Stem Cells!

Carla has done quite well this week.  On Thursday, her blood tests results were ALL within the normal range!  She was able to get her melphalan IV as scheduled.  We made certain Carla's mouth and throat were cold as she ate ice and drank ice water for about 30 minutes prior to taking the melphalan and also for about 30 minutes afterwards.  The melphalan attacks rapidly growing cells and the cells lining of the mouth and throat are of this type.  The cold temperatures cause the blood vessels to constrict and therefore less melphalan gets to them.  Hopefully Carla won't get bad mouth sores.

Friday she got slight over six million of her stem cells replaced.  The transplant process took about 4 hours.  She first had to have the blood tests and wait about an hour for the results.  They don't move her harvested stem cells from storage until they know they can progress with the transplant.  The blood tests, wait for test results and wait for delivery of the stem cells took about two hours.

Carla's APN nurse had to administer the actual transfusion via an IV drip.  I planned to get a picture during this process but was listening to the instructions from the APN about Carla's care over the next two weeks that the actual transfusion was over before I could get the camera out.  It only took about 15 or 20 minutes for the transfusion.  The first side effect I noticed was Carla had this "creamed corn" smell.  The stem cells are preserved using DMSO.  This odor is released through a patients skin for two or more days.  Carla wasn't able to detect the odor. 

Here is a picture of Carla taken during the two-hour wait after the transfusion.  They make the patients stay for at least two-hours so they can monitor all vital signs to see if there is any adverse reaction.

As you can see, Carla had to have oxygen throughout this process and get a saline IV.  The netbook computer is a recent item that I got for Carla.  It weighs less than 3 pounds and she can use it in the hospital 7C while she waits for blood test results and for IV's to finish.  I also brought a wireless router back this time so she can have network access in her bed or recliner.

When we paid our rent this month, we let the church representative know that with Carla's back problems she wasn't able to sit in the recliner or chairs in the apartment.  Yesterday they exchanged our old worn out recliner for a much nicer one.  Carla has been able to use the recliner now.

Yesterday, we finished the lab work about 11:00.  The temperature was about 60 degrees with plenty of sunshine.  We decided we wanted to get out before Carla's blood counts dropped.  So we rushed home to make sandwiches and headed to Hot Springs, AR.  Hot Springs is billed as being the first resort in the US.  We took an elevator to the top of Mountain Tower and toured a restored bath house.  It was a great day!

Now we are in the waiting game.  Carla's blood counts had dropped a lot today.  The APN said she would probably experience fatigue, diarrhea and mouth sores with the worst period being about a week after the stem cell transplant.  We look forward to having all of that behind us!

Stem Cell Transplant #1

We returned to Little Rock last Sunday, Feb. 21 only to find that our refrigerator had quit working while we were gone. A call on Monday got us a new refrigerator.
On Monday Carla had:

• Blood Tests

• Pulmonary Function Test

• EKG

• Echo heart test

Today, Tuesday, she:

• Met with one of the research data staff members

• Had a 2-hour full-body MRI

Tomorrow we

• Meet with a research nurse

• Meet with Dr. Barlogie, and hopefully

• Get her Central Venous Line implanted again

• Start Dexamethasone pills which she will take for four days.

On Thursday she will get her high dose of mephalan.  For information about this drug see:
http://en.wikipedia.org/wiki/Melphalan

and on Friday she will get her stem cells implanted. The stem cell transplant should take about four hours.

After her stem cell transplant it will just be a time of waiting for her body to recover. During this time, Carla will have to go to the lab for daily blood tests and any meds or IV's deemed necessary based on these test results.

Break in Treatment!!

During the white-out snow storm Monday, Carla saw Dr. Barlogie and he approved her taking a two week break. She got the triple lumen catheter out just before things shut down at the medical center due to the five inches of snow. We hurried back to the apartment and decided to try to get out of Little Rock.


During a downpour that turned the snow into slush, we loaded the car and left about 3:00. After consulting the Arkansas and Missouri road condition map, I decided to take the westerly route via Fort Smith, Fayetteville and Joplin. The first hour was difficult driving. There were lots of cars and trucks in the ditch but we made it. After Russellville, the roads were wet and it was snowing but we could make good time. East of Joplin, the snow started sticking and we had to crawl back the last 20 miles but we arrived home shortly after 9:00.

