A friend of mine, who lives in VERY rural West Virginia, called me 3
weeks ago to tell me how rotten she was feeling.  She'd had her period
for nearly 2 weeks and was having an unusually heavy flow.  She
thought she might be anemic - she said she was very pale, that her
lips were white, and that she had bruises all over.

I urged her to go to the doctor right away.  The nearest was over an
hour away, but her husband put her in the car and took her.  She was
diagnosed with AML and transferred to a university hospital in
Morgantown.

Her platelet count was 12, so they transfused her with multiple units
of platelets.  She developed pulmonary edema and had a
life-threatening reaction to phenergan, which included seizures.

She received idarubicin initially and is now receiving ATRA, po.  Her
blood counts are much improved, but she's not in remission, yet.

She was initially told that she'd be in the hospital for at least a
month and that they were considering a bone marrow transplant.
Yesterday, a new team of residents came in and told her that they were
going to send her to a family residence on the hospital grounds for a
few days, then send her home.  She'll need to come in 4 times a week
for follow ups - she lives over 3 hours away.

Everything I've found about chemotherapy for AML strongly suggests 28
days of treatments, b.i.d., or until remission is achieved.  The ATRA
protocol that I found in my searches is IV, not PO - I found one study
where it suggested that PO therapy is ineffective.

She's got major nausea, which responds well to IV Zofran.  They've
told her that she's going to have to learn to deal with it, without
the IV Zofran.  She's concerned about re-starting the bleeding - they
initially told her that her bleeding was secondary to the leukemia;
now they're saying that it's a GYN problem.

I'm really uncomfortable with what they're doing.  Seems to me that
she's sick enough to require more constant monitoring than she'll get
if she follows this plan.

I'm an R.N., but my specialty is surgical / telemetry, not oncology.
I'm baffled.  Am I off base, here?

Kimba
who is grateful as hell to live in a place with a good number of
healthcare options
--You did then what you knew how to do, and when you knew better, you did better.  Maya Angelou