Hematology and Oncology

Settling In

I am coming up on my two year anniversary. Not my wedding anniversary (soon to be 15 years – thanks Maia!), but two years since I joined the ranks of the patients. It was two years ago this week that my day was interrupted by a page from my internist saying, “I don’t know how to tell you this, Brett, but you have Chronic Lymphocytic Leukemia.” At 38, I became one of the small percentage of patients who are diagnosed with CLL at a young age. Several folks have asked me how it has changed me or how I work. It’s funny – I don’t really know how to answer that. Sometimes I am grateful for CLL; it has required me to strive to balance my professional life and private life in a way that I never had to before. I have also been very grateful to my group at…

The Doctor Patient

[caption id="attachment_11096" align="aligncenter" width="594"] Selfie of my pale self in hospital garb on day #2 in the hospital[/caption]   As you can see, no glamour shots for this month’s post. I knew it would come at some point, and my first hospitalization related to my CLL came in a big way in mid-July. Given my interest in global health, it was only fitting that I managed to get sick while out of the country. The plan for July had been to help teach our Asian Clinical Tropical Medicine course in Bangkok, Thailand and Siem Reap, Cambodia for two weeks, followed by a much-needed family vacation. I felt well during the course, but at the very end of it I noticed I was really tired. We enjoyed 2 ½ days visiting Angkor Wat and other sites in Cambodia, then headed to Chiang Mai, in northern Thailand. Initially, I thought I was…

Apixaban for acute VTE treatment

This large multicenter trial randomized patients with acute VTE to apixaban (10mg BID for 1 week, followed by 5mg BID for 6 months) versus conventional therapy (lovenox-warfarin). The primary outcome was similar between groups (symptomatic VTE or death related to VTE), but major and minor bleeding occurred significantly less often with apixaban. Apixaban is a viable oral alternative for treating acute VTE (abstract).

Subsegmental PE same outcome as proximal PE

This study assessed the characteristics and outcomes of patients with subsegmental and proximal PEs, and found they were similar, including cumulative death rates of 10% and 6%, respectively. Subsegmental PEs carry the same risks as proximal PEs and should be treated as such (abstract).

ASA for post-THA VTE prophylaxis

This trial randomized post-THA patients to dalteparin or ASA for 28 days (after 10 days of dalteparin) and found no significant difference in VTE or bleeding rates. After 10 days of dalteparin, 28 days of ASA is safe and effective for VTE prevention post-THA (abstract)