She still hasn't had the giant leap towards going home. Dr. Rousey (hematologist) stopped by this morning. He and Dr. Thurmes are still digging though research studies to see if Pradaxa will be the drug of choice, with Arixta as the runner up. Pradaxa apparently has a shorter half-life which is helpful in case of a complication. Lucy likes the fact that it is oral rather than an injection (OK, so do I!). Neither drug will require as frequent blood testing as Coumadin. I think it is because both drugs are tailored to manage specific coagulation factors while Coumadin takes more of a scorched earth approach?
The IV antibiotics are still going. Right now she gets Vancocin and ampicillin, and both are available orally. While the hematologists are researching Pradaxa, Lucy is still on IV heparin. She has not needed a blood test because she hit therapeutic range.
Julie stopped by this afternoon and really made Lucy's day! It was nice having nearly no interruptions while Julie was here.
Lucy took two walks today. The first was about 50 feet. Her second was close to 150 feet. She would go farther if the damned IVs were done. Her left ankle is loosening up a little. On her second walk, she was able to get her heel on the floor while walking, at least for a few steps. There was still discomfort walking, but she did not get wiped out afterwards. Like last time, her pain started decreasing when she sat down.
Dr. Thurmes will be on rounds tomorrow and said he will stop by. He's been so good to Lucy through this ordeal. He might have the home care anticoagulant and antibiotic choices tomorrow. If so, she will probably be released tomorrow.
Showing posts with label Coumadin. Show all posts
Showing posts with label Coumadin. Show all posts
Saturday, March 3, 2012
Thursday, March 1, 2012
March came in like a lion (in a good way)
Lucy had a very busy day with all the people in and out to check on her.
Dr. Dettis (infectious disease) was by and told her he was better than 90% certain her fevers and leg redness were solely from the clots, but he wants her to be on antibiotics for another day or two. That was reassuring for her to hear.
One of the hospital chaplins stopped by, and then Dr. Thurmes (hematologist) was by to see how she was doing. Unfortunately her hemoglobin was at 7.1 so she received one unit of blood just before going to IR. He feels the Coumadin and Lovenox are not working and had two other anticoagulants in mind. One is Pradaxa, which is a pill. The other is a once per day injection which she couldn't remember. We are hoping Pradaxa is a workable solution. Dr. Thurmes had a couple of areas he needed to research first.
Her TPA procedure was delayed because of a couple higher priority cases. She was originally scheduled for 8:30 and finally went down at 12:45. The procedure was done by 1:15. She no longer is on TPA and they can stop doing the neurological tests in another four hours. She should be able to get more sleep tonight and have fewer interruptions.
She did have to have her arm IV access changed. Getting a different one in was very problematic. Her arms have really been poked. Certain drugs cannot be administered into a port, and her antibiotics are all incompatible with heparin.
Julie called tonight and like last night didn't get much time to talk to Lucy. The arm access IV adventure was just beginning.
Lucy got to sit on the edge of the bed for over a half hour. She even managed to stand up before getting back into bed. Tomorrow she will get out of bed and go for some short walks.
Getting the TPA catheter removed is a step towards going home. The next two steps are getting her off IV heparin and letting her leg heal a bit more. Getting the heparin level in line will probably be the most difficult given her past experience. We still don't have a firm release date.
Keep your fingers crossed, and thank you for all the thoughts, prayers, positive energy and good wishes!
Dr. Dettis (infectious disease) was by and told her he was better than 90% certain her fevers and leg redness were solely from the clots, but he wants her to be on antibiotics for another day or two. That was reassuring for her to hear.
One of the hospital chaplins stopped by, and then Dr. Thurmes (hematologist) was by to see how she was doing. Unfortunately her hemoglobin was at 7.1 so she received one unit of blood just before going to IR. He feels the Coumadin and Lovenox are not working and had two other anticoagulants in mind. One is Pradaxa, which is a pill. The other is a once per day injection which she couldn't remember. We are hoping Pradaxa is a workable solution. Dr. Thurmes had a couple of areas he needed to research first.
