Tag Archives: Lovenox

“The ankle bone is connected to the shin bone…”

The ankle is more complex than a single bone and “Dry Bones” was not intended as an anatomy lesson in song. It is somewhat applicable because Lucy is walking better. Her ankle is pointing forward (12 o’clock) instead of away from her body (2 o’clock). Yesterday she would walk mostly on the ball of her right foot. Today she can get her foot flat and bend it forward towards the ball. She is getting the hang of it. Today she managed to use the bathroom. Two days ago, she couldn’t walk but half that distance. The walker will be temporary.

Her hemoglobin went up from yesterday. It is now at 8.7. It’s been a couple of months since her hemoglobin has stayed steady or has risen a couple of days after a transfusion. Her platelets were 212,000 and her white count was at 5.6. Those counts have vastly improved from when she arrived nine days ago. It sounds like she is in “therapeutic range” for her INR. The Chromogenic Factor X test result was not quite in therapeutic range. Dr. Thurmes came by and explained the results. His feeling is Lucy will be in the hospital until at least Sunday now. Lovenox injections might have been an option, but Lucy was on those for her clots. The heparin is working and they monitor and adjust the dosage as needed.

Lucy managed a walk of about 100 feet tonight with only a small stop to turn her walker around. The Physical Therapy people commented on how pleased they were with the distance. She got her exercise in tonight. There is a Meditation Sanctuary on this floor that she wants to see because of the water feature.

In addition to the various hospital staff in and out of her room today, Lucy had some visitors. Her supervisor and supervisor’s supervisor came by for about 45 minutes. Anh-Thu brought in a beautiful flower arrangement that she had designed. Lucy has some really great co-workers!

Lucy’s sister Julie came by tonight for a couple of hours and brought us some lemon chicken from Leeann Chin. The hospital food is all right, but has a limited menu selection. Lucy does not have dietary restrictions. It was really nice seeing Julie!

Lucy is staying positive. She does get frustrated at times, and so do I. We know this journey will be a battle and there will always be unknowns. That is why the victories both large and small are cause for celebration.

Thank you, everyone!

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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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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.

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