September 24, 2023
We saw Dr. W this morning, and we mentioned the paleness and the other symptoms. He agreed he was pale and his heart rate was elevated in the office. His temp was normal. Chest and lungs sounded clear. Dr. W worried about his RDC, iron, and hemoglobin levels, and I told him what it was at the last oncology visit in August (10.1). It has hovered around there since the liver resection surgery in February. We also told him that the next Y90 treatment is scheduled for Monday, 9/30. He was very concerned that his levels may be low again based on the symptoms and how David looked, so he started him on a Z pack to try to take care of anything respiratory that was going on and took a blood panel to see what his numbers looked like. He said if needed, he would like to get David in for a blood transfusion and/or iron infusion as early as tomorrow.
We got the results in the portal and Dr. W also called this afternoon to say David’s RBC was low, his Hemoglobin was 8 and his iron was reading “undetectable”. He said he would talk with the treatment room at the hospital first thing in the morning and work on getting the insurance pre-auth done for iron and for us to be ready. He said he really expected his hemoglobin to be lower than it was given David’s symptoms and appearance, but it wasn’t quite low enough for a blood transfusion. It needs to be 7 or lower especially during a time of blood supply shortages. He said he would get the iron done outpatient or inpatient if necessary. He said we definitely didn’t want anything to delay the treatment next Monday if we can help it. He is such a great doctor and person. He is so caring and willing to go extra steps to take care of his patients. He genuinely cares about people. We are very fortunate to have been under his care for 20+ years now. Like clockwork, David started running a fever this afternoon and into the evening. He doesn’t have much of an appetite. He says he feels yucky. This thing just never lets up. Oh, his glucose was through the roof at 313 (usually runs around 140 for his diabetes) so he gets another new pill to help with the Metformin he is already taking. The trick is to not give something that will cause him to lose too much weight. We aren’t sure what spiked his sugar, but it could have been the little non-birthday-birthday cake we ate over the weekend to celebrate our blissful 25 years of togetherness or the cup of orange juice he drank with breakfast. Yes, we know better, but he loves orange juice greatly, and we weren’t really thinking about the timing.