Summay of the treatments

Japanese page is here.


Contents

 1. Personal data 
 2. Pathogenesis 20th October 2015
 3. Hospitalization/td> 26th October 2015
 4. The 1st Anti-Cancer Drag Treatments 26th October - 1st December 2015
 5. Changing Hospital 2nd December 2015
 6. Rest 3rd - 10th December 2015
 7. 2nd Anti-Cancer Treatments 11th December 2015 - 7th January 2016
 8. Rest 8th January 2016 - 13th January 2016
 9. 3rd Anti-Cancer Drag Treatments 14th January 2016 - 9th February 2016
 10. Rest 10th February 2016 - 16th February 2016
 11. 4th Anti-Cancer Treatments 17th February 2016 - 14th March 2016
 12. Rest 15th March 2016 - 24th March 2016
 13. 5th Anti-Cancer Treatments 25th March 2016 - 16th April 2016
 14. Rest, Re-start my job 17th April 2016 - 14 August 2016
 15. Recurrence 15th August 2016
 16. 6th Anti-Cancer Treatments 17th August 2016 - 25th September 2016
 17. 7th Anti-Cancer Treatments 26th September 2016 - 20th October 2016
 18. Rest at home 21st October 2016 - 24th October 201610
 19. 8th Anti-Cancer Treatments 25th October 2016 - 16th November 2016
 20.Change Hospital, Bone marrow transpantation 17th November 2016 -


Personal Date



Pathogenesis

About 1 year ago, I was warned at the regular health check that a number of the white blood cells was as high as 10,000 or more. But, the result of the re-examination in the neighborhood clinic showed that it was less than 8000 and was not abnormal.

Then six months later, I was warned again about the blood abnormality in the regular health check. This time, not only the number of white blood cells but also other values were abnormal, and I was reccomended to go to a hospital for blood inspection as soon as possible.

But, you know,it is 80km distance from the workplace to the Hachinohe City, where the nearest blood internal medicine is exist. Moreover, it is written in the homepage of the hospital that they do not accept a new patient at the blood section.

Therefore, I was wondering that I might have a chance to go to a big hospital in Tokyo, when I have a business trip to Tokyo. But the schedule of the business trip is generally too tight to visit a hospital.

The first symptoms came out when I was a business trip to New York in summer. I was attending a reception of a scientific conference at a hotel facing Times Square, and was enjoying a talk with my old friends. Suddenly I had a strange feeling in my nose. It was nosebleed. I tried to stop the bleeding, but not successful. I returned back to my room and lay down on a bed for hours to stop the bleeding.

It seems that the platelet in the blood was not enough to stop the bleeding.


I was anxious about my presentaion at the conference. I was preparing a tissue and a mask in my pocket for the case of nosebleed.

I had an another bleeding when I was return back to the airport.


In October, I was in Lanzhou in China for business. The environmental pollution degree in Lanzhou is the worst in China. Actually, Lanzhou is heavily polluted than Beijing, In a hotel, tap water is not drinkable because of the pollution contained in the water. We had to buy a pet bottle of mineral water for drink. Even in a sunny day, the distance we can see was only 1km. I was walking such a city, and had a chance to climb up the hill of the White Tashan park beside the Yellow River. I felt my body was tired very much.

The photo is the river ride along the Yellow River using a sheep skin boat. I was too tired to try this attraction.


The Yellow River was the muddy water of ocher rather than yellow. The condition of my body became worse and worse, day by day. When I returned back to Japan, my physical condition was really bad.


Since I had continuous pain in my left reg even a few days after returning back to Japan, I decided to go to an orthopedic clinic by driving 40km from my workplace. The doctor took a X-ray picture and MRI (Magnetic Resonance Imaging) cross-sectional image of my body.

This is a photo of the MRI which found my leukemia. The doctor said "the trouble in your leg will be OK within one or two weeks, but there seems to be more serious disease in your body. I can see strange image in your bone in the MRI image. There should be a black image of the blood, but I could not see such an image". He recommend to go to an university hospital as soon as possible, and he wrote a letter to the universy doctor.



Hospitalization

Next monday, I visited the university hospital which is located about 200km from my home.

Results of the blood tests was terrible; the number of the white blood cells was higher than 50,000 (normal number of the white blood cells is 3500-9000), and about 60 percent of which was cancerous. Then the production of normal red blood cells and platelets was inhibited. This was the reason why the nosebleeds was not stopped and I was easily tired in China.

Since there is a danger of life, the doctor recommend to stay in the hospital.

