cells His white blood cell count was very high on admission, above 70K. They started hydroxyurea to lower the WBC around day 1 or 2 and day 3 is when he started his idarubicin + cytarabine chemotherapy. His WBC responded and his counts dropped in a relatively linear fashion https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5dfedd9358924f4510b6ea62/1576983964771/Screen+Shot+2019-12-21+at+6.42.19+PM.png Course - Induction Chemotherapy — Week 1 - Miles walked Getting out of bed and on your feet is one of the best things you can do for your health while in the hospital. Knowing this, I walked with my dad when he was able to and measured how far we walked. I found it correlated well with his overall state and how he was feeling. Before he got sick, Dad enjoyed walking and hiking so walking a lot of not out of the ordinary. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5dfedd137f83a564191cfda5/1576983838492/Screen+Shot+2019-12-21+at+6.39.21+PM.png Course - Induction Chemotherapy — Week 1 - Temperature These show the highest temperatures that Dad had during this time, referred to as “TMax.” Days 3 through 7’s temperatures are not accurate because I did not record them during this time; however, he was afebrile during this time. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5dfedbbe58924f4510b6c9b2/1576983495890/Screen+Shot+2019-12-21+at+6.38.42+PM.png Course - Induction Chemotherapy — Week 1 - Platelets His platelets were lower than normal to start with but, over time (and especially after chemotherapy was started on day 3), they started to go down. No platelet transfusions were given (below 10 is when we were told that a unit of platelets would be given) https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5dfed8f958924f4510b6920a/1576983107983/Overall+AML+Graph+for+Induction+Chemo Course - Induction Chemotherapy — Week 1 - Overall Graph This compares my dad’s hemoglobin, overall state (graded subjectively by myself from 1, being bed bound and obtunded to 10, normal healthy self), appetite (graded from 1, being not eating, to 5, being normal appetite), and miles walked. The pRBC (u) and PLTS (u) are units of blood and platelets given that day; he did not have any blood or platelets during his first week. A few things to note: day 3 is when he started to get chemotherapy but his hemoglobin was already dropping from the leukemia before that. His overall state improved as he first started treatment but then started to go down as the side effects from chemotherapy started to take their toll. The number of miles he walked a day reflects this as well. His appetite was poor during this entire time. https://www.amljourney.com/course/induction-chemotherapy-introduction monthly 0.5 2020-04-20 https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e9cd5176271da34418f4e1d/1587336479707/Induction+White+Count Course - Induction Chemotherapy — Introduction Here you can see how Dad’s WBC (white count) dropped quickly once chemo was started (HOD refers to HOspital Day). This was done initially with hydroxyurea (HOD 1 and 2) and then with Idarubicin (HOD 3-5) and Cytarabine (HOD 3-10). It wasn’t until day 25 or so when his WBC started to rise again after being wiped out. In the interim, he dealt with mouth ulcers, gum and tooth pain, sequelae from low platelets, leg and ankle edema and swelling, and fatigue, among other things. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e9cd86549f74c43e7c111ea/1587337324924/PlateletsInduction Course - Induction Chemotherapy — Introduction Similarly, Dad’s platelets fell because of the chemotherapy and required 3 platelet transfusions after which on day 23 his counts started to recover dramatically. Platelets are typically given 1 unit at a time as opposed to the pRBC (packed red blood cells for hemoglobin) which are given 2 units at a time. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e9cd60c4ee1eb456089c34b/1587336728446/HemoglobinInduction Course - Induction Chemotherapy — Introduction This shows Dad’s hemoglobin throughout his induction chemotherapy. It was already low, around 10, when he was first admitted because the leukemia in his bone marrow was making it difficult to produce more blood. With chemotherapy, the hemoglobin and red blood cells trended down, requiring blood transfusions (on HOD 8, 17, and 21) to keep his count about 7. Transfusions become more frequent as time goes on but thankfully his bone marrow recovered towards the end of his hospital stay and was able to make enough red blood cells that it was able to increase without the use of platelets. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e9ce5544ee1eb45608c673a/1587340636261/OveralInduction Course - Induction Chemotherapy — Introduction This shows how Dad’s hemoglobin and ANC (one of the components of the white count) correlated with his overall state, a subjective grading from 1 to 10 on his overall functional status and well being that I gave every day, his appetite (subjectively graded from 1 to 5), and the number of miles he walked in the hallways. Overall, his overall state, appetite, and number of miles walked per day improved through the course of his hospital day. However, acute decreases in those things correlated well with his drops in hemoglobin and improved after transfusion. Once his ANC started coming up, he started to feel much better. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e9cd7db66bc693a2e3e0f9c/1587337183851/Screen+Shot+2020-04-19+at+3.59.15+PM.png Course - Induction Chemotherapy — Introduction This graph shows the highest temperature Dad had each day of the hospital. The fevers that he had when he first arrived at the hospital ended on day 3 (days 3 through 8 temperatures were poorly recorded but he had no fevers during this time, hence the normal of 98.6).. He had 2 fevers during his stay, both of which were when he was very neutropenic and both of which were treated with IV antibiotics. We believe the infection may have either been from his gut or his gums. His temperature normalized after the second episode. https://www.amljourney.com/course/induction-chemotherapy-week-two monthly 0.5 2020-01-25 https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e0543434ab35465c15d3f99/1577403210250/Screen+Shot+2019-12-26+at+3.32.42+PM.png Course - Induction Chemotherapy — Week 2 - Overall Graph The first thing to notice is at the very bottom with the triangle data points. On day 8, Dad got 2 units of pRBCs (packed red blood cells) because his hemoglobin dropped below 7. He got 1 unit of platelets on day 10 because his platelets dropped below 10 (not shown on this graph). After he received the blood transfusion, he started to feel better overall with his overall state, appetite, and distance walked everyday improving. Of course, because his bone marrow was wiped out by the chemotherapy, his body was not making any significant amount of blood and his hemoglobin started to go down after the transfusion was given on day 8. Overall, he was feeling much better this week than when he first came to the hospital, as he was not dealing with continual fevers and the bad mouth pain and swelling that he had on admission. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e0547e180f81f1fddb68f60/1577404416966/Screen+Shot+2019-12-26+at+3.52.46+PM.png Course - Induction Chemotherapy — Week 2 - Temperature Prior to this week, Dad’s temperatures were fine after HOD 2. This week, he spiked a temperature of 101 degrees on HOD 9 after which blood cultures, urine cultures, and a chest X-ray were done as well as IV Vancomycin started (He was already on IV Cefapime). After the Vancomycin was added, his fever improved. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e0545011679023906ff4c7e/1577403659212/Screen+Shot+2019-12-26+at+3.40.32+PM.png Course - Induction Chemotherapy — Week 2 - White Blood Cells His chemotherapy finished on hospital day 10 and fluctuated between 0.1 and 0.2 the entire week. Because his WBC was so low, he had a fever on day 9 after which IV antibiotics were started. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e0546997cd0dd01432d300b/1577404074916/Screen+Shot+2019-12-26+at+3.47.10+PM.png Course - Induction Chemotherapy — Week 2 - Platelets His platelets continued to trend downwards until he got a unit of platelets on day 10 because his platelets that day were 9. Whenever his platelets were this low, he started to have small pinpoint dark red dots all over his ankles and lower legs. After the platelets were replenished, these little bruises would go away. