IMG_0483 by
hankins.greg, on Flickr
Day 3 of the NIH Campath trial began at 5:00 am, when I was awakened after a very long and restful sleep by the nurse for vitals and a blood draw. They use an amazing Rube Goldberg device to extract blood from the PICC Line and then flush the line. The nurse tells me it's called a "COBE Device." That's a photo of it above.
The white knobs control which syringes, etc. are connected to the PICC line at any time. The nurse makes sure only the first syringe is "live" and extracts the appropriate amount of blood into the syringe. She then twists the knobs to cut off flow from the patient and turn on flow to the second station in line, which is like the typical gizmo used to draw blood into vials. She inserts a vial, and the blood passes from the syringe into the vial. Once the tubes are all full, she uses the tube on the end to flush the line.
The first vial of blood is a discard; after that, it's whatever the doctor ordered. Unlike Day 2, when thirteen tubes were extracted for research, this morning it was only two tubes. We're doing a CBC with Diff each day, as well as a "Chem 20 Panel," which has all the liver and kidney function stuff. And there's also a breakdown of various lymphocytes, including CD3, CD4, CD8, CD19, and Natural Killer cells.
We are past all the screening and testing now, so, after the blood draw, the morning is spent getting ready to have Campath, which happens around 10:00 am, and the afternoon is spent recovering.
Impact on counts
The day nurse kindly printed out my labs, which were pretty interesting. The most amazing result was the lymphocyte count. These are the guys we are trying to kill off to stop the war in my bone marrow. Prior to the 1 MG test dose, the count was 1.15K/uL. The morning after the test dose, the count had dropped to 0.18 K/uL.
A single 1 mg dose of Campath knocked out 84% of my lymphocytes. And I'll have 101 mg by the time we are done.
The other impact included an Hgb drop from 10.3 to 9.5 and a platelet drop from 69 to 52. The test dose basically didn't touch the neutrophils, however, with 1.49 before and 1.47 after. These will probably take a hit from the full doses, but we want them to stay as high as possible -- out of serious neutropenic territory.
First big dose
The first 10 mg dose of Campath started at around 10:00 am and was administered over a two hour period. About three quarters of the way through, the chills started, followed quickly by the rigors. The latter were more severe this time and more continuous. After about ten or fifteen minutes of that, I gave up and went for the demerol. It was probably a good thing. My back was aching all evening -- likely from the tensing and shaking involved in the rigors. All three of my docs -- the Fellow who is my main doc on the floor, the attending who runs the Fellows, and Dr. Olnes, the PI -- all scolded me for doing without the demerol with the trial dose -- as did the trial coordinating nurse, Barbara Weinstein.
The 25 mg of demerol (a half-dose) took less than five minutes to quiet everything down. Just about the time the dose finished, my fever began to climb, hitting close to 104 before coming back down over a period of three or four hours.
Oddly, I had a huge allergy attack later on in the afternoon: Sinus congestion followed by nose running like a faucet. My wife Marcy had gone to grab some lunch at the cafeteria on Level B1 of the older part of the Clinical Center -- the Magnuson building. She was also experiencing some allergy symptoms when she returned.
After supper, at just about the time my sniffles had stopped, she took me back down to the cafeteria, so I'd know how to find it. I immediately began a sneezing fit (I recall that Melissa had a sneezing fit with Campath!), and my nose ran all evening, even after the doc prescribed Zertec. I honestly don't know whether there is some allergen lurking down on Level B1 or if it was Campath-related, but I tend to think the former, since Marcy was affected as well.
There was little other excitement on Day 2. I managed a shower without getting my PICC dressing wet -- they use a thick plastic barrier called AquaGuard. And the dressing was changed. The new one is good for a week, if I don't get it wet.
The second 10mg dose is tomorrow and I expect more rigors and fever. But, with luck, that may begin to tail off on Day 3.