I asked the doctor "Can I keep working till the hospitalization? I have important meetings in next month. Is it OK to come again after the meetings."
The doctor said "You are almost dying. If there are ten steps to die, you are now in the ninth step."

I decided to stay in the hospital. After the admission procedure for hospitalization, a young team of the doctors came to me for self-introduction, At first, there were a serious of inspection; one of the inspection is called Marc - bone marrow puncture to collect blood in the bone. However, it did not work, since there is no blood in my bone because of the disease. Then the doctor change the needle which has bigger diameter to collect the fluid in the bone. According to the biopsy, 90% of the bone marrow of white blood cells were cancerous.

The doctor tried to collect the blood from the bone of my sternum. They inserted needles from the breast, but thiswas also not successful.

The doctor checked the pulse of my heart. I have been pointed out in the health diagnosis of arrhythmia of the heart since a few years ago, there was a statement that "negative T-wave", I did not realize any symptoms. To compensate the lack of red blood cells, my heart tried to work too hard and the tone of the pulse seems to be not so good.

The doctors worried about the unstable tone of my heart, and they tied me up in the bed and connected many electrical wires to monitor my heart.

During three days, I made many alarms. Whenever I tried to do something, for example, tried to open my computer to send an e-mail, the monitor made an alarm and nurses came to my bed and asked "Are you okay?"

After three days, they knew the condition of my heart is not so serious, and they disconnected the wiring. I could leave the bed with the drip stand.

I got a permission to take a shower, For three days, three nurses collaborated to support my body and to laid a waterproof mat underneath my body and put a hot water to wipe the body.



The first anti-cancer drug treatments

After four days, various inspection data were improved unexpectedly. It was decided to start the anti-cancer drug treatments. Initially the start of the treatments was planned 7 days after the hospitalzation to wait the stabilization of my body condition including the tone of my heart.

The course of the standard first anti-cancer drug treatments is as follows; The first three days,Idamaishin (anti-cancer drug) of 23mg is to be supplied within 30 minutes, and kilometers side of 195mg is to be supplied in 23 hours. Then the next four days, only kilometers side of 195mg is to be supplied in 23 hours. Kytril 1A of nausea stop is also suppled every day.

The anti-cancer drug treatments started on Saturday (10/31). Because of the weekend, there was no blood inspenction data for two days. On Monday morning, the doctor realized that FDP (Fiber Destraction Product) value, which indicates the coagulation and the dissolution of blood, had jumped to 306. The doctor said "50% of the people having this FDP number are dying". If bleeding occured in the internal organs, it is very dangerous. To prevent it, all food should be stopped for a while."

The FDP value was further increased to 468 in the evening. In addition, there was discomfort in the mouth, I tried to keep clean inside of the mouth by using mouthwash.

The first 7-days anti-cancer drug treatments have completed safely, and the proportion of the white blood cell (WBC) and cancer of the white blood cells (Blast) also decreased as shown in the diagram on the right.

The FDP value was also falling to 45 on 5th November. Then meal service was provided again after five days.

Since the number of white blood cells was less than 400, which means no resistance against bacteria, I was supplied by antibiotics. Peaceful one week had passed.


The accident has occurred in the next week on 11/17. I had a strange feeling at night and the temperature increased to 37 degree. In the morning, when I went to a shower room, I noticed my entire abdomen was covered by rash. The rash became more severely next day. It becomes eczema-like. All nurses worried about that and asked me "It looks very itching, are you okay?".

However, it was not so itching unless you care about. According to the doctor of dermatology, "Rash due to the drug side effects is typically symmetrical with respect to the center line of the body, and not very itchy".
My doctor said he changed the antibiotic, and this is the side effects of the new antibiotic.

He tried to use aonther antibiotic, but the rash spreaded to upper body and shoulder then to the wrist. Also, it had spreaded from abdomen to the thighs. The body temperature increased to 38 degrees.

Please refer A report of rash (PDF) for details.


Once the body reacts to the antibiotics, it seems the body reacts to similar antibiotics. Even the doctor re-used the original antibiotics, my body reacted to the antibiotics and the body temperature increased.

The antibiotics was supplied three times a day every 8 hours. I could feel that the body temperature increased by 1-1.5 degrees when the antibiotics was supplied. Then the temperature decreased gradually to 0.5-1 degree after 8 hours.

Then the temperature accumulated day by day and reached more than 39 degrees. This was tough.

