Megan Update

On Thursday, August 18, Megan, Mom Lally and I went to Dana Farber for a scheduled appointment. It was Megan's last day of taking a new drug (Seliciclib) on the clinical trial that she is part of, and the intent was to check out her blood chemistry to see the effect of the chemicals, take a skin biopsy to view the effect of the drugs on cell division and perform other, similar trial-centric tests. As Megan has been a part of other trials, we've been through similar routines. This appointment was anything but routine.

The difficulties started earlier in the day after Megan got out of the shower. I observed that she was taking many short, rapid breaths. The appointment was just an hour from now, so we got in the car and made the ~45 mile drive to the Yawkey Center at Dana Farber. During this drive, Megan sat back and closed her eyes, and her breathing slowed to a more normal pace, and so we hoped all was well and she was just anxious for the appointment.

Once in the nurse's care, the "typical" tests were begun. The nurses had difficulty drawing blood, and surmised that Megan was dehydrated. No problem, they'll just run an IV and get her pumped up with fluids. Unfortunately, running an IV became a challenge. Megan's veins are good for playing hide-and-go-seek any day of the week, but even more so when she is a little dehydrated. Perhaps my perception of time is off a bit, but it seemed like 5 nurses took turns for almost 2 hours attempting to find a vein to get fluids running. As they attempted this, periodic blood pressure measurements showed a continual drop.

And the problematic symptoms only increased. During this time, new pains emerged in Megan's lower back and stomach area. She was light-headed, nauseous and eventually got sick. The nurses called an ambulance and let us know that Megan would be admitted to the emergency room because they would have more tools available to aid in getting an IV into her to get her re-hydrated.

Once in the emergency room, an IV was run and they began pumping lots of fluids into Megan. Several tests were run: Chest X-ray, 2 kinds of ultrasounds, and a VQ scan. The only definitive finding was that her gallbladder was enlarged, and the doctor's surmised that some kind of infection was responsible. This explained her other symptoms, as well.

Megan was admitted to the Brigham and Women's Hospital adjacent to Dana Farber in Boston and started on a trial of antibiotics. By Thursday night, her blood pressure was normal and Megan was feeling much better. On Friday, a new blood draw was taken and Megan's BP, pulse and temp were all looking good, and Megan was up and feeling well. Unfortunately, that blood draw showed that her white blood cell count (WBC) and some of the liver function tests (LFTs) were elevated.

It's now Tuesday, and this is largely where we still are today. Megan is still in the hospital. A variety of additional tests have been run, including chest X-Ray, MRI, and many blood draws. The WBCs have been increasing daily. Up until today most LFTs were increasing. Today showed that 4 of the 5 metrics in the LFTs all decreased, however the amount of Bilirubin ("Bili") present in Megan's blood continued to increase. That said, the WBC and Bili increase day-over-day was considerably smaller than the prior day.

The MRI has shown that Megan's liver bile duct, where bilirubin should be removed from the blood and converted to waste, is unobstructed. If this were obstructed, this would be a concrete (and bad) reason for the increased Bili counts in the blood. It's good news that this is not obstructed, but doesn't explain the source of the increased levels. The scan also showed that Megan's gallbladder is back to a normal size. Finally, the Gastro-intestinal Dr said he did not think there was an increase in tumor mass that could explain this, based on the MRI. We're still waiting for results of the chest X-ray to see what else we learn.

The current theory is that Megan does indeed have some kind of infection and that the antibiotics are working as evidenced by the normal sized gallbladder, normal BP, and decrease or slowing in a number of the metrics. The Dr's can justify that the Bili is high even though other metrics have lowered because the Liver likely slowed when infection was at its highest, and a queue of sorts of Bilirubin has built up in the blood and that the liver needs to get caught up. We will continue to watch these metrics over the next couple days. Additionally, a new blood culture has been taken to investigate for additional infectious agents.

That's the latest information. On a less "technical" note, Megan is feeling OK. Pain has decreased. She is often very tired and takes many naps, but when awake is in good spirits. She feels she is in the best care that she could be in, and is in no hurry to leave so long as there are additional questions to answer. When we have some more of the answers, I'll write back. Thanks for all your thoughts, prayers and well-wishes.