Her TPA procedure was delayed because of a couple higher priority cases. She was originally scheduled for 8:30 and finally went down at 12:45. The procedure was done by 1:15. She no longer is on TPA and they can stop doing the neurological tests in another four hours. She should be able to get more sleep tonight and have fewer interruptions.
She did have to have her arm IV access changed. Getting a different one in was very problematic. Her arms have really been poked. Certain drugs cannot be administered into a port, and her antibiotics are all incompatible with heparin.
Julie called tonight and like last night didn't get much time to talk to Lucy. The arm access IV adventure was just beginning.
Lucy got to sit on the edge of the bed for over a half hour. She even managed to stand up before getting back into bed. Tomorrow she will get out of bed and go for some short walks.
Getting the TPA catheter removed is a step towards going home. The next two steps are getting her off IV heparin and letting her leg heal a bit more. Getting the heparin level in line will probably be the most difficult given her past experience. We still don't have a firm release date.
Keep your fingers crossed, and thank you for all the thoughts, prayers, positive energy and good wishes!
Thursday, February 16, 2012
Stop me if you've heard this before...
We fretted about today's oncologist visit, but Lucy's left leg stole the spotlight. We did not even get a chance to discuss the PET scan or CA125 level. Her rash is an erythema and is a sign of a blood clot. Her leg also ballooned up this morning.
Lucy did get her Alimta treatment, so something went right. She can take her multivitamins instead of the prescription folic acid since the multivitamins contain the requisite 400 micrograms folic acid. Lucy's next vitamin B12 injection will be during her next treatment in three weeks.
She was supposed to visit Dr. Thurmes tomorrow, but he saw her while she was getting chemotherapy. Lucy had an ultrasound on her left leg at Suburban Imaging at 6:30. As a precaution, Lucy will be getting twice daily Lovenox injections for a week followed by daily injections for around six months. Her Coumadin was stopped immediately.
We had about 45 minutes between the end of chemo and the ultrasound, so we had a quick dinner at Leeann Chin's about eight blocks from Southdale Medical Building. The Heartland Cafe in the medical building closed several months ago and a Subway is supposedly going in to replace it.
The ultrasound confirmed multiple clots in her left leg. However she was not admitted to the hospital. We'll find out more tomorrow. Apparently the belief is the Lovenox will work on the clots such that she won't require hospitalization or TPA catheters.
I will be administering the injections. It looks like the syringe has a short small bore needle. Lucy has no abdominal fat remaining because it was removed in her debulking surgery. The "tummy poke" is best for her, so I'll have to be careful. It's funny, I could probably give injections to anyone else, myself included, but the thought of giving Lucy a shot worries me. I know it's irrational.
So yes, you've heard the blood clots stuff before. Believe me, we hate reruns, too!
Lucy did get her Alimta treatment, so something went right. She can take her multivitamins instead of the prescription folic acid since the multivitamins contain the requisite 400 micrograms folic acid. Lucy's next vitamin B12 injection will be during her next treatment in three weeks.
She was supposed to visit Dr. Thurmes tomorrow, but he saw her while she was getting chemotherapy. Lucy had an ultrasound on her left leg at Suburban Imaging at 6:30. As a precaution, Lucy will be getting twice daily Lovenox injections for a week followed by daily injections for around six months. Her Coumadin was stopped immediately.
We had about 45 minutes between the end of chemo and the ultrasound, so we had a quick dinner at Leeann Chin's about eight blocks from Southdale Medical Building. The Heartland Cafe in the medical building closed several months ago and a Subway is supposedly going in to replace it.
The ultrasound confirmed multiple clots in her left leg. However she was not admitted to the hospital. We'll find out more tomorrow. Apparently the belief is the Lovenox will work on the clots such that she won't require hospitalization or TPA catheters.
I will be administering the injections. It looks like the syringe has a short small bore needle. Lucy has no abdominal fat remaining because it was removed in her debulking surgery. The "tummy poke" is best for her, so I'll have to be careful. It's funny, I could probably give injections to anyone else, myself included, but the thought of giving Lucy a shot worries me. I know it's irrational.
