Category Archives: DVT

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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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!

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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.

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