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e0548aa1aa65222ba850434/1577404590486/Screen+Shot+2019-12-26+at+3.56.04+PM.png Course - Induction Chemotherapy — Week 2 - Miles Walked Dad continued to walk well. HOD 8 was when his hemoglobin was very low and he received the blood transfusion but after that day, he was able to put some serious mileage going back and forth in the hospital hallways. He was wearing slippers during this time and they broke some skin on his foot. This improved after we got him some more protective, walking slippers that were great for walking while having room for his swollen feet and being easy to put on. https://www.amljourney.com/course/induction-chemotherapy-week-three monthly 0.5 2020-01-25 https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e091cca62f19604dabd09ff/1577655572886/Screen+Shot+2019-12-29+at+1.37.59+PM.png Course - Induction Chemotherapy — Week 3 - White Blood Cells Really no significant change during this week. On HOD 20, the WBC bumped up slightly to 0.2 but his ANC (Absolute Neutrophil Count) stayed at 0.0 this entire week. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e091fe8e3302c0f49cf29b6/1577656310291/Screen+Shot+2019-12-29+at+1.51.21+PM.png Course - Induction Chemotherapy — Week 3 - Miles Walked Walking dropped off when Dad was anemic and dealing with the bloating and nausea but otherwise he was walking decently, continuing to hit about 5 miles per day on some days. His new hospital shoes made it easier to walk comfortably as he was using bath slippers to walk previously (His feet had become very swollen due to all the IV fluids they were giving him). https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e091d4d62f19604dabd1bde/1577655658411/Screen+Shot+2019-12-29+at+1.40.13+PM.png Course - Induction Chemotherapy — Week 3 - Platelets His platelets, as referenced above, were dropping more quickly now as his stores of platelets started to decline. He required 2 units of platelets during this week with onset of a petechial rash over his lower extremities and abdomen and easy bruising whenever they dipped low. While his platelet transfusion during week 2 lasted him about 6 days, the transfusions started to only last about 3 days this week. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e091e5013bb831c9c52498a/1577656070043/Screen+Shot+2019-12-29+at+1.44.17+PM.png Course - Induction Chemotherapy — Week 3 - Temperature Temperatures were fine until HOD 18 when his temperature hit a peak of 103 F. He was started on Vancomycin again (was already on Cefapime) and IV Flagyl was added to cover for anaerobic bacteria, which often are found in the gut. Blood cultures and urine cultures never found a source and were negative. After the Vancomycin and Flagyl were started, his fevers regressed. The Vancomycin was stopped 3 days later and the Flagyl was stopped 6 days later. The Cefapime stayed on until near his discharge. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e0917c041180e2960eaa110/1577654210881/Screen+Shot+2019-12-29+at+1.16.26+PM.png Course - Induction Chemotherapy — Week 3 - Overall Graph When Dad’s hemoglobin fell below 7 on HOD 17, his appetite dropped, the distance he walked dropped, and his overall state dropped more so than HOD 21 when it fell below 7 as well; however, the extent at which his walking, appetite, and overall state dropped was less which seems to be because of the intensity of his oral pain on HOD 17. He required blood transfusions and platelet transfusions more often this week as his remaining red blood cells and platelets continued to die off due to the chemotherapy. Appetite was pretty poor during this week which was secondary to both oral pain as well as feeling bloated. HOD 18 was when he had the fever but he was still able to walk around some and eat better than he had the day before when he needed a blood transfusion. Overall, just in a holding pattern . https://www.amljourney.com/course/induction-chemotherapy-weeks-four-and-five monthly 0.5 2020-01-25 https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e2cacfcf337cc577e7db0a4/1579986180910/Screen+Shot+2020-01-25+at+1.02.39+PM.png Course - Induction Chemotherapy – Week 4 and 5 - Fever No fevers for the rest of the admission and, as previously noted, the Flagyl (which was started after his second episode of neutropenic fever) was discontinued on HOD 26 and the Cefepime was discontinued on HOD 27 (Vancomycin was discontinued after 3 days on HOD 21). https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e2cad514251290eb1397152/1579986259212/ Course - Induction Chemotherapy – Week 4 and 5 - Miles Walked As always, improvement in how much Dad was able to walk after the transfusion he had on HOD 21. With his counts improving, Dad was able to sustain for the rest of the admission without transfusions and his hemoglobin was steady/slowly grew through the remainder of his admission. He logged his longest day of his admission on HOD 25, walking 7.08 miles up and down the hallway. