Waiting and Dropping

We are very much in a waiting game.  Carla only wants to sleep.  She forces herself to eat but does not have an appetite.  We go to the blood lab each day and so far her results have been excellent.  Her blood pressure drops to much when she stands so yesterday she had to get a liter of saline solution as an IV and today it was 1.5 liters.

Basically we are waiting for her old bone marrow to die off and the transplanted stem cells to realize they need to become new bone marrow and make blood cells.  The white blood cells have a shorter life time and therefore their count drops faster than the red blood cells.

Most days they conduct 37 or more different tests.  Mostly I have learned to focus on:
WBC  White Blood Count  These are basically the immune system
RBC  Red Blood Count      These transport oxygen
Platelets                             These clot your blood

Until Carla's platelets fall below 50 K/uL she gets a Lovenox shot to help prevent blood clots.

We also closely look at her electrolytes such as sodium, potassium, magnesium and calcium.  The C-Reactive Protein or CRP count indicates inflamation in the body which can be due to about anything.  A high CRP might indicate an infection.  When Carla's CRP goes up they draw extra blood for cultures.  This time her CRP has been very low.  It spiked at the end of induction 2 when she had a blood clot in her leg.

I have plotted her WBC and RBC since the melphalan was given on 2/25 and the stem cells were transplanted on 2/26.  Initially the WBC goes up because she was on the steroid, Dexamethasone for a day prior to the melphalan up until 1 day after receiving the stem cells.

WBC and RBC Counts Versus Date

As you can see, the white blood cell count is decreasing rapidly and the red blood cell count is remaining almost constant.  Thi week, the WBC has been below 2 K/uL and this is when her immunity is quite low.  Several patients are fighting colds and other infections.  Carla has to wear a mask when she goes to the lab.  We also wash our hands with antibacterial soap a lot.

Platelet Count Versus Date

Her platelet count is dropping quite fast.  It will bottom out near zero similar to the WBC and the new bone marrow will have to make new platelets as well.

Friday will be day 7 since the transplant and they say days 7 - 17 are generally the low times.  Not only are the white blood cells and platelets low, but the patient's energy level is also low.

I pray that Carla can avoid infections and other complications.  So far she hasn't experienced extreme nausea or mouth sores.  She has alcohol-free mouthwash and avoids rough brushing of her teach.

I am amazed at how open the Myeloma Institue is with the test results.  Nurses bring printouts to the patients almost as soon as they receive them.  They want patients to be informed and to track their progress.