Chemo Complications

Carla has had swelling in her ankles for over two weeks.  She was very careful on our flights to St. Kitts/Nevis to get up periodically and walk as well as exercise her feet.  Anyway, yesterday was her day to get her blood tests and the Velcade IV.  The nurse saw the swollen right ankle and reported it to her doctor.  We had to go back this morning for the ultrasound and it was positive for a blood clot.  She was immediately admitted to Cox Hospital for Heparin IV.  They plan to keep her at least two days to hopefully dissolve the clot. 

It is hard for her to be inside on such a nice day and she feels fine except for the swelling. 

Second Quarterly Checkup

Carla had her second quarterly checkup at the Myeloma Institute in Little Rock June 6 - 9.  She had extensive blood tests, that painful bone marrow biopsy and a full-body MRI.  The good news is her multiple myeloma is in full remission and they don't want to see her again for six months! 

Her platelets, white blood cells and hemoglobin counts have been dropping steadily during the six months of maintenance.  The doctor has decreased the Revlimid starting with her July dosage.  The cycle is Revlimid daily for 21 days and then off 7 days.  She has to have new shipment for each cycle and she had just received a shipment so she can not start the lower dose until the next cycle.  With the price of these 21 pills being $7800 the insurance wants her to use up what she has before they send the lower dose pills.

A couple months ago, Carla was anxious to get plants potted in her flower pots.  She did too much bending and lifting.  She said her back "felt" different that night.  Her local oncologist had her back x-rayed the next day but without other x-rays to compare they could only determine that nothing was loose.  We took those x-rays with us to Little Rock and stayed over one more day in order for us to meet with the surgeon that had operated on Carla's back last November.  He could find nothing wrong and thought it was muscle pain.  He cautioned her to not bend her back.  She finds it difficult to wait for someone to help her when she wants to get something done.  She met with her pain doctor and the doctor did not change her dosage of pain meds. 

It looks like we will continue the Revlimid cycle and the weekly visit to the oncologist for blood tests and the IV of Velcade.  Hopefully once Carla gets the lower dosage of Revlimid her blood counts will increase along with her energy level. 

Maintenance Update

Carla has been having blood tests and a Velcade IV every Wednesday at Cox Hospital in Springfield. She has been doing well. Her blood counts have dropped but the Arkansas myeloma doctors say that is normal. She did feel well enough that we were able to visit Carla's mother and sister in California for a week in February.

Last week we went to Little Rock for three days of testing and meeting with doctors. She has a PET scan, a bone marrow biopsy and a full-body MRI. The myeloma doctor said the scans showed no new bone lesions and her old lesions were disappearing or getting smaller. Her pain doctor has started her on pain medication specifically for neuro-pain. They plan to decrease her oxycontin dosage. Currently she is ramping up the dosage of the new pain medication. The pain doctor felt the pain level was normal for four months out from major spine surgery. The spine surgeon thought her back was now strong enough for Carla to do most things as long as she didn't attempt to stoop or bend her back.

Basically we were encouraged by the test results and conferences with her three doctors. Carla's next quarterly check up will be in June. Until then, she will continue her weekly chemo sessions in Springfield. The blood samples for the myeloma markers will only be shipped to Little Rock once a month rather than the current two times per month.

We appreciate all the prayer support for Carla. We were able to rent one of the Home Away from Home apartments for the three nights we were in Little Rock. This was much better than going to a motel!

Carla is feeling well enough that she is busy landscaping our yard and getting on with the painting and minor remodeling jobs on our house that were postponed when she was diagnosed with multiple myeloma.

Home Again, Home Again

We were able to move from our apartment to another Home Away From Home apartment that was only about a block away.  We packed the car in such a way so we could unload only what we needed for one night.  A group of about 20 middle school kids from The Little Rock Church which sponsors the Home Away from Home program came by caroling Sunday night.  They also gave us some coffee mugs with Christmas goodies.  For us being able to use the two apartments was our Christmas gift.