The doctor said the temperature rise is due to fungal infections, such as fungi, and tried to supply further administration of the anti-fungal agent. According to the blood inspection, there was no sign of the fungal infections, and the X-ray photograph of the lung was clean. I asked why you would try to supply the anti-fungal agent, the doctor said "You will not die by the temperature, but you could die by the fungal".

Then the antifungal agent was supplied in addition to the antibiotics, resulting in 40 degrees of my body temperarure. It was impossible to walk, and I was sleeping on the bed for a few days.



There was a sign of increase of the white blood cells on 25th November after 26 days of the start of the anti-cancer treatment. On 28th November the white blood cell number exceeded 3000.

I proposed my doctor to stop the the administration of antibiotics and antifungal agents.

The doctor accepted my proposal and stopped all the the administration of the antibiotics and the antifungal agents. Within a hald day, the temperature dropped to 38.2 degrees, but rose up to 39 degrees, On 28th, it was 39 degrees, but dropped to 38 degrees on 29th. It became 37 degrees on 30th November, and it was possible to get up and walk after a week.

On 30th November, the doctor tried to collect the blood from my bone. He inserted a needle to my back. But still he failed to collect the blood, because of the fiberlization, which he said.

On 1st December, suddenly, there was a news from the National Cancer Center, which is located very close to my home in Tokyo, that a famous doctor could accept me to the hospital. My blood condition was OK for moving the hospital, so it was decided to change the hospital on 2nd December.



Before leaving the hospital there was an interview with the doctor. Here is the summary of the first anti-cancer drug treatments.

1. Can not be sucked out bone marrow aspiration on admission. The cells of leukemia was 90% or higher in the bone marrow biopsy. In addition, components of the fiberization is found in the bone, there is a possibility that complicated with myelofibrosis. Although examination of cell morphology and chromosomes of leukemia was not performed in the bone marrow, as a result of the inspection in the peripheral blood, it was diagnosed as "AML / M5b."

2. A treatment was started induction therapy with an anti-cancer agent from 10/31.

3. From the time of admission, since the numerical value of the inflammatory response was higher, to start the antibiotic treatment with Meropen (Karupapenemu system), from the test results at the time of admission, Gram-positive cocci has added an additional vancomycin (glycopeptide system) for the detection . Change the Meropen to Fini Bucks, I made changes to vancomycin in Tagoshiddo, 11/16 rash on the trunk appeared to, drug eruption a doubt antibiotics again by Tagoshiddo, was changed Meropen, to Hapekashin (aminoglycoside) There, hives that appeared to side effects of blood transfusion was also appearance.

4. Since the fever persists, because the fungal infection was suspected, antifungal agents (fan guard), but was also the start of administration, antipyretic is I was not seen.

5. Although had a treatment considered heat of infections in most, the person is considered the heat generation due to allergy, by the hope of the person, it is finished and antibiotics to 11/28. Currently, has seen a recovery of hematopoietic function, such as with respect to fever, normal immune function is expected to be improved if me to recover.

6. State at the moment, but was seen recovery of blood cells in 11/30, blasts has also emerged, it has been thought the bone marrow puncture in order to examine the therapeutic effect of post-remission therapy introduction, bone marrow fluid can be aspirated It did not. The 12/1, it underwent a bone marrow biopsy again. At the moment, it is not possible to confirm whether remission or non-remission, the results in the white blood cells (lymphoblastoid cell: Blast) of blood test while a small thing and to be seen, the number of lactic acid dehydration dehydrogenase (LDH) rises Since it is, it seems likely that no remission.

7. Thing that could not sucked by the bone marrow examination, because it was also seen evidence of fibrosis of the bone marrow, there is also the possibility of a rare disease "acute pan bone marrow disease with bone marrow fibrosis" in the WHO classification, in which case the prognostic there is a relatively severe possibility to.


Changing Hospital

I went out the hospital after five weeks of hospitalization. Then immediately got on the Shinkansen, and arrived at National Cancer Center hospital. After a blood examination, I met the doctor who is responsible to me.

She said "you need a time to recover your health at your home. During the period, please come to the hospital to have a series of examinations, such as X-ray CT, and MARC (the collection of bone blood).

Here is the plan view of the hospital. There are many leading machines for Cancer, such as a proton beam therapy system, MRI (Magnetic Resonance Imaging), and various kind of CTs.



Rest

During the rest period in my home,I walked every day in the park located between the home and the hospital. Previously, I was jogging in the park along the jogging course of about 4km. I had a feeling that the park is not so big. But after the hospitalization, I felt the park is big enough to walk.