So yes, you've heard the blood clots stuff before. Believe me, we hate reruns, too!
Tuesday, February 14, 2012
Happy Valentine's Day!
A PET scan might not have been the most romantic way to spend Valentine's Day, but battling cancer sometimes causes inconvenient lifestyle changes. The scan took almost 90 minutes overall at Lifescan Minnesota in Edina. An hour was spent for prep and the scan was about 20 or so minutes. The results will be available to Dr. Boente tomorrow afternoon.
Lucy had a bit of an upset stomach today. We're both apprehensive about Thursday's appointment. Lucy has had a series of set backs since November. Her CA125 level has been slowly increasing which necessitated stopping the Taxol/Avastin treatments. The waiting is the hard part.
For the positive news of the day, she did get the latest Coumadin dosing for the upcoming week. She is on a three day cycle of 5 mg, 5 mg then 2.5 mg until next week's blood test. We did not get her hemoglobin level in the voice mail message, but there was no mention of a transfusion.
Tomorrow will be a test of how well Lucy can maneuver a walker. I'll be taking her to the Bloomington Deputy Registrar's office to get her driver's license renewed. Maybe she'll feel up to a belated Valentine's Day lunch or dinner. I did pick up some carnations for her tonight. She likes carnations because they last a long time.
We hope you had a wonderful Valentine's Day. Take a moment to think of the people that love you and remember how lucky you are to have them in your life.
Lucy had a bit of an upset stomach today. We're both apprehensive about Thursday's appointment. Lucy has had a series of set backs since November. Her CA125 level has been slowly increasing which necessitated stopping the Taxol/Avastin treatments. The waiting is the hard part.
For the positive news of the day, she did get the latest Coumadin dosing for the upcoming week. She is on a three day cycle of 5 mg, 5 mg then 2.5 mg until next week's blood test. We did not get her hemoglobin level in the voice mail message, but there was no mention of a transfusion.
Tomorrow will be a test of how well Lucy can maneuver a walker. I'll be taking her to the Bloomington Deputy Registrar's office to get her driver's license renewed. Maybe she'll feel up to a belated Valentine's Day lunch or dinner. I did pick up some carnations for her tonight. She likes carnations because they last a long time.
We hope you had a wonderful Valentine's Day. Take a moment to think of the people that love you and remember how lucky you are to have them in your life.
Monday, February 13, 2012
One person's curse is another person's blessing
We have a number of friends who are not fond of our mild (thus far) winter. The ice isn't thick enough on many lakes and rivers to skate on much less drive across; several drownings and near-drownings have occurred in the past couple weeks. Brown grass is not conducive to cross country skiing. No majestic icicles, very few days of watching snow slowly blanket the ground, and no fools getting tongues stuck on frozen metal objects. Boring indeed for them.
For us, the mild winter has been a blessing. Lucy has been battling leg swelling and blood clots for several weeks and didn't have to additionally battle snow and ice. She was on a weekly chemotherapy regimen until January, and there have been a number of medical appointments we attended on dry roads. Anyway, last year we had nearly double our seasonal snowfall and had some brutal -20°F mornings. Maybe Mother Nature was tired from last year? Today's snowfall was little more than a dusting, but at least our neighbors could have a bonfire without burning down the neighborhood.
Lucy's aunt and uncle, Ardelle and Dale, were here for a visit yesterday afternoon. They brought some stew Lucy's sister Julie had made plus a couple other goodies. It was nice seeing them!
Lucy's left leg is puffing up very slightly and she has a rash on it from the capillaries under the skin ballooning up. Her right leg is almost the same circumference as her left leg and the reddish hue is fading. The skin peeling has almost completed. She is able to walk a few steps without her walker albeit slowly and with some discomfort. Her right ankle still does not have full range of motion and may not for another few days. One of the catheters inserted into her leg was inserted in her ankle. There is still some bruising in the area which is probably the cause of her ankle stiffness. As such, driving is still out of the question for her.