Carla met with another myeloma doctor on Monday and detailed the maintenance plan.  The doctor thought Carla's blood tests showed she was ready to be dismissed.  Carla tolerated the trip home even though we were delayed just north of Clinton, AR for about an hour due to a four fatality car wreck.

Miss Kitty welcomed us home.  She stuck close to us as she had been home alone for just over two weeks.  Carla gained strength each day and Tuesday night settled in the recliner to attempt to crochet another hat.  Missy Kitty attempted to get as close to her as possible as shown in this picture.

Carla asked her primary-care doctor on Wednesday to remove her stitches.  This doctor got back with us on Friday and notified us that she would not remove the stitches due to liability concerns.  Carla's oncologist could not tell us if he could take them out as he was out of his office until Tuesday.  Finally we went to the Urgent Care and got the stitches removed.  Her incision is healing nicely.

Carla will meet with her Springfield oncologist this coming week.  They will line out the dates and times for her maintenance.  Basically we hope to have the Revlimid drugs delivered to her home by December 20.  She will take the Revlimid pills for 21 days and then not take them for 7 days.  During each 28 day cycle Carla will get an infusion of the drug Velcade at the oncologist's clinic.  She will take dexametasone pill each day she get Velcade.  She will have to get her blood tested each week before they can give her the Velcade.  While taking the Revlimid she will also take daily aspirin to ward off blood clots. 

Basically this will be the maintenance schedule for the next three years.  The Velcade infusions can be weekly plus or minus 1 or 2 days.  This will keep Carla tethered and limit our trips to not more than a week as she needs to get the Velcade in Springfield.

The Myeloma Clinic will need Carla to return to Little Rock every three months for PET scans and bone marrow biopsies.  This means we don't have to return to Little Rock until the end of March, 2011! 

Doctor's Appointment Moved to Monday!

Carla got a good report from the infectious disease physician and we have worked with a research nurse to enable Carla to be seen by a Dr. Waheed on Monday instead of waiting for Dr. Barlogie on Thursday.  Dr. Waheed is one of the newer doctors in the Myeloma Institue.  The research nurse got Dr. Barlogie to approve this move.  Carla is scheduled to see Dr. Waheed at 11:00 Monday.

We have been monitoring Carla's blood results.  The CRP level can be an indicator of possible infection.  Yesterday's CRP level was down to 13 with the normal range being 0 - 10.  Yes, it was slightly elevated but I think it will be back to normal by Monday.

We have to clean our apartment and move out by 2:00 p.m. tomorrow as the patient we have been sub-leasing from will be moving in at 2:30.  Home Away From Home did have a patient move out of another apartment.  This patient has kept the apartment rented during their brief trip home.  We plan to move into that apartment tomorrow afternoon and sub-lease it by the night.  We hope we can head home Monday afternoon.  If for some reason we still have to stay longer, we can still have a comfortable place to stay.

Little Rock Stay Extended

We were unable to control Carla's pain with the meds prescribed on her hospital dismissal.  We called the surgeon's office and talked to one of his residents.  Basically they said they weren't responsible now that she was out of the hospital.  They wanted us to contact her primary care physician back in Springfield.

We saw Dr. Barlogie this afternoon.  Once he saw Carla's condition, he wouldn't talk to us about myeloma maintenance.  He said she should not have been dismissed from the hospital.  He told her to take oxycodone for break-through pain and he got her an appointment with the pain doctor in the Cancer Center tomorrow morning.  He is trying to get her an appointment with an infectious disease doctor as he was concerned about her CRP being so high and her blood counts so low.  He wants her to have blood drawn daily so they can monitor her better.  He doesn't want us to leave Little Rock until after we see him on December 10th.  If she is better then, he will talk about maintenance.

Now we have to wait and see how this week progresses and see about where to stay once our sub-lease expires this Sunday.

Dismissed from the hospital

Carla was dismissed from the hospital this afternoon.  She is now settled into the bed in our apartment.  She still has a lot of pain but seems to be doing OK.  Hopefully she will be able to make her 2:00 appointment with Dr. Barlogie.  I am going to attempt to get it cleared at the clinic ahead of time so she can be wheeled directly to the top doc and not have to spent time in the waiting room.  Dr. Barlogie told us to do that this time.

