2nd ASCT - Day 55 - July 12 2012

Full day of testing on Day 55 after my 2nd autologous stem cell transplant to determine if it was helpful or not AND to determine if my vital organs were damaged in any way. Fortunately for me, scheduler Donna, made all my appointments for me!

Jani and I got up at o'dark thirty and were on the road to UCH from Greeley, Colorado at 5:45 AM. I couldn't eat or drink anything other than plain water for my PET Scan which was scheduled first at 7 AM.

PET Scan: Technician pokes your finger for a blood glucose reading. Mine was 107. 

Surprisingly, of all the "pains" I've put up with since diagnosis, this hurt! Then, the technician started a small IV in my hand near my thumb and gave me the nuclear material for the scan. We left the IV in hoping that my blood could be drawn from it later in the morning a the BIC. Then, you have to lay on a gurney in a dimly lit room for 1 hour and drink oral contrast that tastes NASTY (I am whining). I only managed to get 1 cup of the 4 cups down, but the technician said that wouldn't matter. Finally, they take you in the scanner where I laid on my back with my arm fully extended above my head near my ears...comfortable at first and then AGONY as the scan proceeded for 20 or 25 minutes...my shoulders were in SPASM, but I held still and endured...I just wanted it over!

Lab Values: After the PET Scan, met up with Jani in the radiology waiting area and we went directly to the BIC (blood draw area for transplant patients). Right off I saw my good friend, Shawn Egle who was there with her sister. Shawn has been having a rough time and it was wonderful to see her.

The IV put in at PET Scan did NOT work for my blood draw, so I was poked again for the many labs including the myeloma markers to be done. I'll put my blood results in another post and my myeloma markers usually take about 5 days to come back.

Psychologist: The transplant team psychologist, Ben Brewster, came in to visit Jani and I. I always enjoy talking to him and for the FIRST TIME, I didn't cry! Why should I cry, I'm feeling better and stronger each day and I've been home in Mackay, Idaho for the last 4 weeks. We discussed my poor sleep and poor sleep habits...the tv in the bedroom is a no no. Ben is going to send me a list of better sleep habits to review. He also wanted to know if I had any plans for the future...and other than just living my daily life at home in Idaho...and climbing to tree line on Mt. McCaleb, I don't have any other burning desires - life is good at home and I reminded Ben that I would be returning home right after this day of tests.

Bone Marrow Biopsy: Technician Hank came to get us for my bone marrow biopsy. Their new biopsy room is so tiny and hardly had room for Jani -- but, it all worked out. I had been given 10 mg of oral morphine and 1 mg of Ativan orally in the BIC about 1/2 hour prior to my biopsy. However, I did not feel sedated at all. This was my 7th Bone Marrow Biopsy since diagnosis (24 May 2011) and they DO NOT get any easier! Nurse Practitioner Trish Dey did my biopsy.

Using the OnControl "drill" (they are not supposed to call it a drill, but it is a drill)...I think they call it a driver.

I had pain down the back of my left leg during the procedure.

 She got a good core sample.

Jani and I after the bone marrow biopsy. I think the whole experience is hard on her too. We went for some lunch afterwards in the hospital cafeteria, but I didn't eat much of my dry chicken and raw, cold green beans.

Pulmonary Function Tests: Went to the 7th floor for the pulmonary function tests. I thought I did fine, but the uninterrupted results show I didn't do as well as my pre-transplant tests. The conclusion of the test is a 6 minute timed walk wearing a pulse ox meter. My pulse stayed right at 112 and my oxygen never dropped below 91.

Bone Marrow Transplant Dietitian Followup: We met with dietitian, Katie, and she was pleased that I had maintained my weight with little change over the last 4 weeks. I still have to eat a neutropenic diet until Day 90.

Dr. Han Myint Appointment: Before I saw my transplant physician, I saw nurse practitioner Trish Dey who does the history and physical. She gave me prescriptions that Jani picked in the hospital pharmacy. 

Dr. Myint was running behind schedule, but came to see me before I had to leave for my echocardiogram appointment. Won't have the bone marrow biopsy results for a week and Dr. Myint will call me in Idaho on July 20 2012 with the news. He is tentatively thinking I will get some combination of Vorinostat (a pill), Velcade (subcutaneous injection), and Dex to continue to treat my myeloma. 

He looked up my PET Scan results on the computer from this morning (already back) and it was perfectly NORMAL. He said patients with the 4:14 cytogenetic profile don't have bone disease usually. He looked at my pulmonary function tests, but I don't know what he concluded.

I forgot to tell him that I had a sinus injection and just finished a 10 day course of Augmentin.

Echocardiogram: Last test of the day was scheduled at 4:45 PM on the 3rd floor of the inpatient wing. The results were put up on the computer almost immediately and were very confusing. The right atrial clot is still there and Dr. Wolfel concluded it was a central line catheter - but, I DON'T have a central line. I emailed Dr. Myint to get clarification especially since I REALLY WANT to get off of daily Fragmin injections (which I have taken since 2 Nov 2011)!