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e2ca88f4251290eb13877cb/1579985050042/Screen+Shot+2020-01-25+at+12.43.32+PM.png Course - Induction Chemotherapy – Week 4 and 5 - Overall Graph No transfusions this last week. His counts started to recover this week (best seen on the WBC and platelet graphs) and his hemoglobin remained pretty stable (there were a few peaks after his transfusion on HOD 21 which were likely lab errors). Overall, things continued to get better and better for dad as his counts recovered and his oral pain got better. His Flagyl and Cefapime were stopped on HOD 26 and 27, respectively and his repeat bone marrow biopsy, to check if he had gone into remission, was on HOD 27 as well (25 days after the start of chemotherapy); this bone marrow biopsy showed that a hypocellular marrow and that he was in remission, praise the Lord, and he was discharged home that evening on HOD 29, nearly 1 month after he went to urgent care. https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e2cacab86eb9b2324c5c976/1579986097260/Screen+Shot+2020-01-25+at+1.01.18+PM.png Course - Induction Chemotherapy – Week 4 and 5 - Platelets Before HOD 23, the platelet count seemed like it was descending and that Dad would need a platelet transfusion. However, the counts started to hold steady for a few days, delaying possibility of transfusion, and then actively started coming up after HOD 25 in more of an exponential fashion (as opposed to the WBC which was more linear). https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5e2cac1197e6620d628066ae/1579985948386/Screen+Shot+2020-01-25+at+12.58.49+PM.png Course - Induction Chemotherapy – Week 4 and 5 - White Blood Cells The WBC thus far in the 0.1-0.2 range with a continual ANC of 0. On HOD 23, dad’s WBC was 0.1 but, thereafter, his WBC continually rose up with evidence of neutrophils (ANC) on HOD 25 (ANC was .01 on HOD 22 but was not thought to be significant). Every day after HOD 25, the ANC and WBC continued to rise and, because his ANC was trending up and nearly 500, Dad’s oncologist thought it was safe for him to go home on HOD 29. https://www.amljourney.com/course/consolidation-chemotherapy-amp-associated-events monthly 0.5 2020-04-24 https://static1.squarespace.com/static/5dfe54109211ef25fa7a5f7f/t/5ea21acdc2a26f021711370e/1587682745370/Consolidationandevents.png Course - Consolidation Chemotherapy & Associated Events https://www.amljourney.com/course/category/Relapse monthly 0.5 https://www.amljourney.com/course/category/Consolidation monthly 0.5 https://www.amljourney.com/course/category/Induction monthly 0.5 https://www.amljourney.com/course/category/Before+AML monthly 0.5 https://www.amljourney.com/course/tag/aml monthly 0.5 https://www.amljourney.com/course/tag/septic+shock monthly 0.5 https://www.amljourney.com/course/tag/relapse monthly 0.5 https://www.amljourney.com/course/tag/thrombocytopenia monthly 0.5 https://www.amljourney.com/course/tag/transfusions monthly 0.5 https://www.amljourney.com/course/tag/neutropenic+fever monthly 0.5 https://www.amljourney.com/course/tag/neutropenia monthly 0.5 https://www.amljourney.com/course/tag/consolidation monthly 0.5 https://www.amljourney.com/course/tag/chemotherapy monthly 0.5 https://www.amljourney.com/course/tag/anemia monthly 0.5 https://www.amljourney.com/course/tag/Chemotherapy monthly 0.5 https://www.amljourney.com/course/tag/induction monthly 0.5 https://www.amljourney.com/course/tag/sepsis monthly 0.5 https://www.amljourney.com/about daily 0.75 2021-11-06 https://www.amljourney.com/contact daily 0.75 2019-12-22 https://www.amljourney.com/helpfulitems daily 0.75 2020-04-24 https://www.amljourney.com/overview daily 0.75 2020-04-24