Going Up?

Today's blood test results may indicate the stem cells have engrafted and are producing.  The WBC was up to 0.22 from yesterday's 0.08. 

The RBC also showed a slight increase.  The platelet count was back at 30 so Carla had to get a bag of platelets and the Lovenox shot and growth factor shot.  The increase in platelets shown earlier in the graph was due to an earlier bag of platelets.  We are very thankful for blood donors!

The CRP rose to 21.40 from yesterday's value of 15.4 when the normal range is 0 - 10.  This indicates inflamation but could be due to rapid bone marrow growth.  Carla had this same problem during Induction I.

Carla has been very uncomfortable the past two days.  Her back bothers her more and she can't get comfortable in bed or in the new recliner.  I think part of this might be attributable to bone pain due to rapid bone growth.

We hope the upward trend continues tomorrow.  Her immunity will be considered low until the WBC gets above 2.

Still Waiting...

There wasn't much change in Carla's blood test results today.  Her platelet count rose to 40 but that was probably due to her getting an infusion of a bag of platelets yesterday.  Her WBC was 0.08. 

One area of concern is her C-Reactive Protein which came up to 15.40. Normally her CRP value has been about 5.  Normal range is 0 - 10.  The CRP is an indicator of inflamation such as an infection.  Some patient's CRP values get as high as 300.  Carla had a CRP value near 50 during Induction I.  When it was that high she had to get an antibiotic IV and I had to give her infusers of antibiotics at night.  We never did find any test that showed that she had an infection.  So far she has been fortunate to not get mouth sores.  I think we have the diarrhea under control now.

We will just wait and see what tomorrow's results are.  Hopefully the WBC will start rising soon.

Still Waiting...

Carla's blood pressure was almost normal today but they decided to give her a liter of saline anyway.  She also got a bag of platelets since her count dropped below zero.  She also got Lovenox and growth factor shots.

Carla felt much better today.  After going to the blood lab we swung by Subway and got food for a picnic lunch.  We drove out to Maumelle Lake and had a good time before heading home for Carla's nap.  The temperature approached 70 degrees today!

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.

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. 

Still Dropping!

I just updated Carla's graphs.  Everything is still going down and the WBC is approaching zero.

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.

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.