Narrative

Study ID: 143751

Echocardiography Laboratory
Adult Echocardiography Report

Name: Malkiewicz, Judith A Study Date: 07/12/2012 04:35 PM BP: 113/72 mmHg
MRN: 535166 Patient Location: ECHO HR: 79
DOB: 12/08/1950 Gender: Female Height: 62.5 in
Age: 61 yrs Weight: 159 lb
Reason For Study: Multiple myeloma 203.0 BSA: 1.7 m2
Authorizing Physician: Myint, Han

Conclusions
Normal LV size and normal LVEF of 61%. Regional wall motion is normal and there is no
LVH. The transmitral spectral Doppler flow pattern is suggestive of impaired LV
relaxation.
Normal RV size and systolic function.
No evidence of significant valvular disease.
Right ventricular systolic pressure is normal.
The inferior vena cava is normal in size with respiratory collapse, indicating a right
atrial pressure of approximately 3 mmHg.
There is no pericardial effusion.
Compared to the prior study from 6/11/12 there are no significant changes noted.

Procedure Summary
A complete two-dimensional transthoracic echocardiogram was performed (2D, M-mode,
Doppler and color flow Doppler).

Left Ventricle
The left ventricle is normal in size. There is normal left ventricular wall thickness.
Left ventricular systolic function is normal with no regional wall motion abnormalities.
Calculated EF is 60.7 %. The transmitral spectral Doppler flow pattern is suggestive of
impaired LV relaxation. DTI suggests diastolic dysfunction. A false chord is noted
(normal variant).

Right Ventricle
The right ventricle is normal in structure and function.

Atria
The left atrium is normal size. The right atrium is normal. A small echodensity is noted
in the right atrium consistent with an intravenous catheter.

Mitral Valve
The mitral valve leaflets appear normal. There is no evidence of stenosis, fluttering,
or prolapse. There is no mitral regurgitation noted.

Tricuspid Valve
The tricuspid valve leaflets are thin and pliable and the valve motion is normal. There
is trace tricuspid regurgitation. Right ventricular systolic pressure is normal.

Aortic Valve
The aortic valve is tri-leaflet with thin, pliable leaflets that move normally. There is
no aortic stenosis. No aortic regurgitation is present.

Pulmonic Valve
The pulmonic valve leaflets are thin and pliable; valve motion is normal. There is no
pulmonic valvular regurgitation.

Great Vessels
The aortic root is normal. The main pulmonary artery is normal in size. The inferior
vena cava is normal in size with respiratory collapse, indicating a right atrial
pressure of approximately 3 mmHg.

Pericardium
There is no pericardial effusion.

MMode/2D Measurements and Calculations
IVSd: 1.00 cm LVIDd: 3.6 cm FS: 36.7 % RVDd major: 6.4 cm
LVIDs: 2.3 cm RVDd minor: 1.7 cm
LVPWd: 1.0 cm
_______________________________________________________________________

Ao root diam: asc Aorta Diam: 2.9 cm EDV(MOD-sp4): 53.1 ml EDV(MOD-sp2):
2.8 cm ESV(MOD-sp4): 22.2 ml 32.8 ml
LA dimension: EF(MOD-sp4): 58.3 % ESV(MOD-sp2):
2.8 cm 12.0 ml
EF(MOD-sp2):
63.4 %
_______________________________________________________________________
LAV(MOD-sp4): 28.8 ml EDV index(MOD-bp): RVDd base: 2.8 cm
EDV(MOD-bp): LAV(MOD-sp2): 41.3 ml
43.8 ml LAV(MOD-bp): 35.6 ml 25.1 ml/m2
ESV(MOD-bp): LAV(MOD-bp) index:
17.2 ml
EF(MOD-bp): 60.7 %20.4 ml/m2

Doppler Measurements and Calculations
MV E max vel: MV dec time: Ao V2 max: LV V1 max PG: 4.3 mmHg
46.9 cm/sec 0.20 sec 121.6 cm/sec LV V1 max: 104.1 cm/sec
MV A max vel: Ao max PG: 5.9 mmHg
72.6 cm/sec
MV E/A: 0.65
_______________________________________________________________________
PA V2 max: TR max PG: RAP systole: Aortic Valve Velocity Ratio:
82.4 cm/sec 18.0 mmHg 3.0 mmHg 0.86
PA max PG: 2.7 mmHg RVSP(TR):
21.0 mmHg

_______________________________________________________________________
E' Septal Vel: E/E' Septal: 6.8
6.9 cm/sec

_________________________________________________________________________________________

Reviewed and Interpreted By: Eugene Wolfel, MD on 07/13/2012 03:23 PM

Sonographers: Hill, Tracy, RDCS

Component Results

There is no component information for this result.

General Information

Collected:

7/12/2012 4:35 PM

Resulted:

7/13/2012 3:20 PM

Ordered By:

MYINT,HAN, MBBS

Result Status:

Final result

This test result has been released by an automatic process. 

Jani drove me back to Greeley while I napped in the back of Bart. My bone marrow biopsy dressing was itching like crazy...more in another post.