The rash and swelling is not a set back. She had a lot of fluids pumped into her during her hospital stay. Now that she is moving around, those fluids are getting flushed. Lucy still is not as physically active as she was, so there will be some lymph pooling, too. She is maintaining the physical therapy exercises she was doing in the hospital and moving around the house as much as possible.
We are noticing Lucy's energy level is decreasing and she's puffing a little after walking around. That usually indicates her hemoglobin count is dropping. She had her blood work done for the Coumadin dosing and was told to stay the course. A Complete Blood Count (CBC) is also drawn. Since nothing was said about her hemoglobin, we're assuming it to be above 7.5.
Today started the busy week of appointments. Her other appointments are Valentine's Day (PET scan), Thursday (oncologist and hopefully a treatment) and Friday (hematologist). At some point she needs to renew her driver's license. That might be Wednesday.
Enjoy your evening and thanks for your support!
For us, the mild winter has been a blessing. Lucy has been battling leg swelling and blood clots for several weeks and didn't have to additionally battle snow and ice. She was on a weekly chemotherapy regimen until January, and there have been a number of medical appointments we attended on dry roads. Anyway, last year we had nearly double our seasonal snowfall and had some brutal -20°F mornings. Maybe Mother Nature was tired from last year? Today's snowfall was little more than a dusting, but at least our neighbors could have a bonfire without burning down the neighborhood.
Lucy's aunt and uncle, Ardelle and Dale, were here for a visit yesterday afternoon. They brought some stew Lucy's sister Julie had made plus a couple other goodies. It was nice seeing them!
Lucy's left leg is puffing up very slightly and she has a rash on it from the capillaries under the skin ballooning up. Her right leg is almost the same circumference as her left leg and the reddish hue is fading. The skin peeling has almost completed. She is able to walk a few steps without her walker albeit slowly and with some discomfort. Her right ankle still does not have full range of motion and may not for another few days. One of the catheters inserted into her leg was inserted in her ankle. There is still some bruising in the area which is probably the cause of her ankle stiffness. As such, driving is still out of the question for her.
The rash and swelling is not a set back. She had a lot of fluids pumped into her during her hospital stay. Now that she is moving around, those fluids are getting flushed. Lucy still is not as physically active as she was, so there will be some lymph pooling, too. She is maintaining the physical therapy exercises she was doing in the hospital and moving around the house as much as possible.
We are noticing Lucy's energy level is decreasing and she's puffing a little after walking around. That usually indicates her hemoglobin count is dropping. She had her blood work done for the Coumadin dosing and was told to stay the course. A Complete Blood Count (CBC) is also drawn. Since nothing was said about her hemoglobin, we're assuming it to be above 7.5.
Today started the busy week of appointments. Her other appointments are Valentine's Day (PET scan), Thursday (oncologist and hopefully a treatment) and Friday (hematologist). At some point she needs to renew her driver's license. That might be Wednesday.
Enjoy your evening and thanks for your support!
Thursday, February 9, 2012
Blood tests
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| Lucy's other amaryllis opened while she was in the hospital. There are six flower on the stalk. |
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| The tulips Lucy received from Annette and Al |
This afternoon she had her blood drawn to determine if her Coumadin dose is still effective. She now has an alternating daily dose of 5 mg and 2.5 mg until Monday.
Next week is booking up quickly: Monday is her next blood work to see how well the Coumadin dose is working, Tuesday is the PET scan, Thursday is her appointment with Dr. Boente and Friday is her appointment with Dr. Thurmes. As far as we know she will get her next Alimta treatment on Thursday.
We take simple things for granted. Our bodies are amazingly complex bio-mechanical wonders governed by amazingly complex electrochemical networks. Nerves trigger muscles, muscles and connective tissues move joints, joints move limbs, limbs move the body. (Anyone who has studied anatomy or kinesiology in detail will notice this is a simplified 50,000 foot overview.) Lucy's leg is looking less swollen and the redness is slowly turning pink. She still has some stiffness in her ankle and finds relief when she can prop her leg up. She can manage a few steps without the walker and her right ankle is more stable because of some regained flexibility. The pain level is also subsiding. She is hoping to be cleared to return to work a week from Tuesday (her company observes the President's Day holiday on the 20th).
