Monday, August 30, 2010

End of Consolidation #2

Carla is getting her line out and we will be heading home this afternoon.  She has done extremely well during consolidation #2 with few side effects.  She has an appointment this Thursday with the neurosurgeon, Dr. Pait.  We plan to drive back early Thursday, meet with Dr. Pait, have her blood labs drawn here and spend the night at our Little Rock apartment before heading back to Springfield.

Carla meets with Dr. Pait to see what he recommends about her back including possible corrective surgery.  Carla is scheduled to return to Little Rock in 4 to 6 weeks to have tests done before starting on her maintenance phase.  Most of the maintenance therapy can be done in Springfield.  Dr. Barlogie will help schedule the surgery if it is deemed necessary.

Carla's platelete count was coming up yesterday but at 32 it would not be above the minimum 50 required for line removal.  Carla convinced the APN nurse to let us come back last evening for a bag of platelets rather than have to work them into today's schedule.  Because of this foresight it looks like we will be ready to head out of here before 3:00 today! 

Saturday, August 21, 2010

Consolidation #2 Update

Carla has been progressing about as we expected. She had the black bag with the two IV pumps Saturday through Wednesday. At the new Cancer Institute infusion center they basically have not had us stay for the results of the lab tests but will phone us to come back later that day if there are problems that need to be addressed that day. Carla has the normal constipation and other digestive side effects but she has not had the mouth sores or loss of appetite yet.

She has been very careful to not get germs from the other patients. She puts on a glove and uses a disinfectant wipe to clean off the arm rests in the waiting room. She does the same thing when she gets in the infusion center. The chairs in the infusion center are supposed to be disinfected between patients but Carla isn't taking any chances.

Carla got the black bag off Wednesday and  Thursday they started the growth factor shots. Today they stopped giving her the Lovenox blood clot preventer as her platelet count was dropping and the risk of blood clots was decreasing. Generally the white blood count bottoms out about day 10 with days 7 - 10 being the worst. Well today is day 8 and Carla's energy level has decreased.  Due to the growth factor shots her white cell count rose to 13 yesterday.  It will plunge soon.

I mentioned last time that Carla is being treated in the Winthrop P. Rockefeller Cancer Institue that opened August 1.  This is a seven-story tower that houses most of the outpatient services for cancer patients.
Cancer Institue Main Entrance
This is the main entrace to the building with its valet service.  We park in the parking garage instead.
Parking Garage and MIRT Building
The above picture was taken looking outward from the Cancer Institute.  It shows the parking garage.  The tall building down the street from the parking garage is the Spine Institue.  This is the building that houses the Myeloma Institue Clinic (MIRT).  This is where we go when we see the doctors.
Biomedical Research Center
I rotated on around and took this picture of the Biomedical Research Center.  This is where most of the research concerning Multiple Myeloma is conducted.  We have not been in this building.
Entrance From Parking Garage
This is Carla in front of the patient entrance from the parking garage.  The parking attendants in the first picture were just to the left of this photo.
Carla In The Waiting Room 
The Infusion Center for myeloma patients is on the fourth floor.  I hear there is another Infusion Center on the first floor but we have not been there.  When we get there, Carla has to sign-in at the desk at the back of this picture.  The patients usually take the chairs with the tall backs and the caregivers sit beside them.  Carla is in the center of this picture with her mask on.
Part Of Infusion Center Waiting Room
I took these pics on a Friday and it was a slow day.  The waiting room is generally about 90% full.
a
Eating Area and TV Area of the Waiting Room
The actual Infusion Center first has an area where patients are weighed and temperature is taken as they enter the Infusion Center.  Patients are assigned to one of three areas depending upon their condition, the results of prior tests and what they need today.  When Carla got her black bag and had it serviced she was it what are pods.  Each nurse is responsible for a specific number of pods.
Pods With a View
Each of the pods had a TV monitor, a comfortable chair and a blood pressure/temperature instrument.  The assistant that calls the patient in the waiting room takes all measurements before the nurse comes to collect the blood samples and administer any IV's that may be necessary.  If there are problems, an APN nurse is summoned.  Each patient is assigned to a specific APN nurse.
Other Pods Showing Patients, Caregivers and Nurses
In walking to a pod we discovered that one side has private rooms for patients who can't sit in chairs and need to be in bed.
Private Rooms for Critically Ill Outpatients
Since Carla got the black bag off, we discovered there were a limited number of areas referred to as "Rapid Injection" areas.  These do not have as comfortable chairs and most patients are there for drawing blood samples.  I imagine that when Carla's WBC drops below 2, she will again go to a pod in case she needs IV's of sodium or potassium or she needs blood or platelets.
Carla Having Blood Drawn in "Rapid Injection" Area
Hopefully this give you an view of the new Cancer Institute at the University of Arkansas for Medical Sciences.

We learned this week that a church has purchased the Senior Apartments where we are staying this trip.  They plan to turn it into a transition facility for criminals.  The none UAMS patient residents now have to find a new place to live.  Myeloma patients starting their treatment had planned to stay here during all of their treatment.  Those of you following Carla's treatment know this usually lasts for 10 to 12 months.

I also saw the auto body guy from Hope, Arkansas who wife got the upper lung infection and was in ICU.  She is now out of her coma, out of the ICU but still in the hospital.  He said today that things were looking up.  Her hospitalization is approaching a month.

Friday, August 13, 2010

Consolidation #2

We returned to Little Rock on Monday.  We were hesitant as we weren't able to get another apartment with Home Away From Home.  We did get an apartment at Hidden Creek Retirement Home.  This is a small furnished apartment at a former nursing home.  The apartment is smaller but so is the rent.  We don't have Internet access there so I have to use the Internet while at UAMS.

Tuesday she had blood tests and that dreaded bone marrow biopsy procedure.  Wednesday it was an MRI and then wait for the results.  Yesterday was our appointment with Dr. Barlogie.  Our appointment was at 1:30 but it was after 6:30 when we got out.  They had failed to order Carla's Thalidomide.  At our July discharge, We had warned the doctor that we only had enough for two days and she needs four days of Thalidomide for the Consolidation.

Basically they faxed the prescription to CareMark and I periodically called them.  Today I got notification that it will be shipped overnight and I will have to stay at the apartment from 8 - noon tomorrow to sign for it.

As a result of the delay at the doctor's office yesterday, Carla couldn't get her line implanted in her chest yesterday.  She is getting the line put in now but won't be able to get the black bag with the two IV pumps until tomorrow.  This means were are getting a day later start to her chemo but her meds should be here as she needs them.

I did note that they failed to get us the prescription for the dexamethsone that she takes with the thalidomide.  I am attempting to get that phoned in to Walgreens so she will have it in the morning.  We have found you have to really check on what is done to make certain that nothing has been omitted or that the wrong meds/IV's have been given.

The treatment is in the newly opened Winthrop Rockefeller Cancer Institute.  Both the Infusion Center and 7C are now combined into one location.  The Blood Draw and MRI are also in the new tower.  I will try to post some pictures in a later blog.

One lady from Hope, AR that we shared an infusion room with several times is in ICU with a lung infection.  She has been in a comma for at least 12 days but appears to be improving.  Please remember to pray for her.  We are taking special care to prevent infections as Carla's immunity goes down hopefully for the last time.