Labs Plummet and a Platelet Transfusion - March 24 2012

Jani and I left for UCH at sunrise for our 8:15 AM appointment at UCH. It takes us just over an hour to make the trip one way.

They drew my blood out of my PICC Line. It is nice to have line so I don't have to worry about how many pokes it will take to access my blood. We had to wait a LONG TIME for the blood results to come back. I was cozy in the recliner...

 and Jani in the chair...not so much...

My white blood cell is even more CRITICALLY LOW than it was March 22 2012 at 0.5 (norms 4-11.1). My platelets are just 17 (norms 150-400) which will require a platelet transfusion this morning. My hemoglobin hanging in there at low, but okay at 11.0 (norms 12.1-16.3). My absolute neutrophil count (ANC) is dangerously low at 0.3 (norms 1.8-7.8). So, I'm wearing the mask!

The wait for the lab values was probably because they could not do an auto-differential (done with a machine) on the complete blood count (CBC) since there were so FEW white blood cells. It required a peripheral smear which is done by hand via a microscope. My Absolute Neutrophil Count (ANC) is CRITICALLY low at 0.3 (norms 1.8-7.8) so I have to be extra cautious not be exposed to anything.

 My comprehensive metabolic panel was good overall.

 My LDH (lactate dehydrogenase) was good at 117 (norms 98-192).

My serum protein and albumin are getting back to normal which indicates that I am eating well despite my raw gastrointestinal  tract.

They ordered my platelets and RN Christine was very organized and ready to hang them. The platelets that I received today were obtained from a volunteer donor who went through apheresis (hooked to a machine that takes your blood out and separates the platelets from the other components and then replaces the other components back in to the donor). 

It is only suppose to take about 15 minutes for platelets to run in by gravity, but for some reason, mine took more like 45 minutes. I declined the Benadryl that they usually pre-medicate patients receiving transfusions with, but I took the pre-medication Tylenol (650 mg).

RN Christine cautioned me not to bump or cut myself, avoid dental floss, brush with a soft toothbrush, and to call if I got a nose bleed.

We left UCH around 11 AM and drove back o Greeley - I snoozed in the back of Bart on the way home. I don't have to return to UCH until Tuesday, March 27 2012. Hopefully, the Neulasta injection that I received March 22 2012 will have kicked in by then. The Neulasta has certainly caused my back and rib to ache.

Day 20 - Morning Update - October 3 2011

Jani took me for my blood draw appointment at 8:15 AM. Since I have sinus drainage, the nurse also did a nasal washing for organism identification. It was not as bad as I thought it would be  - she used a syringe of normal saline and squirted it in my left nostril and then suctioned back to gather the sample. The result may take a few days.

My white blood cell count is 2.3 which I think is terrific. Remember, the 4.1 on October 1st was neupogen induced, so the 2.3 is more reflective of my real bone marrow function. My platelets are awesome at 87 and my hemoglobin is just about the same at 10.7.

My Absolute Neutrophil Count is 1.4 which is also good in my book. 

My protein (6.2) and albumin (3.7) levels are excellent and reflective that I have been eating adequate amounts of protein.

My weight in the BIC Center at UCH was 147 this morning with clothes on. My blood pressure was low with a systolic below 100, so they advised me to drink more fluids. I assured them I would, but getting up early enough to eat breakfast, get ready and be at the hosptial by 8 AM is hard to throw fluids in the plan too.





Day 18 - Blood Test Update - October 1 2011

Faye Hummel drove me from The Timbers to my 8:15 AM appointment to have my blood tested at the University of Colorado Cancer Infusion Center. I was happily surprised to see Dana Godec, RN working there and I was her patient :).

Happily, my weight is down to 149. I weighed 140 pounds when I was diagnosed with multiple myeloma on May 24 2011. I weighed 150 on admission for the stem cell transplant on September 12 2011. On discharge from the hospital on September 27 2011, I was up to 158 pounds. They told me it was retained fluid and it must have been, as I've been peeing like a race horse and my weight is down!

We didn't have to wait long for the blood results probably because it is Saturday. My white blood cell count is up to 4.1 which is awesome, but you cannot really believe that number since I was given Neupogen on Thursday, 9/29/2011 and it may reflect a "false high". The next time I get my blood drawn which will be Monday, October 3rd or Day 20 will be more reflective of my actual bone marrow function.

My platelets were up to 56 which is wonderful as Neuopogen doesn't really affect their production. Nurse Dana said a value over 50 meant that my platelets have engrafted in my bone marrow - YIPPEE ~ Now, before you get too excited, 56 is still way too low (150 to 400 is the norm), but I'm on my way.

My hemoglobin is 10.5, so I am still anemic (norm is 12.1 to 16.3), but I'll take it~

All of my electrolytes were normal except for a low normal potassium at 3.3 (norms 3.3-5.0), so I had to take 40 mg of potassium pills (thankfully, easy to swallow).

My protein and albumin levels aren't as good as Day 16 (last night measured at 6.2 and 3.6), but they are reflective that I am eating meals with protein at 5.9 and 3.7. Thank you caregivers Jan Martin and Faye Hummel !!!!!!!!!!!!!!!!!!!!!!!!!!

We were in and out of there in 1 hour flat - a miracle considering my previous appointments!

I have a bit of a sinus-like frontal headache (just between my eyes), so I took a Claritin which seemed to help. Don't know if I should have done that, but they do let me take Claritin when I get Neuopogen shots, so, who knows - I'll ask at my next appointment on Monday.

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.