There probably won't be an update until Monday. Until then, thank you for taking the time to read this and showing your support for Lucy!
Wednesday, February 8, 2012
Home sweet home
Yesterday was spent getting settled in at home. Lucy wanted to how her ankle would react to the home setting. That went better than either of us expected. No problems navigating with the walker, she can stand for more than a couple minutes, and she has cut way back on the pain meds. She is still doing her physical therapy exercises and her energy level is still pretty good.
Today we took a trip to Lions Tap in Eden Prairie. It got her out of the house for a bit, they have great burgers, and she had a birthday coupon. We took her walker along, but it turned out she managed OK without it. I noticed she didn't need much support when I held her arm. She still has discomfort in her ankle and her knee is still a touch stiff. There is no way she can drive yet. Her leg bothers her more if she sits for extended periods of time.
Tomorrow she has some blood tests to ensure her Coumadin dose is still correct. The test is later in the afternoon so the results may not be known until Friday.
We know this posting isn't as action packed as the hospital posts, but we're having a lot more fun!
Today we took a trip to Lions Tap in Eden Prairie. It got her out of the house for a bit, they have great burgers, and she had a birthday coupon. We took her walker along, but it turned out she managed OK without it. I noticed she didn't need much support when I held her arm. She still has discomfort in her ankle and her knee is still a touch stiff. There is no way she can drive yet. Her leg bothers her more if she sits for extended periods of time.
Tomorrow she has some blood tests to ensure her Coumadin dose is still correct. The test is later in the afternoon so the results may not be known until Friday.
We know this posting isn't as action packed as the hospital posts, but we're having a lot more fun!
Sunday, February 5, 2012
Sunday, Sunday
Lucy had a chorus of nurses and nurse's assistants come in and sing "Happy Birthday" to her this morning. That was really nice! Steve and Liz brought a strawberry tart cake. Julie and Suzy came by for a few hours, so Lucy had all her siblings here. Everyone got to see Lucy go for a walk with the Occupational Therapy person. Lucy also had someone from Physical Therapy come by. They worked on some exercises and Lucy has some new ones to add to the mix. Lucy's dad called to wish her happy birthday and see how she was doing. Lucy didn't wear a hat or scarf today so everyone got to see how much hair she has. I think that is the first time she went "topless" since she lost her hair in the first cycle of chemo.
Suzy and Julie did get to see Lucy's leg and it may have been a bit unpleasant. Lucy assured them it was a lot worse and much more painful eleven days ago. Her leg looks like it had a sunburn with a little peeling in a couple areas. There are areas on her lower leg where the color is getting towards normal. Her leg is slightly warm to the touch rather than hot. She has full sensation in her leg and it is not painful to touch it.
Dr. Singh came by to check on Lucy's progress. Lucy's Chromogenic Factor X reading today was in therapeutic range. She will have the heperin drop through the night and will have blood drawn for another test tomorrow. The results will be back in the early afternoon. If the Chromogenic Factor X test is in the therapeutic range again, Lucy could be discharged. The transfusion last night took her hemoglobin up to 10.7. It's been awhile since it was close to normal.
We will have some questions for the discharge meeting. There will need to be some appointments set up to test her blood. The hospital will lend her a walker for a week or two. We will also need a list of symptoms that necessitate a call to the doctor or a trip to the hospital. It is very possible Lucy will need to extend her disability leave another week.
There is a minor issue with pain management that still needs resolution. Lucy knows that she will not be totally pain free tomorrow. It will take a week or two for her leg to get back to normal. Her pain increases when she puts weight on her ankle. After she sits down, the pain starts subsiding. It sounds like the pain increase is not much. She describes it as annoying when she walks. It does not keep her awake at night and it does not distract her when she is sitting with her leg propped up. Lucy has been fortunate to never require hospitalization until her surgery in April 2010. She has never broken a bone or needed stitches. All the stuff she is going through is uncharted waters to her. It's hard for her to describe what type of pain, or how much pain she feels. Now that she has told them when she feels an increase in pain and when it starts to diminish, some of the concerns have abated.
