Shirley Stewart

As you know, Garry’s situation is much improved.

In spite of being told that his bone marrow was no longer able to produce white blood cells and the red blood cells were being phagocytized.(eaten) he has seen a significant improvement in those counts. Unfortunately, the white blood cell counts, WBC, have fluctuated from a high of 4.8 and have trended downwards the last few days to a WBC of 2.4 today.

We were hopeful that the bone marrow would continue, without any additional help, to produce these cells. However, it appears that they may reinstate the grastofil injections along with the corticosteroid to stimulate the bone marrow to produce the WBC’s.

Garry’s haemoglobin continues to rise and was at 79 today so a blood transfusion is no longer indicated. His platelets are also holding their own at 46 which is an acceptable level.

His blood pressure still tends to be a little on the low side, but not dangerously so, and he needs to be careful when he gets up because there is a little bit of dizziness and instability.

His temperature is normal but he continues to get the IV ceftazidime every eight hours to ensure the organism that caused the septicaemia and wound infection are dealt with. He will complete this course of treatment on July 20 and will likely be discharged shortly after that. At this point he has been in hospital for 26 days, most of that time in isolation.

His pain level is much decreased, and instead of being a seven or eight out of 10 when he would get up to walk, it is now a one or two. He is no longer taking any breakthrough Hydromorphone or Tylenol to make it through the day. As you can imagine it is a tremendous relief for Garry to be able to be almost pain-free once again.

We are so thankful for all of this good news, and ask that you continue to pray with us that his WBC counts continue to go in an upwards direction and be maintained.
The hospital is now looking at his discharge needs and it seems he might need a wound care nurse once he’s at home.

I’m really starting to miss him and can hardly wait for him to be discharged.

It has been wonderful that his sister Gail has been here twice and just left today after being here this past week. She was great company and we enjoyed a number of restaurants including Harth, Bellisimo’s, Nuburger, and Sushi N. Such nice treats!

Garry is able to have visitors as long as they mask and wash their hands before going into his room. He finds the days long and would enjoy a visit.

His appetite is back and he just finished consuming a pretty large grilled Reuben sandwich which I prepared for him at home. Do you think he might be a little bit spoiled?
Yeah, I think so too!

Well, that’s the report for today and I’m glad that it’s mostly good news. Thanks again for being on the journey with us, for your love, support, and especially your prayers.
We are blessed!

With love and thankfulness
Shirley and Garry

Friday, July 7 was an incredibly difficult day.

Garry’s blood pressure was critically low at 78/43. At that level there is not enough blood pressure to perfuse your organs to give them an adequate blood supply. Without adequate blood flow you can experience organ failure. There was a distinct possibility that Garry would be admitted to the ICU and this young female doctor said to us what do you want as far as end of life treatments? Garry replied to do whatever was necessary to maintain life as long as it didn’t leave him in a vegetative state.

They did begin to treat him with IV fluids, and corticosteroids, and that did help to raise the blood pressure to a slightly better level.
Later that afternoon, the head haematologist came to say that due to chemotherapy and all the other treatments for the lymphoma, they had caused his bone marrow to fail. At that point, they had been giving him injections of Grastofil, a treatment designed to increase your white cell counts(WBC). They began Grastofil treatments June 28, but had seen no improvement in the white cell counts. He also indicated that Garry’s red cells were being eaten by macrophages, causing him to have a low haemoglobin on top of everything else.
He said Garry had no capacity to fight off infection and his future was to live in a bubble, which he said would be very difficult, and that his life would be short as any infection would likely be fatal. As far as he was concerned, they had tried many things to boost the white cell counts, and that there was nothing more that could be done.
To say that we were devastated, would be an understatement.

Gail, Garry’s sister has come from Victoria, BC to visit him while he is in the hospital. We haven’t seen Gail in person for the last two years and it was a very emotional moment when she first saw Garry this morning.

We saw the internal medicine resident while we were there and of course I had a number of questions for him. The biggest concern at this time is the lack of white blood cells. Garry’s count is at a critical level of 0.2. We still don’t have the results of the bone marrow biopsies, one which was taken last Wednesday and then another last Friday. Hopefully the results will show why Garry’s bone marrow is not producing cells.

Garry has been in hospital for a full week at this point. 
He is on E5020 in a positive pressure isolation room at SBGH. He is on what is called reverse isolation and is able to have visitors as long as they wash their hands before entering his room and it’s also recommended that they wear a mask.
The days are long and I know he would appreciate a visit from those who are interested in seeing him.

His situation is still critical as his bone marrow is still not producing any white cells.
The white cells are what protect us and give us immunity against infections. They are planning to give Garry a blood transfusion today to help give his body a boost.
The bone marrow results are still forthcoming, but they feel that the bone marrow has stopped producing white cells. It is, however, producing platelets and red cells.
They still don’t know what has caused the neutropenia, but are thinking it is may be related to previous chemotherapy treatments and possibly the CAR-T therapy that Garry had in 2021 in Toronto.

The Journey Blog is under new management. Shirley will be taking over content creation and Garry will be providing technical support.

Garry has a significant number of new things going on with him.

He has been somewhat confused and angry, which is very unlike him. Yesterday the doctor told him he had delirium that can be caused by an infection, the pain he is in or the pain meds. He also has abnormal blood clotting factors, so they have him on anticoagulant therapy to deal with that.

I‘ve gone with him the last two days to HSC CancerCare  by a stretcher transport for his last few radiation treatments, with the last dose #20 being this afternoon.

His white cell count is still very critical and he has no white cells in the differentials and an extremely low count of 0.3. I didn’t know that such a result was even possible!
His haemoglobin had dropped from 122 to 70 and they are now doing testing to see if his red cells are auto hemolyzing. As best they can tell, it appears his bone marrow has stopped producing cells. They are doing another bone marrow biopsy this morning as they feel they didn’t get an adequate sample the other day.

So far his blood cultures and urine cultures are negative but they are repeating them just to be sure.

They have now given him some heavy duty IV medications, Vancomycin, and Meropenem in addition to the previously given Piperacillin and Tazobactam, as he was still running a fever yesterday. Last night his temperature spiked but was normal this morning.

The doctors are doing a lot of testing as he has a significant number of other concerning results in his blood chemistry. It appears that he will be in isolation, in the hospital for some time. The internal medicine resident yesterday said that they  had more questions than answers at the moment.

The dietitian has also been involved with providing Garry a nutrient dense, high fibre diet, along with many snacks throughout the day to encourage him to eat more. Due to all the medications and pain that Garry has been in, he has not been eating properly and has lost weight, which he certainly cannot afford to lose.

So, our journey continues, but we are receiving such wonderful medical care with so many people helping us along the way.

Thanks to everyone for your care and concern.