Category Archives: transfusion

by | February 1, 2012 · 2:45 pm

And on the seventh day…

Lucy’s Coumadin dosage needs adjusting upward, so she will be here at least one more day. Unfortunately, her hemoglobin dropped from 7.8 to 6.1 so she needed a two-unit transfusion. Lucy’s birthday is Sunday the 5th and I would love to see her home by then! It is a day-by-day holding pattern.

Molly, Dr. Nashawaty, and Jackie from Minnesota Oncology were by to see her progress. Acute anemia can show up in patients receiving chemo. Lucy was originally scheduled for her next Alimta treatment on Thursday, February 2nd. The treatment moved to February 16th. Her body will get a little more chance to recover. Her white count is stable and in the normal range, and her platelet count is normal and stable.

So maybe today didn’t start great, but there is still good news. Molly noted that Lucy’s calf skin is less taut. It no longer looks like it is going to split open. She still has quite a bit of swelling in her right ankle and a slight amount in her left ankle. The left ankle swelling will reduce as she becomes more active. Her right leg still cannot be massaged and they can’t put a “puffer” on it because there are still a couple small clots. They do not want the clots to dislodge and start traveling. A “stay-cation” is good enough for the clots.

Lucy only needed one Dilaudid shot last night for pain. She is taking oxycodone tablets to manage pain. Her pain pump got removed last night.

A Physical Therapy specialist came by this morning and checked Lucy’s strength and range of motion. She also had Lucy do a series of simple exercises that could be done in bed and left a booklet detailing how to do the exercises. Lucy will do them twice a day.

An Occupational Therapy specialist came by about an hour later. She assisted Lucy out of bed. Lucy managed to walk around the bed. Lucy’s pain doesn’t increase very much when she puts weight on her leg. Her ankle still has a limited range of motion so getting her foot flat on the floor is a challenge. After a couple of minutes she can stand flat-footed. Walking is very slow. She is not unsteady on her feet. Lucy has surprising physical strength for someone so petite. The goal is to keep her from losing strength while her leg gets better. She will try using a walker tomorrow.

Give your loved ones a hug from us, and thank you for your support!

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by | January 30, 2012 · 8:21 pm

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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by | January 29, 2012 · 6:04 pm

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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by | January 26, 2012 · 10:31 pm

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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by | January 25, 2012 · 8:11 pm

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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