Carla was coughing up some mucus tonight and I feel like I am coming down with a cold.  Hopefully a good night's sleep in the quiet apartment will help both of us.

Happy Thanksgiving

As we reflect back on this year, there are so many things for which we are thankful.
a.  For our many family and friends who have support us as Carla has gone through this myeloma experience.  Your thoughts, prayers, friendly phone calls and uplifting words have meant a lot to us.
b.  For the great doctors and researchers who have persevered in their hunt for a cure for this terrible disease called multiple myeloma.  Dr. Barlogie is leading this charge.  We are thankful that the Myeloma Institute is within driving distance from Springfield.  Many of the myeloma patients and their caregivers have to fly to Little Rock for each of their sessions of therapy and for their many checkups during maintenance.
c.  For Home Away From Home apartments for which we have been able to use for all of the chemo treatments but one and during this stay for Carla's surgery.  It makes me wonder what needs are in our community back home that need to be addressed by us.
d.  For God's sustaining strength as Carla "walked in the shadow of death" during each of her six chemo therapies and stem cell transplants. 
e.  For good medical insurance that has spent upwards of a million dollars on Carla's treatment.

Update on Carla's condition:
Early in the week it seemed like they could not control Carla's pain.  Tuesday evening they installed a morphine drip and a couple pain pills besides her oxycotin she has been on since her August 2009 back surgery.  Once the pain subsided, Carla was able to get her badly needed rest.

Wednesday she was able to get up and sit in a chair a couple times.  This was a good break from the bed.

Tuesday night her temperature went up to about 100.5 and stayed there for about 24 hours.  It is only slightly elevated now.

If they can get her off the morphine today there is a good chance she can be discharged to our apartment tomorrow.  If not Friday at least by Saturday.  She has an appointment to see Dr. Barlogie at 2:00 on Monday.  We plan to head home whenever we determine Carla is up to the four-hour trip.  We have the apartment rented until December 5.

I thought I would share a couple pictures with you.  Carla lost her hair during Induction 1 the first of December 2009.  Since the completion of her chemo the first of September, her hair has returned.  The myeloma patients are always concerned about what color their hair will be when it returns.  You can see a red tint to Carla's hair.  The scab on her scalp was where a needle sensor was inserted during her surgery to monitor her brain signals. 

Carla is on the eighth floor of the "new" hospital.  Her large east window looks down Capitol Street.  The tall tower on the left is the new Rockefeller Cancer Institute.  This is building houses the Infusion Center.  During each chemo sessions Carla would go to the Infusion Center each day for her blood draws and any necessary IV's or blood transfusions.

The tall building on the immediate right is the Eye Institute.  The next building on the right is the Spine Institute.  This building houses the Myeloma Institute.  Dr. Barlogie's office is in this building as are all of the MIRT physicians.

Far down the street that runs by the Spine Institute is the Arkansas Capitol building.  It is near the two tall buildings in the background.  This is a nice view at night.  I thought I would get a picture of the lighted Capitol but the last two evenings have been too stormy and foggy for a good picture.

Here's wishing you a very Happy Thanksgiving!

Surgery

We reported to the UAMS Hospital at 5 a.m. only to be told Carla was an "add-on."  Nobody could tell us what that meant only that she was not scheduled for surgery.  About 7:30, the surgeon's nurse came and told us that in preparing for the surgery the surgeon had deemed the June CT scans to be outdated for a myeloma patients whose bones grow and change rapidly.  So Carla was rushed for a CT scan and then went to the OR about 11:00.  She was in recovery shortly after 2:00 and in a private room shortly after 5:00.

The surgeon said he removed the rod from her back and replaced it with a longer one.  The rod extends from vertebrae T5 down to T11.  He also attached bones to the existing vertebrae. 

Carla is resting comfortable now that she has her does of pain meds.  I probably will leave if she seems settled for the night.

