The weather today was great. I wanted to get outside some this afternoon but Carla was fighting a migraine headache. I did sit out on our balcony some while doing loads of laundry.
Saturday, March 6, 2010
Same ol' Same ol'
Carla's blood test results were good and about the same as yesterday. The platelet count droped below 50 but instead of not getting a Lovenox shot, she got one of a smaller dosage.
One area of concern is Carla's blood pressure. Her highest blood pressure was only 79 today and 76 when standing. She had to get another liter of saline solution.
The weather today was great. I wanted to get outside some this afternoon but Carla was fighting a migraine headache. I did sit out on our balcony some while doing loads of laundry.
The weather today was great. I wanted to get outside some this afternoon but Carla was fighting a migraine headache. I did sit out on our balcony some while doing loads of laundry.
Friday, March 5, 2010
Almost Zero!
Carla's WBC was down to 0.07 K/uL. Over the past 24 hours it could have reached 0 and started up or it may be still dropping. The APN ordered giving daily growth hormone shots. She got her first one today. This growth shot will stimulate the production of white blood cells.
The platelets dropped too as they were at 59. Today was probably Carla's last day for Lovenox shots. The blood has so few platelets that the danger of her getting a blood clot is quite low.
Carla's immune system is quite weak. There is a respiratory infection going around the patients getting daily blood tests. Carla is wearing a mask most of the time she is in 7C.
Carla had a bad diarrhea case last night and she didn't get much rest. She started taking some medicine and hopefully she is over it.
The platelets dropped too as they were at 59. Today was probably Carla's last day for Lovenox shots. The blood has so few platelets that the danger of her getting a blood clot is quite low.
Carla had a bad diarrhea case last night and she didn't get much rest. She started taking some medicine and hopefully she is over it.
Thursday, March 4, 2010
Still Dropping!
I just updated Carla's graphs. Everything is still going down and the WBC is approaching zero.
Carla has some nausea, fatigue and diarrhea. She also had low blood pressure when she stood (89) so she got another liter of saline solution. Her CRP was up slightly which indicates inflamation somewhere. Hopefully this was just due to an irritated gut and not the start of an infection.
WBC and RBC
Platelets
Her platelet count was 80 so she had to get the Lovenox shot for bloot clots. They will discontinue the Lovenox when the platelets drop below 50 which will probably be tomorrow.Carla has some nausea, fatigue and diarrhea. She also had low blood pressure when she stood (89) so she got another liter of saline solution. Her CRP was up slightly which indicates inflamation somewhere. Hopefully this was just due to an irritated gut and not the start of an infection.
Wednesday, March 3, 2010
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.
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.
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.
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.
Sunday, February 28, 2010
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!
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!
Tuesday, February 23, 2010
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:
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.
On Monday Carla had:
- Blood Tests
- Pulmonary Function Test
- EKG
- Echo heart test
- Met with one of the research data staff members
- Had a 2-hour full-body MRI
- 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.
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.
Wednesday, February 10, 2010
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.
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.
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