There still left autumn leaves and ginkgo yellow leaves. Those leaves and the blue sky were very beautiful.


My wife liked to walk with me. We visited the Japanese garden in the park together, We had a Japanese tea and sweets. I thanked my disease for having this kind of time with my wife.



Second anti-cancer drug treatments

I consulted with my doctor how to proceed the treatments. She said that the Bone Marrow Puncture (Mark) test did not show the complete remission, but the status is not very bad. She recommended me to start the second anti-cancer drug treatments as soon as possible, by using the Cytarabine of 4100mg for 3 hours twice a day at the 1st, 3rd and 5th days. The concentration of the drug is about 20 times higher than the first treatments. "The high density drug will penetrate into the bone marrow and kill the cancer cells.", the doctor said.

Therefore, by performing a so-called consolidation therapy, look at its elapsed, it becomes possible to examine the subsequent treatment policy. Specifically, the first day, third day, it is administered twice in 3 hours cytarabine 4100mg is an anti-cancer agent to the fifth day. The concentration of this cytarabine is about 20 times higher than the concentration at the time of the previous induction therapy. And to penetrate down into the bone marrow, it is aiming to be complete disappearance of cancer of the white blood cells in the bone marrow. Because of the high concentration, might be a side effect of the attitude is different. Eyes than that might be failure out, eye drops have also been prescribed.

Left hand refers to infusion needle, after performing an infusion of nausea stopped, and began an anti-cancer agent administration. And I was stabbed infusion needle in the thigh and left wrist in the previous hospital, but at the same to compare and very smart. But, it is the anxiety and or not clogging because it is not in the thighs as thick blood vessels.

The doctor inserted the PICC (Peripherally Inserted Central Catheter) from my left arm, and started to supply the anti-cancer drug.


The second anti-cancer drug treatments started on 14th December 2015. Here is the history of the second treatments, showing the change of the white blood cell (WBC), red blood cell(Hb), and platelet (PLT).

The white blood cells (WBC) rapidly decreased. It also showed rapid decrease of the number of red blood cells and platelets at the same time. On 18th December, the white blood cell number was reduced to 1500 and I moved to the clean room.

On 12/24, there was an accident. When I took a shower, I lost my memory because of the shortage of the red blood cell HHb), which was less than 6. I remember I pressed the emergency call button, and falled down to the floor. According to the nurse, I lost my memory for 3-5 minutes.

Until New Year's eve of 31st December, my body temperature was normal. But just after the transfusion of platelet, the temperature increased to 38 degrees. Since the CRP value, which indicates inflammation in the body, was showing a rise from 28th December, infusion of antibiotics started from the New Year's eve.

According to the doctor, the instantaneous heating of the 12/31 rather than the inflammation, but I think because of the platelet transfusion, 12/28 elevated CRP value has been seen from time, it is good to get started the infusion of antibiotics thing of it was timing. In addition, it is certainly, since like structure that is sensitive to antibiotics, choose less antibiotic of Toka allergy. Although out 37 degrees stand the heat, if you can put up, because the CRP value is high, it was that it and want to continue this remains antibiotic.

Around the sign of an increase in white blood cells appeared to 1/4, now keep in normal body temperature even put the antibiotic. Since the number of white blood cells also increased, antibiotic drip stop Omotte 1/5. Since 1/6 results of blood tests was good, my hope and it is possible that home care can be my home is in the immediate vicinity, it was decided discharge of 1/7.



Rest

I could leave the hospital on 7th January after nearly one month hospitalization in the clean room.

I walked to the hospital on 8th January to have the blood examination and the MARC (collection of bone blood). The number of the white blood cells were 5800, Hb was 8.9 and PLT was 18. My doctor was very much impressed with the rapid increase of the blood. CRP value is also low enough.

The MARC (collection of bone blood) was also successful.

Here is the photograph of the trace of the MARC.


In this year, I was kept in the clean room during the Christmas and the New Years days.

I could not see the sunrise on the New Years day, but I saw a beautiful sunrise from the living room in my home.


I went to a shrine with my wife and prayed.

Then we ate eel and ramen, which I could not eat at the hospital.



Third anti-cancer drug treatments

After the rest in my home, I entered the hospital again on 14th January 2016 to have the third anti-cancer drug treatments.

Same as the second treatments, high density anti-cancer drug was supplied to annihilate the cancer cells in the bone.

The supply of the anti-cancer drug started on 15th January 2016.

