Sunday, December 20, 2009

New Wig

I failed to capture all of the things Carla tried on at the Catholic Hospital last week other than the black curly wig.  This morning Carla went to Sunday School and Church with me.  She wore the wig she got last week.  I think it resembles her original hair quite well.


Carla's new Do

In reading this blog, Carla reminded me that I hadn't mentioned about her kids, Carissa and Ed, visiting us in Little Rock at Thanksgiving.  Here is a picture of Ed and Carissa with their Mom in the 7C ward of the hospital.  You can see the black bag that Carla carried around for four days.  It had two IV pumps in the bag.  Each of the bags contained two of the chemo chemicals.  So in all, she had four chemo chemicals by IV and than had Thalidomide and Dexamethosone by tablet each of those four days.


Ernie, Carissa, Ed and Carla

The Northwest Logo on the shirt also reminded me that I never mentioned that the Northwest Missouri Bearcat Football team won the NCAA Divison II national championship a week ago.  This was their fifth consecutiv national champtionship game but their first since their '98 and '99 championships.

This Christmas my daughter Sandy and her husband and five kids plan to visit us this Wednesday and then Ed plans to visit us for a few days around New Years.  My sister has gracious agreed to keep our cat until Carla completes her myeloma therapy.  We didn't have time to do anything with Miss Kitty before going to Little Rock.  She did very well but it is difficult to have a cat around when Carla was neutropenic and it complicates the search for available apartments.  I plan to drive Miss Kitty to Nebraska near New Years.  I really appreciate Karan's offer to take Miss Kitty.

Hanging out in Little Rock apartment

Carla and I wish all of you a very Merry Christmas!  We appreciate all the prayers on our behalf.


Saturday, December 19, 2009

Home!

On Tuesday, Carla got good news after her blood tests.  Her platelet count had to be over 50 before they would remove the Quinton catheter.  Her platelet count was 51!  Between her blood tests and the appointment with the doctor, we went to the New Outlook shop at the Catholic Hospital.  They let her pick out a wig, two hats and a couple scarfs.  She hasn't modeled her wig for the camera yet but here is one I liked...



The doctor issued the order for the removal of her catheter and said she could go home.  We made arrangements for blood testing in Springfield twice a week and tentatively scheduled Induction 2 to start either January 6 or 8.  She was relieved to get the catheter removed and we went back to the apartment to pack.

We got back to Springfield Wednesday night and are glad to be home!

Saturday, December 12, 2009

Stem Cells!

Carla was having her stem cells harvested from 7:00 a.m. until 11:15 today.  We won't know the quantity of stem cells collected until Monday.  Basically this machine is a large centrifuge that separates out the stem cells and some blood platelets.  It adds an anticoagulant and some calcium ions to the blood as it is returned to her body.  Just prior to returning the blood to the patient the plastic tube wraps around a heater so the returning blood will be at body termperature. (Upper left in picture.)


Harvesting Stem Cells

Note the Quinton catheter in Carla's upper left chest.  It has two ports.  One for blood coming out of her body and into the machine and the other for the blood returning to her body.


Cells

This is the collection bag.  It is similar to when you donate blood.  I failed to get a picture of the final collection but it contained probably 5X as much as when I took this picture.

The collected cells will undergo some post processing before they are frozen.  The stem cells will be separated more from the red blood cells and possible myeloma cells.

Tomorrow we have to go to 7C for blood tests and growth hormone shot at 8:00.  I suspect that Carla will have to have a platelet transfusion as the harvesting of stem cells also collects some platelets.  Her platelet test was low today so it will probably be lower tomorrow.  We will also have to go back at 5:00 p.m. for another hormone shot.

Hopefully the second stem cell harvest session at 7:00 a.m. Monday will be Carla's last such session and she can get her catheter removed. 

Carla's hair has been falling out since Wednesday.  We got a hair net for her but she finally got tired of dealing with it.  This evening when we returned from getting the hormone shot we stopped at a salon and she got a "buzz" cut.  Monday we will go shopping for wigs. 

Perry, one of the patients farther through the treatment, gave her a red, while and blue bandanna like you often see bikers wear.  She wears that a lot around the house and the green knitted hat shown in the picture.

Friday, December 11, 2009

Stem Cell Harvest!

Sorry but the past few days have been so full I didn't find time to update this blog.  I can skip the details and say we are to report for stem cell harvest Saturday 7:00 a.m.

The values for the white blood cell count were:
Wednesday 0.7
Thursday    1.94
Friday        7

This morning they sent a sample of her blood over to the stem cell folks and they said the population density of her stem cells was sufficient for harvesting.  We had to get her catheter replaced with the Quinton catheter which only has two ports rather than three but these ports are larger and are required for the higher blood flow utilized in the harvesting of stem cells.

We had hoped that there would be time afterwards to have a harvest session today but the surgeons had an emergency and Carla had to wait about two hours to get her new catheter.  There wasn't time afterwards for the stem cell harvest.

They required at least two harvest sessions of 4 to 5 hours in duration.  They want to collect at least 20 million stem cells.  They think that in Carla's case they can accompolish this with Saturday and Monday harvests.