Little Rock would have been a frozen sheet of ice on Tuesday and probably wouldn't have been a good time to leave either.

Carla's daughter, Carissa, graduated with her Masters in December and arrived at our house about two hours prior to our arrival so she had the house warmed up before we got there.

Due to Carla's two blood clots, she had to get a daily Lovenox shot. Growing up on the farm I had given shots to livestock. I find giving Carla her daily Lovenox injection to be more stressful. Only 11 more shots! Carla has to get blood work done on Mondays and Thursdays with the results faxed to the Myeloma Institute. They have to draw additional vials on Monday and overnight them to Little Rock for running the myeloma marker tests.

We plan to return on Sunday, Feb. 21 with testing on Monday and Tuesday, Dr. appointment and catheter implant on Wednesday, high dose of Mephalan chemo on Thursday followed by stem cell transplant on Friday. Depending on Carla's response, it will take 2 to 3 weeks for her recovery from this treatment before we can return home. I guess that shots most of March.

The treatment protocol says we can start the second stem cell transplant anywhere from 6 weeks to 6 months after the start of the first transplant.

Ice, Ice and more Ice!

Last Thursday night and off and on Friday Little Rock got rain, sleet, ice and snow.  Fortunately the ice didn't form on the trees.  With our 4-wheel drive Highlander we were able to get in to the blood lab for tests on Friday and Saturday.  We were able to help transport another patient whose wife was afraid to drive on the ice.  Harvey did not go in to the lab on Friday and by Saturday he was in need of a blood transfusion and antibacterial IV.  His CRP was over 200.  Normal CRP range is 0 - 10.  He had a sinus CT scan yesterday as the doctor feared he had a sinus infection.

Our apartment is in the southwest corner of the parking lot.  There is a hill just in front of our apartment where I park our car.  These Little Rock folks don't get enough ice and snow to be experienced at driving on ice.  A Ford Expedition attempted to turn the corner and go up the hill in the parking lot.  Sitting in our apartment I could smell burning rubber.  I went out to help but didn't want to actually climb in behind the wheel in case I would hit other cars.  He left his car in the middle of the parking lot.  He put a huge rock behind the wheel but during Friday night the car slide down the hill and into another car.

Ford blocking part of driveway

This picture is taken from the back of our car.  You can see how much this white Ford blocks the drive.  I was able to back up the hill and get around the Ford on Saturday after helping another patient get his van moved.  The van driver and his daughter are both being treated at the Myeloma Institute.  He needed to get in to have his stem cells harvested.

At the top of the hill behind our car was this view.

View from our parking spot

This gives a view of the ice coated hill.  Note the black car at the top that has slide into another car.  We got both of the cars out Sunday afternoon.  The drivers had never heard of using sand to get better traction on the ice. 

Once I got our Highlander out, I parked in a different spot.  I felt fortunate that no car had slid directly down the high into our car!

Blood Clot

Carla's blood chemistry had been so good the end of last week that on Saturday they told us not to come in on Sunday but rather come in Monday at 7:30 a.m. so the results would be back before our 10:00 appointment with Dr. Barlogie. The APN predicted that we would be able to get the catheter out and we could go home for a few days before starting the first stem cell transplant.


The blood test results had a moderately high CRP of 50 which can indicate an infection or some inflammation. The doctor had them do a blood culture and an ultra sound on her legs. They found a new blood clot in Carla's left leg and an old one in her right leg. One of the side effects of Thalidomide is blood clots.

Carla had to go back to the blood lab and get a Lovenox injection. She will have to continue these for a few days.

Carla had an MRI for a hour late last night and is getting a PET scan this morning. Hopefully these will show no active lesions!

The hardware in Carla's back tends to shift around some in spite of her brace. We wanted to get a consultation with the neurologist but haven't been able to get that arranged. If it would require major surgery she could not have it until she is finished with all of thise chemo. It would be nice to know what our options are for repair of the August surgery.

Basically we were rather discouraged last night. At the start of the day we had high hopes of being back in Springfield Monday night or Tuesday. Now we don't know if we will be able to go home before Carla has the first stem cell transplant.