Getting Over the Chemo and AFIB Hurdle

Lab test results following the first chemo session showed that Ed’s white cell count dropped from 72,800 to 4,300. WOW! The lymphocytes were very low and so was the hemoglobin. The bendamustine was good at doing its job, even at the possible cost of causing AFIB.

Ed and Pattie were very impressed at the progression of the treatment. Just three weeks after being released from the hospital, Ed began his second cycle of chemo.

After checking in with the receptionist, Mary, Nurse Robin came to escort them back to the infusion room. She took Ed’s weight, which was down a couple more pounds. His blood pressure was normal. As they settled in for the infusion and all of Ed’s “plumbing” was hooked up, a volunteer brought them fresh cups of coffee and Nurse Robin went off to the pharmacy to fetch Ed’s “chemo cocktail.” The next two days were uneventful and Ed was into the anticipated after-effects. His appetite was gone and everything was tasteless or had a brassy taste on his tongue. There was no sleep for the next three days. Ed was experiencing a limited attention span and found that using his laptop or reading books and magazines did not hold his interest. He began to wonder if he had developed adult attention-deficit disorder.

Ed and Pattie were full of hope that the chemo would bring Ed’s leukemia into remission. Then, four days later, Ed was back in the hospital with atrial fibrillation. Ed had electrical cardioversion twice that night, and his heart would not stay in normal rhythm.

The cardiologist began an IV to help slow Ed’s heart down. Three days later it was tried again, and then after two more attempts, Ed’s heart returned to normal rhythm.

Ed and some of the doctors felt there had to be a connection between the chemo and the AFIB. As referenced in CURE, Jeffery Jones, an assistant professor of Internal Medicine at The Ohio State University Comprehensive Cancer Center, updated attendees at the 2016 National Comprehensive Cancer Network (NCCN) Annual Conference. He cites 10 cases of AFIB reported during trials of another drug Imbruvica (ibrutinib) for treating CLL relapse. So, there is some indication of AFIB induced by cancer drugs.

Ed was scheduled for a lengthy follow-up with his cardiologist, Dr. Sunnergren. Drugs were added to his regimen and an echocardiogram was also scheduled as Dr. Sunnergren detected a change in Ed’s aortic heart murmur.

Following the echocardiogram, the cardiologist was not himself. He and Ed had known each other for 15 years, and so Ed went on alert. Dr. Sunnergren sighed deeply and slowly said, “Ed it is time. Your aortic valve is deteriorating rapidly and the stenosis is much worse than it has been. We knew this time was going to come someday. You need a new aortic valve.”

Ed had to swallow hard on that one. Not much ever disturbed him, not even pursuing a wounded bear into the brush with a 45 caliber pistol, but that was over 30 years ago. A rush of anxiety washed over him as he asked how soon the procedure would need to be done.

Dr. Sunnergren replied, “We need to keep a closer watch on you now. It cannot be done while you are on chemotherapy. Also, when you do re-enter remission, your weakened immune system may prevent surgery until it gets stronger. I will continue to coordinate with your oncologist, Dr. Asif.”

Dr. Sunnergren continued, “There is an experimental procedure where a mechanical valve is inserted through a catheter and stuffed directly into the defective valve, taking over the function of the original valve immediately. It is the least invasive approach, and we may be able to get you approved since you have complicating situations. You will need to be admitted into the MedStar Washington Hospital Center in Washington D.C. for a catheterization examination. They have the most experience in this field and have performed many of these implants. I will work with Dr. Asif to determine when it is safe for you to undergo this procedure. Until then, I want to see you as soon as possible after each chemo session. My assistant can make all the appointments if you can provide her with your chemo schedule. I hope we are using the correct medications to control your heart and avoid any more AFIB issues.”

Ed was visibly disturbed when he came home and discussed the heart issues with Pattie. Pattie said, “I will be with you and we will get through this too.” Ed was now leaning heavily on hope.

“…but we also glory in tribulations, knowing that tribulation produces perseverance; and perseverance, character; and character, hope. Now hope does not disappoint, because the love of God has been poured out in our hearts by the Holy Spirit who was given to us.”Romans 5: 3-5