Monthly Archives: January 2012

Slowly becoming untethered

Lucy is continuing to make progress. Her calf diameter is another ½ cm. (0.2″) smaller. She no longer needs her pain pump and is taking oral pain medication. Her hemoglobin dropped very slightly from 8.1 to 7.8. However, her white count is now in the normal range. She still needs assistance getting out of bed and cannot walk more than a couple of steps on her right leg. Physical Therapy will be by tomorrow to see what else they can do. Lucy would like more mobility. She has always enjoyed walking for recreation and exercise.

Lucy’s friend Diane visited us this afternoon and brought a little stuffed “Hug Me” elephant. That really brightened Lucy’s day. Yesterday’s delay in Lucy’s procedure precluded her sister Julie from coming to visit. Julie and Lucy have been on the phone a few times. Those calls also brighten her day. We know her sister Suzy is under the weather and we hope she feels better soon.

We don’t have a firm idea of when Lucy can go home. The two main milestones are getting her off IV heparin and they would like to see her calf less swollen and red. Her Coumadin restarted yesterday. Since the INR test will not be accurate, they are using a Chromogenic Factor X test instead.

Molly and Dr. Nashawaty from Minnesota Oncology checked in on Lucy this afternoon.

Lucy has a “Braden risk” bracelet. That means she is at risk for pressure ulcers (“bed sores” is the archaic term). She tries to change her position in bed regularly and so far has no signs of pressure ulcers. The risk will vanish when she is more mobile. It is not a cause for alarm.

Cellulitis is a concern. She is still getting Levaquin once per day as a preventative. And yes, the medical term for “preventative” is “prophylactic”. Lucy is not showing any symptoms of cellulitis.

That’s all for tonight. We’re very touched by the number of people reading the blog. It means the world to us!

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Filed under cancer battle, DVT, family, friends, hospital

Take 4

Lucy was initially scheduled for her procedure at around 8:30 this morning. An emergency case came up and she got bumped for the time being. She has her Nook Color to help pass the time.

Her blood transfusion occurred without incident last night.

As part of her blood clot treatment, she has a simple neurological check performed every two hours, even at night. She says she falls back to sleep quickly afterwards.

A very large part of the hospital is cell phone friendly and the patient rooms have Wi-Fi Internet access. The IV Therapy area and Day Surgery suites still require cell phones be shut off, but Wi-Fi access is in those areas.

This might be a multiple update day. Bear with us.

UPDATE #1: Lucy finally went down to Interventional Radiation at 12:15 pm. Her procedures have averaged a bit over two hours, so I was pleasantly surprised when she returned at 1:05! All the “plumbing” on her left leg is gone. She went from nine infusers plus a pain pump to two infusers plus a pain pump. There are some small clots remaining in her calf region but they are going to let those dissolve on their own. After four hours, Lucy potentially could get out of bed and walk a bit.

UPDATE #2: Lucy is restarting Coumadin tonight. She is also still getting heparin. They had to run an IV into her arm so they could administer some Levaquin, an antibiotic, as a preventative. The skin on her right leg looks sunburned. A skin infection called cellulitis may form if the antibiotic is not administered.

She still has a couple very small clots in her right calf, but Dr. Siddiqui wants to let the clots dissolve on their own. We know she will be in the hospital until at least tomorrow and until she no longer needs the heparin IV. Molly and Dr. Weinshel from Minnesota Oncology were by to see how Lucy was doing today.

Lucy did manage to stand up with some help and took a few small steps. She was confined to bed Thursday and her leg immobilized for a couple of days. Her ankle was very stiff which hindered walking. However, she has noticed a little more range of motion in her ankle as time goes on. She had a large catheter inserted on the inside of her ankle. That also contributes to the swelling in the area. Her pain has dropped down a bit. She was grading herself on the 10-point pain scale at an 8. After her procedures, it dropped to 5. At 7:00 pm, she gave it a 4.

Her calf circumference is another ½ cm smaller (about 0.2″). It doesn’t sound like much, but it is getting smaller. Her thigh is still open and the color has nearly returned to normal. The bottom of her right foot has normal coloration instead of being very dark pink. The Doppler flow detector does not need the volume set to maximum just to pick up a faint pulse. Her right foot and ankle pulses sound as loud as the pulses in her left foot and ankle.

Lucy also got a fun little ride today. Even though she is a petite woman, she got put in a patient lift and thought it was fun. The lift also ensured her weight was more evenly distributed. For us, the big plus is it helps prevent injuries to the care staff. Even a person of average weight is difficult to lift and balance. Too many care providers suffer injuries or disabilities from an awkward patient lift.

We’re hopeful of Lucy coming home yet this week. Thank you for your thoughts, prayers, love, and support. You really help us get through this!

