2nd ASCT - Day 11 - No Question About It - I Have Engrafted! May 29 2012

Today is Day 11 after transplant and Day 19 of this hospitalization. 


I continue to have a terrible headache and do not feel like blogging. However, I wanted to get the word out that I have engrafted after my 2nd Autologous Stem Cell Transplant (ASCT).
On May 28 2012
4 AM WBC 0.7; ANC 0.5
4 PM WBC 1.4; ANC 1.2
On May 29 2012
4 AM WBC 3.6; ANC 3.3
4 PM WBC 4.7; ANC 4.3 (because my counts are so high, I did not receive neupogen today - hopefully, that will help with my headache. Yet, I still have a headache.


I just need one more blood draw on May 30 2012 with a high WBC and ANC and it will be official that I have Engrafted.


Lindsey McMenimen, RN came to do the discharge teaching with Jani and I. I will be discharged about 2 PM tomorrow, May 30 2012 to the hotel near the hospital. Will be nearly 80 degrees outside and Jani brought my shorts for me wear! ~


Tomorrow, Katie, the nutritionist will come to teach us the diet restrictions post ASCT. 

 Jani designed and ordered a new Mackay, Idaho TShirt for me. I love it!

2nd ASCT - Day 10 - May 28 2012

My stem cells have engrafted. My white blood cell count is up to 0.7. However, I have a terrible, ongoing  headache probably from neupogen which has slowed my blogging. Look back for more posts if the dang headache EVER gives up.

They disconnected me from all of my maintenance intravenous fluids and now I have to drink all my builds by mouth. Good buy IV pole.

2nd ASCT - Day 7 - Pain - May 25 2012

I developed a new pain tonight, May 25 2012. I have a right sided headache that extends to my right orbit and upper jaw. I do not feel like it is a migraine headache as I have not had one in years. RN Emily suggested that it could be Neupogen pain and I'm inclined to agree with her. I did take the Claritin at 3 PM today, but it is no guarantee. They have given me an ice pack and that seems to help.


RN Jamie gave me plain tylenol early morning May 25 2012 and within an hour, my gripping facial pain ceased! It was wonderful. I had a good day without any pain after that. Dr. Gutman thinks the pain may be Neupogen related, but he does not think it is anything serious.

2nd ASCT - Day 6 - Lab Values May 24 2012

My labs are low to non-existent as expected. My white blood cell count is 0.3 which is probably because they gave a Neupogen shot and Claritin (to help with bone pain associated with neupogen)  last evening (May 23). My hemoglobin is just 8.5, but they do not give blood transfusions until it dips to 8.0 or below. My platelets are 69 (norms 150-440).

My nurse aides today, Bryan and Joe. Joe is training Bryan since it is only his 2nd day on the job.

Day 16 - Dr. Han Myint Appointment - September 29 2011

Jan Martin drove me to my first out-patient appointment since the Stem Cell Transplant with Dr. Han Myint on September 29 2011. My appointment was scheduled for 3 PM and they actually had us in an exam room right at 3 PM.

However, we sat and sat in the exam room for more than hour before Nurse Practitioner Denise came and showed me the lab work results from this morning and asked me a few questions. Denise noted my serum protein and albumin levels and was impressed that Jani had maintained my diet so well since discharge - making sure I was eating adequate levels of protein each day despite my continued nausea. If you look at the values over time chart below, you can see, I never ate enough protein while I was hospitalized with the Protein value ranging between 4.8 and 5.1. Now 2 days post hospital discharge, my protein level still is not in the normal range of 6.4 to 8.3, but much closer at 6.2.

Around 4:30 PM, Dr. Myint came in and said I was doing fine. He decided to give me a Neupogen injection to stimulate my new bone marrow into action since my white blood cell count had dropped from 2.8 on Day 14 to 1.3 on Day 16.

I'm scheduled for a bone marrow biopsy on November 2 2011, just prior to my Day 60 when the decision will be made on whether I will require a tandem (2nd) stem cell transplant. If that bone marrow biopsy shows any abnormal cytogenetic (DNA changes), I will need the tandem transplant. If the cytogenetics are normal and I'm in the top 3 categories of remission, then I would not require the tandem stem cell transplant. If I need the tandem transplant, it would be done right after all of the bone marrow biopsy results are done and finalized. My insurance company, Anthem, has already approved the tandem stem cell transplant.