Surgery Update

Carla's surgery is scheduled for 7:00 a.m. Monday at the UAMS Hospital in Little Rock.  She is to check in at 5:00 a.m.  We plan to drive down on Sunday and take the westerly route through Centerton, Arkansas.  We will have lunch with my son John, his wife Lauren and their soon-to-be year old daughter Olivia.  It is longer to go this way rather than highway 65 but it is four-land all the way and it is less hilly.

Praise the Lord!  We received a call yesterday from Home Away From Home.  We have an apartment that that we can get this Sunday and cane stay as late as December 5th.  Another myeloma patient has it rented but is going home on break and wanted the apartment when they returned so they are subleasing it to us!

Spine Surgery Scheduled for Monday, November 22

Carla's back surgery is scheduled for Monday, November 22.  We plan to drive down on Sunday.  This surgery is to repair the loose screw holding the bottom of the rod used to fuse the two vertebrae above T7 with the two vertebrae below T7.  The T7 vertebrae is the one that was partially removed in her August '09 surgery.  Likely the surgeon will remove the rod and insert a longer rod thereby fusing more vertebrae together. 

The loose screw is dangerously near Carla's spinal cord.  This surgery will remedy that problem and hopefully it will make her back be more comfortable with less pain.  Hopefully the pain meds can be reduced.

The surgeon thinks Carla will be in the hospital about five days and he wants her to stay in Little Rock for a week after surgery.  We may be able to sub-rent one of the Home Away from Home apartments or stay in a motel.  Hopefully her hospital stay will not be extended due to Thanksgiving.

Surgery Is Delayed

We just received word from Dr. Pait's office in Little Rock that Carla's scheduled spine surgery has been postponed due to the influx of trauma and critical myeloma patients who are currently in the hospital.  We don't know when they will be able to schedule it now.  Their schedule for surgeries for next week is full.  They hope to give us at least a day's notice due to our four-hour travel time.

Pray that she can get scheduled soon and won't have to repeat the pre-op tests she had completed when we were down the first of October.

Stay tuned for further developments!

Upcoming Spine Surgery

We have enjoyed our time back in Springfield but is\t is about time to head back to Little Rock. We spent October 4-6 in Little Rock where Carla underwent a PET scan, MRI scan, blood tests and pre-op tests. Her PET scan showed no active lesions. The MRI showed that the 50+ lesions she had are getting smaller. The blood tests showed no myeloma components!!!


We will return to Little Rock this Thursday, October 28th, and Carla is scheduled to have the surgery on her back on Friday at the UAMS hospital with Dr. Pait as the surgeon. Dr. Pait thinks he will have to take the rod out that was implanted August 2009. This rod fuses the two vertebrae above T7 with the two below T7. T7 was the vertebrae that was practically devoured by the multiple myeloma and was pinching the nerve last summer. They probably will implant a longer rod and hopefully the screws will hold now that Carla's bones are stronger and denser.

The doctor anticipated Carla would be in the hospital about five days and he wanted us to stay in the Little Rock area for another week. As yet, we haven't been able to locate a reasonably priced furnished apartment we can rent for two weeks. We are on the waiting list for Home Away From Home but it looks like we will have to stay at a motel. Last summer, Carla found our recliner to be very comfortable as she was recovering from surgery. I hope to get it loaded in the Highlander so we will have it if she wants it.

The doctor has not claimed that the surgery will decrease her pain... only that he hopes it will. He is primarily concerned with the loose screw that is very near her spinal column. Please pray that the surgery will correct this problem and that she might be free from the pain and off her Oxycotin!

Carla had all the tests that needed to be done before she starts her maintenance phase. The Myeloma Clinic plans to see Carla just prior to our returning to Springfield. They will give her about a month to recover from surgery and will commence the Velcade and Revlimid about the first of December.

Carla's Back

We got back to Springfield on August 30 but returned on September 2 for a consultation with the UAMS neuro-surgeon, Dr. Pait.  Basically the CAT scan revealed that the rod in Carla's back has shifted and the bottom loose screw is dangerously near her spinal column.   

We returned to Springfield on September 3rd to wait for Carla's blood to recover from the consolidation #2 chemo.  We expect that to take until the first of October.  Dr. Pait said the surgery would probably require her to be hospitalized for five days and he wanted her to stay in Little Rock another week. 