UPDATE #3: While we don’t have a definite date when Lucy can go home, we did get some really good news about her Complete Blood Count (CBC) from tonight. Her hemoglobin went up higher than expected after the transfusion. Her white count is back in the normal range and there is still no indication of infection. It’s nice to have a couple more victories!

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Lather, rinse, repeat

Lucy’s third TPA procedure took about two hours. She will need a fourth procedure tomorrow. There was clot material just under the sheath they put in near her knee. They removed that sheath. Lucy will be here through tomorrow.

Lucy’s hemoglobin is starting to drop again. After her transfusion on Thursday, it was at 9.8. Yesterday it was at 8.0. Today it is at 7.3. She will be getting a one unit transfusion tonight just to bring it over 7.5. The anticoagulants and clot dissolving drug plus all the IV fluids she has had can “dilute” her hemoglobin levels.

There is good news to report, too. Her calf circumference is already 1 cm (0.4″) smaller after today’s procedure, though we could expect some fluctuation. The color is not so dark red and her foot and ankle pulses are louder through the Doppler flow detector.

Molly stopped by, and Dr. Thurmes visited about a half-hour later. Dr. Thurmes feels Lucy’s mild fever spikes, occasional chills, and slightly low blood pressure (hypotension) is due to the clots, not an infection. Her blood cultures are still “unremarkable” which is great.

Please indulge me for a moment while I go off the subject of Lucy for a moment:

  • In blog related news, comments work and we encourage you to use them. Blogger has had some issues with spammers injecting crap in the comments, so we will moderate comments.
  • For those of you who have a Facebook account, I have set up a “Journey of the Teal Owl” group. I am looking at using RSS Graffiti to automatically publish the blog posts on the Facebook group page. Bear with me on that.
  • In addition, those of you with a Twitter account can follow @tealowljourney. I will try to send a tweet when there is a new or updated post. This is all a work in progress and will be quite fluid for a while.

Thank you for your patience! We are so grateful for all your love and support!

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Filed under administrative, cancer battle, DVT, hospital, transfusion

Clotbusters III (without Bill Murray)

Because it’s the weekend and people may be checking the blog a bit more frequently, I’ll be updating this posting at least once more today.

Lucy had a good night. She says she slept much better. The pain pump is knocking her pain back a bit. She was running a mild temperature, which elevated her heartbeat slightly. Apparently, that is a side effect of a DVT. Her temperature came down and her heartbeat is around normal. She has been getting Tylenol to reduce her temperature. Her potassium level is back to normal. Her calf circumference has not gotten smaller yet. I don’t know how quickly that will happen.

She went to Interventional Radiology at 9:00 this morning to have the catheters moved. The last procedure took 3½ hours. I don’t know if this procedure will take as long.

UPDATE: Lucy was back in the room at 11:30, which is an hour less than her previous procedure. The reason the bottom catheter got shut off last night was a kink occurred. She may have kinked it getting situated to use the bed pan. Her right ankle is immobilized with an arm board as a precaution. To minimized potential bed pan problems she had a catheter inserted. Her bladder and kidneys are fine.

She apparently had more than one clot in her leg, one in the thigh and at least one in the calf. That is not unusual.

As we get older, our veins start constricting and lose some of their elasticity. Lucy had a minor constriction in her thigh, so they did a balloon angioplasty and an AngioJet to open things up. Her thigh is looking a lot better and the redness is turning pink.

Dr. Thurmes stopped by and seemed pleased with her progress. He did order an antibiotic for safety’s sake. Molly from Minnesota Oncology also has rounds this weekend and stopped by to see how Lucy was doing.

She will have the procedure done one more time tomorrow morning at 8:30.

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Clotbusters II

Lucy’s procedure finished around 1:00. She moved down to the Surgical Specialties unit on third floor, so there goes the view.

They gave her a pain pump and she is already noticing a decrease in pain. This is the first time this week where her pain self-assessment went down.

The clot treatment consists of a “clot busting” drug (alteplase) as well as a blood thinner (heparin). Alteplase is the activator and the procedure is formally named “Tissue Plasminogen Activator” or TPA for short. The hardware looks impressive: seven infusers and a pain pump. Two of the infusers got shut off after a couple of hours, one managing the clot buster and the other administering the blood thinner. We’re hoping this is a good sign. Lucy will have the catheters moved tomorrow and her hematologist will be by on rounds, too.

Lucy changed rooms twice today. She is in a bigger room. The care providers have some elbow room now. She actually had some time to herself tonight. The fast-paced choreography of this morning has slowed to a graceful ballet. Now she’ll get more of a chance to relax.