We were still waiting for the neupogen injection when the nurse poked her head in the room and said they were waiting for insurance approval. Neupogen costs about $250 per one 300 g dose. Not long after, an obviously pregnant nurse came in the room with the neupogen and I asked her if there was a another nurse who could give the injection. The nurse looked so hurt and said, "Yes, there is." I quickly told the pregnant nurse that I had shingles and then she understood. The 2nd nurse came and gave me the injection and I took a Claritin tablet that I brought with me.

Now 5:00 PM, we went downstairs to schedule future appointments. Jan Martin waited at the desk with the scheduler and I went through a door to the Apheresis Department which has temporarily moved to the 1st Floor while the new space is being remodeled. Jessica Jones from Apheresis was there and we had a good visit.

With appointments in hand by 5:35 PM, Jan Martin drove us back to The Timbers. I told Jan that if I had to wait all afternoon by myself at the University of Colorado Hospital Outpatient Cancer Clinic - it would have been miserable - but visiting with Jan was wonderful and the 2 1/2 hour appointment didn't seem that LONG~

I collapsed into the bed for a 2 1/2 hour nap. Jan Martin made me mashed potatoes, fried chicken, and canned spinach for dinner and I ate it all - so yummy and loaded with protein.

Day 5 - Evening Update September 18 2011

Faye Hummel stayed until 5 PM and helped me with my dinner order. I decided nothing sounded good and ate a small bowl of cereal that Faye got at the store on her way here this morning. Per usual, the food does not help ease my nausea. Nurse Practitioner Carley came in and chatted with me about the nausea. I'd only managed to get almost one bottle water (16 ounces) all day, so Carley decided to increase my IV maintenance fluids from 75 cc/her to 125 cc hour.

My nursing care continues to be top notch. Here are my day Nurse Jennifer at change of shift this evening with Nurse Sherry September 18 2011 7 PM.

They started me on a neupogen shot this afternoon too (I think the dosage was 300 mg). The neupogen is to stimulate my new baby stem cells into action.

My 4 PM blood draw results aren't much different than this morning,

.

Stem Cell Harvest Day 3 - August 18 2011

Again up at o'dark thirty for the 70 mile drive from Greeley, Colorado to Aurora, Colorado. The distance is further because I am paying to take the E470 Toll Road which adds about 10 miles but, cuts traffic DRAMATICALLY~

I arrived at the University of Colorado Apheresis Department shortly after 7 AM. Jessica Jones and Martin Bromley got me hooked up to the machine after they drew my blood from my Trifusion Hickman Catheter.

 jm and Martin Bromley at the UCH Apheresis Department August 18 2011

Day 2 of Stem Cell Collection yesterday yielded an actual value of 3.68 million stem cells. So, we hoped to collect 3.30 million today which would bring the total value to nearly 8 million stem cells.

My electrolytes were somewhat off and Martin hooked me up to additional potassium and magnesium which ran over several hours. My bones ache from the Neupogen and I'm a tad tired, but really I was fine~

Apheresis machine on left with potassium and magnesium running via IV Pump on the right

When my time on the machine was up, Cassie from the stem cell lab ClinImmune came to pick up my stem cells. She is always right on time and very nice. She told me that she had processed my stem cells from yesterday and they were safely in their freezer.

Martin Bromley and Cassie with my stem cells August 18 2018

Jessica Jones gave me Neupogen 780 mcg (2 injections) before my apheresis session was up and signed me up to return tomorrow for Day 4 Stem Cell Harvest to complete the 10 million.

Stem Cell Harvest Day 2 - August 17 2011

Up at o'dark thirty again and I drove myself again this morning from Greeley, Colorado to the University of Colorado Hospital at the former Fitzsimmon's Army Post location in Aurora, Colorado for my 7:30 AM appointment in the Apheresis Department (2nd floor of the Anschutz Cancer Pavilion).

Jani packed my rolling personal assistant again today. The bottom cooler has cold drinks and yogurt. The middle cooler has bread and snacks. And my laptop computer and with cooling fan tray grace the top. Works very well and I have everything I need throughout the day as I'm tethered to the stem cell machine.

At the Apheresis Department, I was greeted with smiles by Jessica and Martin. Jessica got me started on the apheresis machine. She drew blood first, but we didn't have to wait for the results like yesterday to get started - so, by 7:30 AM, I was hooked up and collecting stem cells. However, the blood test results came right back. My Stem Cell CD34 value was down to 41 from yesterday's 56.5.

My white blood cell count was up to 35.9 from yesterday's 28.8

 My blood type is A Positive.