We haven't talked with Dr. Barlogie about her surgery and what she will need to do if she postpones the start of maintenance until December.  That will need to be determined.

Carla's blood tests yesterday showed her white cell count had only climbed back to 2.1 which is still quite low.  Her red blood count is somewhat low. 

Carla doesn't feel up to much travelling so it looks like I will make a quick trip to Nebraska to retrieve our cat from my sister who has been caring for her since the first of January.  Thanks Karan!

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! 

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.

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.

Home July 6th

Sorry for not updating this blog when we got home on July 6th.  When we are home my schedule changes and I forget about giving you an update. 

Carla's white cell count kept dropping when we got home.  It was 1.99 when we left Little rock and then dropped to 1.68 on Thursday and 1.51 on Monday.  We were concerned and kept contacting the Myeloma Institute.  They told us to wait before getting any growth hormone shot.  Thankfully it was up above 2 yesterday.

Carla has been feeling stronger and has decided she had had enough of my 10 months of attempts at cooking so she has started fixing some of our meals.  She still is tired some and attempts to work in a two-hour afternoon nap. 

We are scheduled to start Consolidation #2 on August 10.  This should be the last therapy before the three-year maintenance.

Disappointment

Dr. Barlogie approved Carla's getting the CVL line out today once her platelets were over 50 and then leaving tomorrow if her blood tests were OK.  But things have changed.  I knew they would have to draw blood, get the results, determine if she needed platelets, order platelets, administer platelets, draw another blood sample, wait for test results, see if she needed more platelets.

So, I dropped Carla off at the infusion center about 9:00 and went back to clean the apartment so it wouldn't take much to get it ready to leave tomorrow.  Carla called me once they got her blood results back and her platelets were down to 15 and her red blood cell count was critically low as was her hemoglobin.  She was questioning if she was really well enough to leave.

I took her lunch about 1:30 and eventually it was decided to spend the weekend in Little Rock with her going to the infusion center each day.  Hopefully her blood will improve enough so on Tuesday she can get her blood tested, get platelet count over 50 with platelets if needed, get the line removed from her chest and head home.

Today she got two bags of platelets and one bag of whole blood.  We got home about 5:30.  This is the second day in a row that she has missed her afternoon nap. 

We both were disappointed but would rather have the nurses with experience with  myeloma patients tweaking her blood.

We met with a nurse scheduler and it looks like we will be returning to Little Rock for Consolidation #2 on about August 15th.  This should be the last extended therapy phase.  It will be followed by 3 years of maintenance which can primarily be done in Springfield with initially quarter checkups in Little Rock which should later be at 6 month and possibly yearly intervals.

I am concerned that Carla has a runny nose and a slight cough tonight.  Hopefully she hasn't caught a cold or virus while sitting in the lab frequented by other sick myeloma patients.

Meeting with Top Doc

Carla's white blood count was up to 1.51 from 0.49 but her platelets had dropped to 19.  Her CRP which is a measure of possible infection or inflammation was much lower than the 30 yesterday.  She has had problems with low blood pressure so they gave her another liter of saline solution.  Our appointment to see Dr. Barlogie was for 1:00 and we got in to see him about 3:30.  He decided everything was on its way up.  He could have the CVL line pulled tomorrow or we would have to wait until next Tuesday because of the Fourth of July three-day weekend.  He decided for her to get her blood work done tomorrow but after they give her a bag of platelets.  They will repeat this if necessary to get her platelets up to 50.  Then she will get her line out.

We will stay in Little Rock and go back to the Myeloma Infusion Center early Saturday morning for a blood draw.  After the results are reviewed by the APN she will be free to return to Springfield IF there are no concerns.  The main concern generally is the WBC.  If it is below 2 we will have to remain in longer in Little Rock.  Of course there is still the possibility of infection which would raise her CRP and we would have to vacation longer in Little Rock.

The local news tonight said there had been 28 days this June where the temperature was above 90 degrees and the average for June is 4.  With an average high of 94.7 degrees this was the third warmest June in Little Rock's recorded history.