Any oncologists on here?

[Alan A]

Have a question about heparin. Sick relative.

[Chocaholic]

Why not post your question? May not be any Oncologists around but several other docs and a wealth of experience on the board.

[Alan A]

It’s long. Aren’t they all.

80+ yo. Long term multiple myeloma patient. He’s been stable while treated - biweekly infusions.
Faculties are slightly diminished - memory issues.
Tested covid +ve two weeks ago.
Hospitalized 10 days ago - mostly dehydration, lack of appetite and weakness - he fell twice at home.
Found a PE in both lungs almost a week after admission.

Platelet count is 52 and dropping. He’s missed at least one of his cancer treatments and those don’t seem to be scheduled either. His historic numbers fluctuate between 45 and 60.

He’s had lovenox, but his doctors are refusing to treat the PE with blood thinners if his platelet numbers drop below 50 - despite published works saying heparin is beneficial at a reduced dose down as low as 25 for myeloma patients.

They’ve given no reason for the refusal. Wondering if there are contraindications they just aren’t communicating. I’m not his health proxy - my wife is - so can’t press them.

[John Rogers]

I'll have been on immunotherapy 3 years this coming April. When I started it, I had a cancer spot in the upper section of my left lung. Before I got the 1st dose, I had a meeting with the doctor who had tested this medicine at another hospital, the meeting was about 2 hours long and we went over the effects and side effects that could show up and I was started on a full spectrum blood test that day and the following week I got the first dose. I get both blood work and infusion every 3 weeks and the medicine named Libtayo's only side effect is I get tired and I have to force myself to eat. I use edible TCH to help me sleep with the okay of my surgeon and my oncologist so generally I go to bed about 9PM.

I have Medicare and Tricare For Life and so far, Medicare is footing the $6000 per dose bill and the oncologist said I'll get this for the rest of my life probably. Sounds like the various people your relative has caring for him don't seem to be talking with each other? My Oncologist, surgeon, ear specialist, skin specialist, PET scan specialist all communicate monthly about me and other people getting these meds!
John

[Noah930]

Mrs. Noah is/was a nurse practitioner for MM patients in a previous lifetime. But that was pre-Covid and as an outpatient basis, so not necessarily directly applicable to your family member in the ICU.

Is your FIL getting daily lovenox (injections)? He was receiving subQ heparin injections in the past? Or an IV heparin drip?

There are 2 slightly different issues with anticoagulant treatment FWIW. Lovenox and heparin don't dissolve clots. They just prevent clots from forming/propagating. It's a thrombolytic drip that will dissolve a blood clot.

The PE is already there. Your family member hasn't passed, yet. The body can/will dissolve it itself with time, even without anti-coagulant agents.

Best wishes for your family member in this challenging time.

[pavulon]

It sounds like his team believes his anticoagulation status is optimized for his situation. Heparin induced thrombocytopenia is a thing to consider as well and he's not showing much cushion for a reaction like that. It's tempting to chase perfection but better is often the worst enemy of good.

[Alan A]

Originally Posted by pavulon

It sounds like his team believes his anticoagulation status is optimized for his situation. Heparin induced thrombocytopenia is a thing to consider as well and he's not showing much cushion for a reaction like that. It's tempting to chase perfection but better is often the worst enemy of good.

Let’s just say that I’m not thrilled with the actual tangible quality of his care and leave it there. That more than anything else is causing me to question the things I can’t see.