Here is the summary of the 3rd treatments; transition of the White Blood Cell(WBC), Hemoglobin(Hb),Platelet (PLT), and CRP value, which is the index of inflammation. Although the results are similar to those obtained in the 2nd treatments, there are some different points;

1. Only one transfusion of red blood cell, (cf: four times in the 2nd treatments)
2. CRP value, which is an index of inflammation, was not so high as the value in the 2nd treatments,
3. Body temperature did not exceed more than 37.2 deg. (cf: 38 deg in the 2nd treatments, 40.2 deg in the 1st treatments)

These indicate that the 3rd treatments proceeded very well.


The only one accident in the 3rd treatments was the obstruction of the PICC; Peripherally Inserted Central Catheter). The pipe of the PICC was pluged up. To prevent the obstruction, salin water was injected every day. I do not know the reason why.

The PICC was pulled out and a new infusion needle was inserted after some trial of failure.


Rest

My brother and my sister will have the inspection of bone marrow conformity, which does not mean the immediate bone marrow transplantation. The risk of the bone marrow transplantation and the risk of the recurrence would be compatible.

Since the probability of marrow matching is 1/4 in case of brother, the probability of the matching of my brother and my sister is expected 1-(3/4x3/4)=43.8%.

I will have an inspection of blood and MARC on 12th February 2016.


4th anti-cancer drug treatmens

I returned back the hospital on 17th February, and the 4th anti-cancer drug treatments started on 18th February 2016.

Just same as the second and the third anti-cancer drug treatments, high density anti-cancer drug was supplied to annihilate the cancer cells in the bone.

18th 15:00-18:00 4100mg
19th 03:00-06:00 4100mg
20th 14:00-17:00 4100mg
21th 02:00-05:00 4100mg
22th 13:00-16:00 4100mg
23th 01:00-04:00 4100mg

Here is the summary of the 4th treatments; transition of the White Blood Cell(WBC), Hemoglobin(Hb),Platelet (PLT), and CRP value, which is the index of inflammation.

The general tendency is just the same as the 2nd anti-cancer drug treatments and the 3rd anti-cancer drug treatments.

Only the differences are;

1. Twice of the transfusion of red blood cell, (cf: four times in the 2nd treatments, once in the 3rd)
2. CRP value, which is an index of inflammation, was increased higher than that in the 2nd treatments,
3. Body temperature exceeded 37-38 deg. (cf: 37.1 deg in the 2nd treatments)

One of the accidents in the 4th treatments was the inflammation at the inlet of PICC (Peripherally Inserted Central Catheter) in my left arm. I felt a little pain.

The surface temperature near the inlet increased to 38 deg., as shown in the infrared image.

The increase of the CRP value might be related to the inflammation at the inlet of the PICC



Rest

I returned back to my home on 14th March for the rest.

3月23日に通院して、血液検査と骨髄穿刺検査の後、担当医師と今後の治療について相談しました。

4回の抗がん剤治療を受けて、完全寛解(症状が治まり、末梢血液中にはがん細胞がない)の状態にはなっており、このまま退院して、様子をみるという選択肢もある。もし、骨髄が弱っていたり、抗がん剤の副作用に耐えられない状態であれば、そうすべき。

しかし、私の場合は、

1.最初の抗がん剤治療(寛解治療)で、80%の人がなるという完全寛解の状態にならず、2回目でやっと完全寛解の状態にほぼなった。完全寛解のあと、3-4回の地固め治療を行うというプロトコルに従えば、もう一度、地固めを行うべき、

2.これまでの骨髄穿刺の結果は、第2回目、第3回目と抗がん剤治療をするごとに、染色体異常の細胞の割合が順調に減っている(4→1)ことを示している。第4回目の治療後の骨髄穿刺の染色体検査の結果が出るまでに2-3週間かかるが、今回でほぼゼロになっているだろう。全てのがん細胞を殲滅する(Total Cell Kill - TCK)という考えに立てば、第5回の治療を行って念押しをすれば、再発の可能性が低くなり、また再発する場合でもそれまでの期間を延ばせるだろう、

3.骨髄、身体とも、第5回目の抗がん剤治療に耐えられる状態にある、

以上の理由から、第5回目の抗がん剤治療を行うことにしたものです。


5th anti-cancer drug treatmens

I returned back to the hospital on 25th March, and the 5th anti-cancer drug treatments started on 26th March 2016.

Just same as the previous anti-cancer drug treatments, high density anti-cancer drug was supplied to annihilate the cancer cells in the bone.

