Monthly Archives: January 2012

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!

Leave a Comment

Filed under cancer battle, DVT, hospital

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!

Leave a Comment

Filed under cancer battle, DVT, hospital, transfusion

Fill ‘er up! No, not quite…

Today is getting longer than we expected. I’m doing this entry via my phone so please excuse the egregious spelling mistakes.

Lucy’s leg is about the same. The pain relievers zonk her out so she had some quality time getting re-acquainted with the backs of her eyelids.

Lucy went to Minnesota Oncology to have an INR test and get a Lovenox shot. Tomorrow is the meeting with the hematologist.

She had the chills before the INR test. Lucy had a CBC test done in addition to the INR. Her hemoglobin was 5.5, which was very low.

After her Lovenox shot, Lucy went to Fairview Southdale for a transfusion. Her temperature is 102.8°F, so she is being held overnight. They are starting antibiotics and doing a blood culture.

Her transfusion started at 10:00 pm when her temperature was 98.1°F. It was stopped at 10:45 when her temperature rose to 102°F, then started again at 11:15 when it went down to 100.9°F.

Here’s hoping tomorrow will go better!

Leave a Comment

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

Another day, another poke

Lucy had another Lovenox shot today. For those of you with some medical background, Lovenox is a SC slow-push injection. The ideal area for the shot is in the belly region. Cringe-worthy for sure, but it’s also not as painful. Lucy has mentioned feeling only a couple of the injections. You can’t begin to understand how much we appreciate skilled nurses!

Starting around Thanksgiving Lucy had noticed her sense of taste was getting impaired. We did have a couple unusual food experiences where she believed her taste buds were on vacation, but they weren’t (trust me!). By and large she has mentioned food not having much flavor, even spicy Asian and Mexican cuisine. Many people going through chemo mention food tastes changing and some will develop food sensitivities. The past few days, Lucy is noticing food tasting better and her appetite increasing. This is good news!

Her leg swelling is slowly getting better and the coloration is looking a lot less “angry”. Her right ankle is swollen and not very flexible at this time. It is swollen to the point tonight that getting a boot on was nearly impossible. She got around that by pulling the insert out of her Sorel boot so it could easily slip on. I thought that was pretty clever! If the weather were still as mild as it was two weeks ago, boots would not be necessary. The Twin Cities area finally has a couple of inches of snow on the ground. We’re thankful the temperature was in the +20°F’s today and not the -20°F’s we can and do get.

Lucy is out on disability for the next two weeks. This is not a bad sign. She has had a tremendous fight going the past few months and her body needs a rest. Walking is still very painful and driving is out of the question especially with painkiller involved. She moved to a different cubicle at work after their reorganization and it means more walking for her.

The blood clot issue will resolve and her leg will get better. She is anxious to start using our treadmill, rebuild the strength in her leg, and be her usual independent self again.

Leave a Comment

Filed under cancer battle, clinic, DVT, weather

Start of Chemo Round Four

Our society places a great deal of celebratory value on the passing of the old year. We look back on the old year and hope the new year is better. With as bad as 2011 was, 2012 has to be better, right?

The new year did not start out as nicely as hoped. Because there was a slight increase in Lucy’s CA125 level, Dr. Boente wanted labs done a couple days in advance. A CA125 test takes about two days to complete. The labs indicated her hemoglobin had dropped to 6.8. Lucy needed a transfusion on January 4th. Her next scheduled Taxol/Avastin treatment was scheduled for January 5th. This would have been the first treatment of the fourth cycle.

After Lucy’s CA125 level dropped dramatically during the second treatment cycle, it had been steadily increasing since. She was also having leg pain and stomach problems. Lucy’s cancer had become Taxol-resistant and platinum-resistant. The Taxol/Avastin treatments were cancelled and she was to start Alimta instead. Alimta is given once every three weeks in a very short infusion. Her first Alimta treatment was scheduled for January 12th.

While Dr. Boente was examining Lucy, he checked her legs to determine why they were painful. He did a Homans’ test on both legs. This involved Lucy sitting at the edge of the exam table with both legs dangling over the edge. He then supported her ankle with one hand and started pushing her foot back towards her shin. The left leg was painful while the right leg was not.

Because Homans’ test not a good indicator of a deep vein thrombosis (DVT, a blood clot in a vein deep under the skin), Lucy was scheduled for an ultrasound on her left leg. Fortunately, Suburban Imaging is one floor down from Minnesota Oncology. She had an appointment for that afternoon. The ultrasound determined there was a clot in her left calf. We went back upstairs so Lucy could get a Lovenox shot. Lovenox is an anti-coagulant drug. It is not designed to dissolve an existing clot. She received a prescription for Coumadin, another anti-coagulant. The Coumadin would start after a series of four daily Lovenox shots.

Coumadin is a fickle drug to properly dose. It requires frequent blood testing. The test is known as PT/INR, and is more commonly called an INR test. It’s short for Prothrombin Time/International Normalized Ratio. The desired result should be between 1.0 and 2.0. Lucy’s was at 8.9 after two days on Coumadin. Her Coumadin was reduced from 5 mg to 2.5 mg until she was retested in two days. It was also noted that her hemoglobin dropped below 7.0. Instead of getting her Alimta treatment on January 12th, she had a blood transfusion on January 13th. The Alimta treatment was rescheduled for January 18th, and the next INR test was January 16th.

The January 16th INR test reading was better at 3.9. The Coumadin dose was cut again, now down to 2 mg. Lucy was told to get an ultrasound on her right leg after its examination.

The ultrasound showed there was a clot in her right thigh. Her Coumadin was immediately discontinued and she received a Lovenox shot. The Lovenox shots will continue daily for a week. On January 25th she will see a hematologist. The hematologist meeting will decide her Coumadin therapy and try to find the cause of her chronic anemia.

DVTs are incredibly painful. Lucy’s right leg has ballooned up to twice its normal size but is slowly returning to normal. Walking is still very difficult.

There is some good news despite all the speed bumps she encountered. Lucy did receive her Alimta treatment on the 18th. Unlike her previous rounds of chemo, Alimta is a quick one hour infusion given once every three weeks. Her previous round of treatments took between two and three hours each week except for her “off” week. She is not experiencing any side effects from it. Having to make fewer trips for chemo will be a big plus.

It’s been a frustrating start to the new year. We’re both trying to stay positive. We may not say it enough, but thank you for your concern, prayers, support, and the love you have for Lucy.

Leave a Comment

Filed under cancer battle, chemotherapy, clinic, DVT, transfusion