We're cautiously optimistic about her going home tomorrow. It really depends on the blood test. Please keep your fingers crossed for her!
Thank you for all the birthday wishes today! Lucy is lucky to have such an amazing group of supporters!
Saturday, February 4, 2012
Room with a View
Lucy took a short walk this morning. It helps clear the fog of the pain pills. Her leg color has gotten noticeably better in the past day. Her right calf circumference is within 3 cm. (about 1.2") of her left calf. She says her ankle is stiff but is getting a bit more range of motion. Lucy has been working on her physical therapy exercises. Her Braden risk bracelet was removed because she is more active and her skin can air out.
Dr. Singh from Minnesota Oncology came by. Lucy was moved back to 8th floor this afternoon. Her hemoglobin dropped after yesterday's increase so she will be getting a two unit transfusion. This means the four transfusions she has had since being admitted have required eight units of blood. She will be here until Monday at the earliest. The rest of the blood work sounded OK. Her Coumadin dosage was dropped to 2.5 mg and they did not have to administer a quick "blast" of heperin (called a bolus). We hope this means she is getting close to being removed from the IV heperin and her Coumadin dose is getting set.
I did get to take Lucy to the Meditation Sanctuary before she was moved. We used a wheelchair because it was a quick trip. She liked the fireplace and water feature. Changing her scenery also helped.
The view from her room is great. For those of you in the Twin Cities area, she overlooks Crosstown and France Ave. The fog lifted and the sun came out and we can see all the way to Highway 100.
Lucy's birthday is tomorrow and she will be spending it in the hospital. I'm grateful for getting to celebrate another birthday with her! I do wish she could have been released today. Comments are working, so please feel free to send her birthday greetings tomorrow. Thank you so much for your support!
Friday, February 3, 2012
"The ankle bone is connected to the shin bone..."
The ankle is more complex than a single bone and "Dry Bones" was not intended to be an anatomy lesson in song. It is sort of 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 months since her hemoglobin has stayed steady or risen a couple days after a transfusion. Her platelets were 212,000 and her white count was at 5.6. Those counts are 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 results were 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 heperin is working and it can be monitored and adjusted 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 hours and brought us some lemon chicken from Leeann Chin. The hospital food is alright, but the menu selection is limited. 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!
Her hemoglobin went up from yesterday. It is now at 8.7. It's been a couple months since her hemoglobin has stayed steady or risen a couple days after a transfusion. Her platelets were 212,000 and her white count was at 5.6. Those counts are 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 results were 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 heperin is working and it can be monitored and adjusted 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 hours and brought us some lemon chicken from Leeann Chin. The hospital food is alright, but the menu selection is limited. 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!
Thursday, February 2, 2012
Eight days on the road...
There was a little additional news from last night that didn't make the post (and I was too tired to do the update). Lucy got to sit on the edge of the bed last night for almost a half hour. I got to give her a long back rub which helped her relax. Her calf diameter went down another ½ cm. Her pain level has stayed the same, but it is significantly better than a week ago. Her blood work is showing normal values except for her hemoglobin being low. Adult women are supposed to be between 12.1 and 15.1 grams/deciliter (g/dL). They want Lucy's hemoglobin to stay above 7.5. If it goes below that, she will get a transfusion.
This morning was incredibly foggy. It has been a very mild winter here unlike last year's near-record seasonal snowfall and unusually cold temperatures. We earned a break after last year. I normally can drive from home to Fairview Southdale in about twenty minutes for the six mile trip. France Ave. has a bunch of unsynchronized stoplights once I cross into Edina from Bloomington. Today I needed fifty minutes. There is a large lake and marshy area near Normandale College at 98th St. and France Ave. The fog in that area reduced visibility to about fifty feet. Even the inside of the hospital parking ramp was a bit foggy.