26th 13:00-16:00 3000mg
27th 01:00-04:00 3000mg
28th 13:00-16:00 3000mg
29th 01:00-04:00 3000mg
30th 13:00-16:00 3000mg
31st 01:00-04:00 3000mg

第5回抗がん剤治療の経緯は、右図のとおり。 ほぼ、これまでと同様の経緯でしたが、赤血球(ヘモグロビン;Hb)の初期値が10近くと高かったので、赤血球の輸血は2回のみでした。2回目は血液製造工場が復活するところだったので、結果論からいえば必要なく、事実上1回のみの輸血でいけたはず。血小板は2回でしたが、本来は3回必要だったと思います。


今回のアクシデントは、日本赤十字センターの血小板が不足しているようで、血小板の輸血が遅れ、一時、1.5という低値にまで下がったこと。

これまで血小板不足は、採血を失敗した時に、注射針による内出血がなかなか止まらず青あざになったという症状しか無かったのですが、今回は、手や下あごの毛穴から出血しました。

内出血しなくて良かった。


第2回から第5回の抗がん剤治療の、白血球(WBC)数の推移をまとめてみました。

非常に再現性が良く、第2回を除けば、ほぼ同じ曲線上にすべての点があります。第2回でも、抗がん剤投与を開始してから21日目に血液工場が再生して白血球が上がり始めるというのは同じです。


右図は、第2回から第5回の抗がん剤治療の、CRP値(体内の炎症に係わる数値)の推移を纏めたものです。

これも第2回を除けば、ほぼ同じ曲線上です。骨髄抑制の時期(抗がん剤治療開始後、10日〜20日)の後半にCRP値が上がってきて、血液工場が再生して白血球が上がり始めるとピーク値となってから下がっていくという経緯です。(CRP値は2,3日の時間遅れがありますから、白血球が上がり始める直前がピークということ)

第2回は、17日目に38度の熱が出て、抗生剤の点滴生活に入ったのですが、この図をみると、第2回の時には本当に早めに炎症が起こっていたようですね。


第5回の抗がん剤治療を終えて、退院となりました。退院後の通院時の担当医師との面談の要旨は以下のとおりでした。

1.当初の状態からは大きく改善し、通常の生活が可能となった。
2.ただ、再発の観点からいえば、『高リスク群』に属する。
3.今後は、定期的に血液検査を行う。当面は月一回の頻度で受診する。
4.再発の場合、骨髄が元気なので、抗がん剤治療で繋ぐことになるだろう。
5.なお、兄と姉との骨髄適合検査は不適合であった。
6.臍帯血移植は、身体が大きいので無理だろう(私の身体に見合う巨大な赤ちゃんが必要)

今後、体力の回復を待って、仕事復帰の予定です。


退院、静養、仕事復帰

4月19日に退院。4月22日に通院で血液検査や骨髄穿刺を受けて、晴れて自由の身になりました。

担当医師を相談して、今後は1ヶ月に1回の割合で通院して、血液検査と診察を受けることになりました。

2016年5月2日には、半年ぶりに、職場復帰。私の部屋も机もそのままにしてあって、パソコンの電源を入れると、そのまま仕事ができる状態でした。待っていてくれたんだなあと皆に感謝。

R2D2の電源を入れると、こちらは半年ぶりとあって、接触不良のために動きがぎこちないようです。"Hey, R2!"と呼びかけて"Pipopo"と返事をしたところで、"Go on patrol"と指示を与えると、ガクッガクッと停止を繰り返しながら部屋の中のパトロールを始めました。


6月25日には、私の快気祝いということで、東京から、昔の仕事仲間がわざわざ訪ねてくれました。同僚のスペイン人と3人で私の希望で、T市の昭和の香りのする『昭和小路』に繰り出しました。

私としては、半年ぶりの夜の街。また仲間と一緒に飲み歩けるなんて夢のようです。

スナックをはしごして、深夜までカラオケで盛り上がりました。


夏休みには、新婚旅行の地を37年ぶりに訪ねました。結婚式は愛媛の松山で行い、松山から大阪まで観光船で、そして大阪空港から岩手の花巻空港に飛んだのでした。写真は、宮沢賢治ゆかりの花巻市のイギリス海岸です。小説などでしか知らなかった北上川を実際に見て感激したのを覚えています。記憶にあった北上川がそこにありました。