Unfortunately, the prediction of between 4 and 5 million stem cells during yesterday's Day 1 Stem Cell Harvest turned out to be only 3.01 million stem cells. So, I have a ways to go to get to 10 million~

jm at UCH Apheresis Department Day 2 of Stem Cell Collection August 17 2011

I had a slight reaction after I was hooked up to the machine this morning. My lips tingling and my eyeballs felt jittery. I told Martin and he immediately gave me a bolus of intravenous calcium and very soon after, I felt fine.

Dana Godec, RN spent a long time with me going over the Stem Cell Transplant inpatient guidelines. I felt like I was in school again~

I was surprised with a visit from my cousin, Diane Dynia Miller, today while I was donating my stem cells. She is the oldest daughter of my father's youngest sister (both still living). We had a nice visit and she made me laugh which is imperative in this adventure. I missed getting Diane's picture because Jessica was giving me 2 more Neupogen injections (780 mg total) in my left arm.

By 12:20 PM, my stem cell collection was over for the day. Jessica looks pleased with the collection - won't know the number of cells until tomorrow morning.

Cassie arrived from ClinImmune to take possession of my stem cells and transport them to the lab in the cooler.  Cassie told me that my stem cells from yesterday are now safely frozen at their facility. Cassie is so nice. Jessica and Cassie have to read a lot of numbers and verify everything before Cassie leaves with the stem cells.

Cassie packed my stem cells in a blanket with a thermometer to make sure the temperature is maintained on their way to the lab.

I'm returning for Day 3 of Harvest tomorrow morning.

Neuopogen Injections Day 4 or 4 August 15 2011

I gave myself the two Neuopogen injections this morning (300 mg and 480 mg) and took the Claritin tablet. In addition, I  flushed my Trifusion Hickman Catheter with Heparin Flush Solution.
I've had a headache and still do this morning, but it is not bad.

Neupogen Injections Day 3 of 4 August 14 2011

I gave myself the two Neuopogen injections today (300 mg and 480 mg) and took the Claritin tablet. In addition, I  flushed my Trifusion Hickman Catheter with Heparin Flush Solution. So far, I have not experienced the bone pain often described with Neupogen injections. My bone marrow biopsy site (of August 10 2011 on my right iliac crest) still hurts, as does my Trifusion Hickman Catheter site on the left side of my neck. I also woke with a slight headache.

Neuopogen Injections Day 2 of 4 August 13 2011

I gave myself the two Neuopogen Injections (300 mg and 480 mg for a total of 780 mg) in my belly. The needles were super sharp and I had no trouble piercing my skin and giving the injections. I took Claritin by mouth at the same time which had been shown to help decrease the bone pain associated with Neupogen.

Neupogen Begins August 12 2011

Jani wheeled me down to the University of Colorado Hospital BIC Center where we waited a few minutes for my Nurse Transplant Coordinator, Dana Godec, RN.

 Jani sat in an extra wheelchair while we waited.

Dana Godec, RN gave me my first 2 Neuopogen shots subcutaneously (one in my arm and one in my abdomen) for a total of 780 mg. The Neuopogen stimulates my bone marrow to send my stem cells to my blood stream for the stem cell harvest to begin, Tuesday, August 16 2011.

I think I was expecting more pain - but, afterall, I did have conscious sedation meds still on board from the Trifusion Catheter placement. I'll be giving my own Neuopogen shots at home August 13-15 2011.

Per usual, Dana Godec, RN is wonderful and sure makes navigation through the system at UCH easier for us. I'm always impressed with her knowledge base.

Updated Calendar appoaching Stem Cell Harvest on August 16 2011

Updated Calendar appoaching Stem Cell Harvest on August 16 2011

My Adventure with Multiple Myeloma is about to take some new turns August 2 2011

I had a call from Dana Godec, RN, Transplant Coordinator at the University of Colorado Hospital today. They want to begin harvesting my stem cells on August 16 2011. In preparation for the stem cell harvest, I will have to have my 2nd bone marrow biopsy, repeat pulmonary function tests, repeat echocardiogram, repeat  EKG, repeat chest x-ray, blood labs, the placement of a TriFusion Catheter in my left chest (interventional radiology does the placement), paperwork and consent forms session, and Neupogen injections (780 mcg subcutaneously) to stimulate my bone marrow for 4 days prior to harvest. I'm to take Claritin (over-the-counter) each day that I have the Neupogen injections.

So, that's alot to happen in the next 2 weeks and much new to me. I'm concerned with the bone marrow biopsy and Dana Godec assured me that they would medicate me for the procedure this time. Here is the calendar of events:

Bard Hickman Trifusion Catheter for intravenous access. All of those 3 pigtails will be outside my skin and require sterile dressing changes.