After the harvesting of sufficient stem cells Carla will have an appointment with her doctor and then get the catheter removed before we head back to Springfield!  We would like to be out of here on Tuesday or Wednesday.

The original PET Scan (taken during our first week of tests in Little Rock) showed 11+ focal lesions.  The PET Scan done a week ago (after chemo) showed the focal lesion on her right femur was the only one left and it was about half as big as before! 

Basically this is the end of Induction 1.  When Carla meets with her doctor next week, they will schedule Induction 2.  Basically this will be the same as Induction 1 except there will not be any harvesting of stem cells and the growth hormone shots will only be once rather than twice a day.

Fever up to 102 has been quite common for Carla this week.  All blood cultures for bateria and for virus infection were negative.  The APN said some patients tend to run low-grade fevers when they have low white blood counts.  Now that her temperature has gone down we don't have to give the infusers. 

Another happening during the last few days has been Carla's hair loss.  More about her bad hair days later...

P.S. The other BIG happening at the UAMS today was the 3 month premature birth of the 19th child of the couple with the TLC program "18 and counting."

Tuesday, December 8, 2009

Waiting Game

Carla's white blood count has been going up each day but it is slooow!  Sunday it was 0.05, Monday 0.09 and today it was a whopping 0.29.  It has to be above 2.0 before we can move on towards harvesting stem cells.

The past two days Carla has been fighting a low fever.  When we went back for the 5:00 growth hormone shot today, they took a blood sample for a culture.  They want to see if she has an infection of some kind.  They did that twice last week but the cultures did not reveal anything.

I thought I would let you know more about the Central Venous Line that was installed in Carla back on the Monday before Thanksgiving.


Central Venous Line

As you can see Carla has three ports.  This allows the nurses to readily access her vein for getting blood samples, inputting an IV or giving a platelet transfusion.  They take care that this does not get infected.  The covering is dated when applied and is changed regularly.  We have large pieces of clear plastic that has adhesive edges for covering this when Carla takes a shower.

Carla gets an IV antibiotic each morning in 7C.  She takes antiviral medicine morning and night.  Since she first had a fever, they have been sending a thing called an infuser home with us.  The infuser reminds me of a baby bottle with a balloon inside containing the medicine.  I can disinfect Carla's port and attach the infuser.  This is one way she can get the equivalent of an IV at home.  We first had a potassium infuser which took 5 hours to empty.  Now we have two antibiotic infusers each day that only take 30 minutes to empty.

Infuser

Before the stem cells are harvested, the CVL will have to be replaced by a Quinton catheter.  The Quinton catheter has two large ports.  The flow of blood out of her body and into her body is much faster than IV's so it necessitates larger ports.  Hopefully her WBC will get above 2.0 and she can be fitted for this Quinton catheter soon.

Sunday, December 6, 2009

End of week 3

Well we have been at the Myeloma Institute for three weeks now.  Carla finished the chemo for her first induction last Tuesday.  We are still waiting for her white blood count to rebound while she takes growth hormone shots twice a day.

Yesterday her WBC was 0.04.  Down from the 0.11 on Friday.  Her potassium level was low again.  We got a prescription for K tablets (horse pills) and her potassium level came up by Sunday. 

Today her WBC was 0.05 and her platelet level was down.  She had to get a platelet transfusion.

Basically we go to 7C of the Medical Hospital at 8:00 a.m. for blood tests.  Generally the results are back in about an hour.  If anything is critical as was her platelet level this morning, the lab calls back so the nurses don't have to wait to remedy the situation.  During the week, Carla's APN Nurse will come by and check on her similar to a visit to a doctor's office.  Depending on what corrective actions are necessitated we are out of there some where between 10:00 and 1:00.

After eating, Carla takes an afternoon nap.  About 4:30 it is time to head back to 7C for the second growth hormone shot.  No blood tests are required.  We can usually be back to the apartment by 6:00.

Hopefully we can harvest stem cells by the end of this week.

Friday, December 4, 2009

Induction I

Carla's chemo ended on Tuesday.  She received her first growth hormone shot on Wednesday.  She will continue to receive a shot morning and evening until her white blood cell count (WBC) starts to increase.  Once the WBC gets above 2.0 they will collect a blood sample each day to test to see if it contains sufficient stem cells for harvesting.

Since her WBC increased slightly (0.79), we mistakenly thought she was approaching stem cell harvesting.  Today her WBC was down to 0.11.  Her blood platelets were below 30 so she had to get an infusion of platelets besides some antibacterial IV's.  So instead of going in the clinic at 8 and out by 10 it was out by 1:00.  She will get her second shot of the day at 5:00.

We are very careful about limiting the contact she has outside our apartment (mask) and what food we allow in the apartment while she is neutropenic.  Neutropenic is when the WBC count is < 2.0.  For a good list of precautions for neutropenic patients see http://www.oncolink.org/treatment/article.cfm?c=2&s=13&id=68

Oh well... Maybe tomorrow.