『高リスク群』ということで、再発を意識しながら過ごした4ヶ月は、仕事の面でも、私生活の面でも、とても充実した日々でした。


再発、入院

8月13日に微熱が出て、風邪かなという感じで寝て直したのですが、胸の痛みが残ったままでした。

8月15日の夜、それが酷くなったので近所の診療所に急診をお願いし、レントゲン撮影と血液検査をしました。レントゲン撮影では肺は綺麗とのこと。確かに、痛むのは肺というよりも胸の表面近くの胸骨です。血液検査の結果は、白血球が14000と増えていて、『再発し、異常増殖する白血球のために骨が圧迫されての痛みだろう』との診断。早速、私の主治医に連絡し、17日に診察をお願いしました。

8月17日早朝には、胸骨の痛みだけでなく、全身の骨が痛む状態となり、これまで経験したことのない全身の強烈な痛みで歩くこともできなくなりました。それでも、車椅子を使って新幹線に乗り、新幹線の降り口では息子が駅員さんと一緒に車椅子で出迎えてくれ、息子の車で病院へ。

病院では即、入院。痛み止めの措置をして、CT撮影の痕、病室に入りました。痛みのために呼吸困難や心臓の鼓動も変調を来していたため、ベッドでは酸素マスクを装着し、心電図の配線をしました。あとで聞くと、敗血症も併発していたようです。



6回目抗がん剤治療

6回目の抗がん剤治療は正直言って覚えていません。

ベッドに縛り付けられ、抗がん剤と痛み止めの措置を受けて、日々、痛みが消えていきました。

9月初めには、やっと容態が落ち着いて、心電図や酸素マスクも外れました。



7回目の抗がん剤治療

6回目の抗がん剤治療では白血球と血小板の上昇はみられたものの赤血球が増えず、寛解状態に入りませんでした。9月20日に一時退院して自宅で1泊するも、9月21日の夕方には再入院。9月26日から、第7回目の抗がん剤治療が始まりました。

9月26日:キロサイド190mgを24時間+エトポシド130mgを2時間+ノバントロン7.5mgを5分間
9月27日:同上
9月28日:同上
9月29日:キロサイド190mgを24時間+エトポシド130mgを2時間
9月30日:同上
10月1日:キロサイド190mgを24時間
10月2日:同上
の3種類の抗がん剤を組み合わせた7日間のコースです。

第7回抗がん剤治療の経緯をグラフにすると下図のようになります。

これまでの抗がん剤治療との違いは、

1.当初より炎症反応を示すCRP値が高く、しかも、後述するようにPICCからの感染のために途中で更にCRP値が高くなってしまったこと。
2.骨髄抑制が終わり、造血機能が再生して白血球が増えてきても、赤血球が増えるのが遅かった。ただ、第6回目抗がん剤治療の時に比べると、赤血球に分化する途中の細胞が増えてきていたので、いずれ赤血球も増えるだろうとの医師の診断でした。

今回のアクシデントは、右腕から入れていたPICC(中心静脈カテーテル)から細菌が入り、白血球が無いのでそれが増殖して、左腕がパンパンに腫れてしまったこと。熱も38度台まで上がって、血液をとって培養すると、皮膚の表面にいる普通の細菌であることが分かりました。いや〜、白血球が無いということは、こういうことかと再認識しました。

右腕からPICCを抜いて、左腕から点滴針を入れようとしましたが、病棟で1,2を争うベテランの看護婦さんが3度失敗。若手医師を呼んで、点滴でなくPICCを入れて点滴針代わりに使おうというアイディアで、若手医師が3度失敗。とうとう、担当医師まで呼んで、何度か失敗したあげく、やっとPICCが入りました。


今回の治療中に、今日は息子がフィアンセを連れて見舞いにきてくれました。

会うのは二度目ですが、清楚で可愛くていい感じ。



一時退院、自宅静養

10月21日に一時退院。

10月24日に通院して、血液検査とCT撮影、骨髄穿刺検査、歯科検診を受けました

この一時退院に会わせて、急遽、郷里の松山から兄が見舞いに来てくれました。兄と一緒にすぐ近くのモール街を歩いて、屋上のテラスで日光浴をしました。青空のもと、日差しを直接に浴びるのは、ホント、久しぶりです。

屋上テラスには、クライミングの施設があって、6才くらいの女の子がオーバーハングした壁を登っていました。


また、再入院した二日目には、夕方に、友人夫婦が見舞いに訪ねてくれました。抗がん剤を始めたばかりで、まだ白血球は通常の人と同じなので、面会可能なのです。

クリーンルームエリアを出て、同じ階の休憩所で1時間ほど楽しく会話して、元気をもらいました。



8th anti-cancer drag treatment

10月25日に再入院し、第8回目の抗がん剤治療を始めました。前回と同じく、

10月26日:キロサイド190mgを24時間+エトポシド130mgを2時間+ノバントロン7.5mgを5分間
10月27日:同上
10月28日:同上
10月29日:キロサイド190mgを24時間+エトポシド130mgを2時間
10月30日:同上
10月31日:キロサイド190mgを24時間
11月1日:同上
の3種類の抗がん剤を組み合わせた7日間のコースです。