This does it for tonight. Thank you so much for your good wishes for Lucy!

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Who you gonna call, CLOTBUSTERS!

Fairview Southdale’s Oncology wing is on the top floor. Being eight floors up allows for some nice views. That’s a wonderful little perk. We wish the skies would clear at night so we might see the northern lights before they fade.

This morning started with some hustle and bustle as the staff prepped Lucy to have the catheter procedure performed. There was some good news today.

I forgot to mention that when Lucy received her three units of blood last night, she received a diuretic called Lasix. Lasix administration helps flush some of the excess fluid that builds up during a transfusion. The excess fluid can cause blood pressure elevation to unhealthy levels. If any of you play the ponies, you have heard that some unscrupulous owners used to give horses a Lasix injection before a race. An injected horse becomes several pounds lighter after multiple bladder voids thus giving it an unfair advantage. That’s probably where the slightly vulgar observation involving a Russian race horse originated. One side effect of Lasix is it can reduce potassium level and Lucy’s potassium is slightly low. They will address the deficiency with oral or IV potassium supplements. She also likes bananas and Gatorade, which will give her a slight potassium boost.

Lucy had ordered breakfast before getting told she was NPO. The Latin phrase Non Per Ora means nothing by mouth though she is allowed sips of water. She had to watch me eat her French toast and hash browns. I’ll figure out a way to make it up to her!

Lucy has Blue Cross for her medical insurance. They have been wonderful once one finally gets through to a human. Dante must have foreseen Blue Cross’s automated phone system and used it as the inspiration for the ten circles of hell in “The Inferno“. The only thing missing would have been getting Heath Ledger in his “The Dark Knight” Joker role to intone “Omnes relinquite spes, o vos entrantes” (Abandon [relinquish] all hope when you enter) and cackle maniacally when the system answers.

The platelet transfusion worked even better than expected. Her count jumped from 53,000 to 98,000. Dr. Thurmes was very pleased with that. He also noted that her white count also improved and that’s something that has to come up on its own. After all the pounding her bone marrow took from the previous three rounds of chemo, perhaps her bone marrow is getting back to normal. That will bode well for her anemia if that is the case.

Her blood cultures still show no sign of infection after two days. While her leg is still very red and swollen, it is from the blood clot. The clot is bad enough to battle, she doesn’t need a few hundred million microscopic critters playing rough and adding to her discomfort. They will watch her cultures for a total of five days.

She went down to Interventional Radiology on third floor for the catheter insertion at 9:30. The preliminary estimate is about two hours, mostly due to allowing the anesthesia to kick and recovery time afterwards. Lucy is a little slow recovering from even local anesthesia. She is getting moved to a room in Surgical Specialties for at least one day. They want to keep very close watch on her to make sure the clot doesn’t do something very unpleasant. The likelihood is very small, but there is still a risk.

I’ll have another posting tonight. Thank you for keeping Lucy in your thoughts!

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Some steps forward, a couple of steps sideways

Sometimes a journey has a few sideways steps in order to go forward. Lucy’s blood clot is not responding as well as hoped. Dr. Thurmes, a hematologist, stopped by this afternoon. He wants to use a catheter inserted closer to the clot and use a stronger blood thinner. The catheter insertion happens tomorrow unless something changes. The process will take about two days and Lucy obviously will stay in the hospital until at least Saturday. He also ordered a head CT scan as a precaution.

One thing noted during her blood work is her white count and platelets are a little low. This is most likely from the Taxol used in the previous round of chemo. Because of the blood thinner they are using, she will receive a platelet transfusion tomorrow.

Cancer can cause blood-clotting problems. Lucy also has a blood-clotting factor discovered during more thorough blood work, which could put her at a slightly higher risk of recurrence. The factor also means a standard INR test is misleading. This means they will use a different clotting factor test.
Right now, the focus is on getting the clot dissolved. Lucy will likely be on Coumadin for a time after she gets released from the hospital. It’s still too early to determine exactly for how long. We did not get a chance to discuss her anemia, but that needs addressing in the near future.

The last sideways step is she is still having pain management issues despite getting Dilaudid in her IV. It does make her sleepy so she is getting rest.

Now on to the steps forward! Lucy’s appetite is good and her sense of taste is a lot better. The blood transfusion took several hours last night, but she did get all three units without too much drama. Her hemoglobin is 9.8 several hours after the transfusion, which is a big step in the right direction. She has good color in her cheeks again. Her blood work did not indicate infection and her kidneys are working well.

It was a long night for both of us. Lucy managed to get more sleep than me. She will be getting her pain medication in a few minutes and then I’m heading home. We’re thankful for the steps forward!

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Filed under cancer battle, DVT, hospital, transfusion