Since Dad’s discharge as an inpatient in the Blood & Marrow Transplant (BMT) unit at the Moffitt Cancer Center on March 1st, Dad has been going daily to Moffitt to have his central line catheter flushed and to receive blood support. He has been given blood transfusions to elevate his hemoglobin (red blood cells), platelet transfusions, and neupogen shots to increase his white blood cell count. During this time, Dad was also taking Bactrim to treat his PJP and voriconazole to address potential fungal nodules in his lungs.
On Wednesday, March 9th, Dad had his follow-up CT scan at the Moffitt Cancer Center at International Plaza (MIP). Late that afternoon, Dad received a phone call from Dr. Ayala’s office stating that Dr. Ayala would not be able to see him as originally planned on Thursday, March 10th. Dr. Ayala had the flu. Dad’s appointment was then rescheduled for Monday, March 14th. Mom and Dad were highly disappointed. They had set their sights on Sunday, March 13th, as an inpatient admission to the BMT unit for Dad’s transplant….even though no one had given indication of a new admission date nor transplant date. Mom and Dad were extremely eager to get this transplant moving. Dad had experienced so many delays. The delays were weighing down his spirit. Mom was struggling with Dad being disheartened.
Early Thursday morning on March 10th, we went to Moffitt Cancer Center’s main campus to meet with Dr. Baluch, BMT infectious disease. We had actually never met Dr. Baluch when Dad was an inpatient earlier this month. Dr. Baluch had been out ill and then had gone on a ski vacation. We were eager to finally meet Dr. Baluch as her positive reputation had preceded her.
In the Blood & Marrow Transplant (BMT) clinic, we first met with Dr. Baluch’s nurse. She came in to review Dad’s information and medications. The nurse wanted to know about Dad’s respiratory symptoms. Dad said that he always has had a runny now (since he has been getting cancer treatments). Dad did not have a sore throat. The nurse inquired about any fevers, diarrhea, shortness of breath, etc. The nurse took a respiratory virus panel to check the status of Dad’s rhinovirus (aka the common cold).
Dad asked the nurse to assist him in getting in contact with Denise, transplant nurse, or her backup, Diane. Mom seemed to think that Denise was out of the office. Dad needed additional line flush and blood support appointments scheduled through Monday, March 14th, the day of Dad’s appointment with Dr. Ayala.
Dr. Aliyah Baluch
Dr. Baluch, BMT infectious disease, then came in to see Dad. She asked about any history of hemorrhoids, toe nail fungus, and mouth sores. She wanted to know Dad’s travel and career history along with his current living arrangements and hobbies. Dr. Baluch asked how Dad had been feeling the past few days.
We had a long discussion about his “vori” (voriconazole) medication. Dr. Baluch sought to understand when Dad first started taking vori and what dosage. Dr. Baluch confirmed that, from the BAL (bronchoalveolar lavage), two diagnoses were made, rhinovirus and PJP.
Dad successfully finished the two week therapy for PJP. The Bactrim dosage reduction is a precaution to keep Dad from being infected to a new exposure of PJP. Dr. Baluch also wanted to check his vori level via a blood test. It would take about three days to get the results. If needed, she would tweak his vori dosage. She had prescribed vori for Dad as an anti-fungal because he had lived in Ohio during his childhood through college. She indicated that Dad could have picked up something fungal in Ohio earlier during his childhood. The fungus stays with you for life.
Dr. Baluch reviewed the CT scan with us by comparing the prior one from late February to March 9th’s. She was impressed that Dad had cleared so well in only two weeks. It normally takes a minimum of three weeks.
She wanted to check Dad’s CD4 counts by running an immunodeficiency panel considering his numerous atypical infectious disease related infections. It will take one week to get the results back. One way to measure the strength of the immune system of a patient is to measure the T cell count (CD4). CD4 cells are types of white blood cells called T lymphocytes or T cells that fight infection and play an important role in immune system function. This will help her determine risk stratification prior to Dad’s stem cell transplant. Dr. Baluch said that she would be keeping this in her back pocket as a means to make smart decisions about managing Dad’s future risk of infection. Dad will see her when he is an inpatient for transplant.
Dr. Baluch cleared Dad for transplant! She noted that Dad is high risk due to the fact that he has had CMV (cytomegalovirus) and PJP.
Dr. Baluch is extremely engaging and highly impressive. She is Moffitt’s only stem cell transplant infectious disease doctor. She attended medical school, here in Tampa, at the University of South Florida (USF) and did her residency at USF and the Moffitt Cancer Center. Dr. Baluch then moved to the University of Alberta for her fellowship in transplant infectious disease. Subsequently, Moffitt created Dr. Baluch’s current position for her.
After spending time with her on Thursday, I am a firm believer in that every BMT unit must have an infectious disease doctor dedicated to transplant. I say this as no one dies from the actual stem cell transplant itself. Infection remains a major cause of mortality in stem cell transplant patients. Prevention of infection in these patients remains the optimal method of decreasing morbidity and mortality. Once infections occur within a transplant recipient, the mortality rate is high. Pathogens that are benign in an immunocompetent person can lead to significant mortality in transplant recipient patients, who are immunosuppressed.
Our discussion with Dr. Baluch flashed me back to college when I had planned to go to medical school. It reminded me of why I had wanted to be a doctor. I found medicine to be tremendously fascinating and the challenges of saving a life intensely thrilling and purposeful.
I shouldn’t have let my organic chemistry class and the future years of highly expensive medical schooling change my major to engineering.
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