第7回抗がん剤治療とほぼ同じ経緯を辿りましたが、今回もPICCによる感染があり、1週間ほど40度以上の熱に苦しめられました。血液培養により細菌が同定され、それに合う抗生剤を点滴してもなかなか体温が下がらないのです。

結局、体温が急に下がって平熱になったのは、造血組織が再生して、自分の白血球が増えてきてからでした。白血球、すごい!! いつから私の造血組織が再生するのかについて、これまでの抗がん剤治療の実績をまとめると

第1回寛解治療 10月31日投与開始 11月26日再生開始 Xday... 26日
第2回地固治療 12月16日投与開始 1月2日再生開始  Xday... 19日
第3回地固治療 1月15日投与開始  2月5日再生開始  Xday... 19日
第4回地固治療 2月18日投与開始 3月10日再生開始  Xday... 21日
第5回地固治療 3月26日投与開始 4月15日再生開始  Xday... 20日
第6回寛解治療 8月18日投与開始 9月7日再生開始   Xday... 20日
第7回寛解治療 9月26日投与開始 10月17日再生開始 Xday... 21日
第8回寛解治療 10月26日投与開始 11月15日再生開始  Xday... 21日

つまり、地固め治療の場合は19-21日、寛解治療の場合は最初以外は20-21日になります。担当医師もこの辺りは良く分かっていたようで、第8回寛解治療が始まった時点で、転院日は11月17日と決めていたのです。


Change Hospital, Bone marrow transplantation

11月17日に骨髄移植のために転院しました。白血球は16日の時点で1900ですから、まさに白血球が十分になったその日に転院という、ギリギリのタイミングでした。

転院してから2週間は、いろいろな検査がありました。人間ドッグの検査をより詳しく、2週間かけてやった感じです。

血液検査は2日に1回の割合で行いましたが、心配していた赤血球(ヘモグロビンHb)も順調に増え、2週間目には、Hbは8.8になりました。もちろん、標準値(男性)13〜16.6と比べると格段に低いのですが、抗がん剤治療注の5台と比べると多く、歩いていて目眩や息切れがすることも少なくなりました。

白血球や血小板も十分にある、いわゆる寛解状態なので、病院の中を自由に歩くことができます。(本当は病院の外でも大丈夫)。

このタイミングで、松山から姉夫婦が面会に来てくれました。久しぶりに会って、楽しい時間を過ごしました。元気な身体を見せられてよかった。お土産の愛媛の柑橘類も美味しく頂きました。


ここで、検査結果をまとめると

腹部エコー検査:問題なし
心電図検査:問題なし
心臓エコー検査:問題なし
歯科:両奥歯の歯茎が後退していて、虫歯菌の住処になっている可能性があるので、念のために抜歯しました。奥歯を3本。まだ使えそうな歯でしたが、治療のために仕方ありません。
骨密度測定:10分間、低エネルギーX線を大腿骨とか腰骨に照射して測定しました。結果は、『普通の人より、骨太で密度が高いですね』とのこと。)
呼吸器検査:肺活量や酸素の吸収能力などを測定。タバコを吸わないせいか、肺の機能は上々でした。
MRI検査:造影剤なしと、造影剤を注入しながらの撮影。特に問題なし
上部消化管内視鏡検査:問題なし
CT検査:造影剤なしと、造影剤を注入して撮影。問題なし
胸部X線撮影:問題なし
骨髄穿刺:顕微鏡下では、ガン化した白血球(Blast)は認められなかったとのこと。

耳鼻咽喉科:鼻の穴から麻酔スプレーして、内視鏡を突っ込み、鼻孔の中を観察しました。『タバコを吸ったことないですね。深酒もしないですね。とても綺麗です』とのこと。耳の内視鏡検査では、『かなり溜まってますね』と耳垢を取ってくれました。その他、耳鼻咽喉科としては異常なし。
神経科:身体の反射機能とか、操作機能(目をつむって、指定した通りに腕や足が動くか)を調べて異常なし。
骨髄検査:背骨に針を入れて骨髄液を採取。

その他、放射線科や神経内科との面談がありました。

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