Dr. Thurmes stopped by to see how Lucy was progressing. Her Coumadin dosage still needs a tweak. She had noticible improvement in her hemaglobin after yesterday's transfusion, rising from 6.1 to 8.4. Lucy will probably be here until Saturday at least. Dr. Thurmes wants to see two consecutive acceptable results before disconnecting the IV heperin.
Lucy had the PT and OT people here today. She ran through her exercises and has a walker to use. She can get out of bed without needing a handrail. Her right ankle is still very stiff. She walked close to one hundred feet in total today, half with the walker, in four walking sessions. Now she has a recliner to sit in so she spent most of the day in the chair. It still takes her a moment after she stands up before her ankle loosens up enough to slightly work.
Thank you for taking the time to read this and for your concern for Lucy!
This morning was incredibly foggy. It has been a very mild winter here unlike last year's near-record seasonal snowfall and unusually cold temperatures. We earned a break after last year. I normally can drive from home to Fairview Southdale in about twenty minutes for the six mile trip. France Ave. has a bunch of unsynchronized stoplights once I cross into Edina from Bloomington. Today I needed fifty minutes. There is a large lake and marshy area near Normandale College at 98th St. and France Ave. The fog in that area reduced visibility to about fifty feet. Even the inside of the hospital parking ramp was a bit foggy.
Dr. Thurmes stopped by to see how Lucy was progressing. Her Coumadin dosage still needs a tweak. She had noticible improvement in her hemaglobin after yesterday's transfusion, rising from 6.1 to 8.4. Lucy will probably be here until Saturday at least. Dr. Thurmes wants to see two consecutive acceptable results before disconnecting the IV heperin.
Lucy had the PT and OT people here today. She ran through her exercises and has a walker to use. She can get out of bed without needing a handrail. Her right ankle is still very stiff. She walked close to one hundred feet in total today, half with the walker, in four walking sessions. Now she has a recliner to sit in so she spent most of the day in the chair. It still takes her a moment after she stands up before her ankle loosens up enough to slightly work.
Thank you for taking the time to read this and for your concern for Lucy!
Wednesday, February 1, 2012
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 has been moved to February 16th. Her body will get a little more chance to recover. Her white 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 travelling. A "staycation" 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 was 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 can be done in bed and left a booklet detailing how to do the exercises. Lucy is supposed to 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 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!
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 has been moved to February 16th. Her body will get a little more chance to recover. Her white 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 travelling. A "staycation" 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 was 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 can be done in bed and left a booklet detailing how to do the exercises. Lucy is supposed to 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 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!
Monday, January 23, 2012
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 got 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. So it was 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 was also given 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 fairly frequently blood testing. The test test is known as PT/INR, 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 note that her hemoglobin dropped below 7.0. So 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 was better, 3.9. The Coumadin dose was cut again, down to 2 mg. When her right leg was examined, she was told to get an ultrasound on the right leg.
The ultrasound determined there was a clot in her right thigh. Her Coumadin was discontinued immediately and she received a Lovenox shot. The Lovenex shots will continue daily for a week. On January 25th, she will see a hematologist. The hematologist meeting will determine her Coumadin therapy and try to determine the cause of her chronic anemia.
DVTs are incredibly painful. Lucy’s right leg 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 is going to 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.
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. So it was 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 was also given 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 fairly frequently blood testing. The test test is known as PT/INR, 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 note that her hemoglobin dropped below 7.0. So 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 was better, 3.9. The Coumadin dose was cut again, down to 2 mg. When her right leg was examined, she was told to get an ultrasound on the right leg.
The ultrasound determined there was a clot in her right thigh. Her Coumadin was discontinued immediately and she received a Lovenox shot. The Lovenex shots will continue daily for a week. On January 25th, she will see a hematologist. The hematologist meeting will determine her Coumadin therapy and try to determine the cause of her chronic anemia.
DVTs are incredibly painful. Lucy’s right leg 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 is going to 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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