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!

Mondays are supposed to suck, not Fridays

Lucy's leg started getting worse this morning. She called Minnesota Oncology and they set up an appointment for 2:00 this afternoon.

Her nosebleed started at 1:30 and finally let up around 3:00. The nurse practitioner at Minnesota Oncology helped Lucy with her nosebleed. Anticoagulants are so fun. She also was contacted by Dr. Thurmes who was at Fairview Southdale on rounds.

She was admitted to Fairview Southdale as a precaution. Lucy also had some extra blood work drawn along with blood cultures. They need to wait 18 hours after her Lovenox injection before they can start IV heparin. That means she will get woken at 4:30 am. She just had completed an IV antibiotic because they suspect cellulitis. An ultrasound of the left leg found that the clot in her groin was solidifying. We are hoping she will not need a TPA catheter started tomorrow. In the past few hours, she started running a fever which is at about 102° right now. The Tylenol will help reduce the fever.

It is frustrating that this clotting problem flared up again. More than likely she is here until Sunday. We were looking forward to a nice quiet weekend at home and having her leg continue to heal. Now it's back to a wait and see mode. Keep Lucy in your thoughts and prayers this weekend. It helps us get through these setbacks.

At least I don't have to play Nurse Ratched with the Lovenox while she's in the hospital. See, I did manage to find something positive.

Blood, sweat and tears

We know that nosebleeds are a side effect of blood thinners. Lucy had one that lasted for almost 45 minutes. She had another this morning that was done in about 10 minutes.

We arrived at Fairview Southdale IV Therapy at 7:30 am for her transfusion. The type and match took a little longer than usual, so her transfusion started at 9:00 and was done at 12:45.

She is still really tired. Last night she had problems sleeping and woke up several times. Now she's home, warm, fed and relaxing. Her leg isn't quite as sore as yesterday and the swelling has abated somewhat.

Lucy's next blood test is Monday afternoon. There may not be another update until then. In the meantime, give your loved ones a hugs from us and thank you for your support!

Down to once per day

We started today with about two inches of snow. That is normally boring news but this has not been a typical winter. This stuff was like the mashed potatoes served in the school cafeteria. The snow blower had problems with it because the discharge chute kept plugging. I think the snow lovers might be disappointed with the stuff, too.

Lucy's leg puffed back up a bit by almost 2 cm though her pain is about the same. She is really run down today. We had been suspecting her hemoglobin was dropping and it has. She is at 6.8. Her two unit transfusion is scheduled tomorrow at 7:30 am. It will probably take four hours to complete.

She also has to change her injection schedule before the next labs. We were targeting her injection for around 6:00 pm. This would avoid conflicts with work schedules, dinner and TV. Now she is to get her injection at 11:00 tomorrow and work towards 10:00 by Monday's lab appointment. The lab is also getting moved to 4:30. Of course she's going the be at Fairview Southdale IV Therapy at 11:00 tomorrow.

One thing we are happy about is she is down to daily injections rather than twice daily. We also enjoyed Julie's stew tonight. OK, enjoyed is an understatement, devoured is more like it.

 Here's hoping we have a dull and boring day tomorrow.

Tomorrow will be a better day

Lucy couldn't visit her dad today. Her thigh was too painful. This happened the last time she had a clot in her left leg. The good news is her calf diameter was almost a full centimeter smaller and the erythema is almost gone. Her right calf diameter also was 0.8 cm smaller.

It is astonishing at how painful a blood clot can be. Her clots are maybe the diameter of a single piece of couscous. At times she rates the pain as worse than her post-surgical pain. I'm hoping her leg pain is better tomorrow.

I visited her dad today. On my way there I saw three bald eagles soaring over Highway 100 at Minnehaha Creek. He's in pretty good spirits and enjoyed having company. Suzy and Steve also came by. Lucy's family has treated me so well through the years and I enjoy being with them. I'm very lucky because I know too many people who have issues with their in-laws.

Her first injection went well today and her second one was OK. I must be getting the hang of it or she's learning to lie really well (just kidding!). I picked up one of her favorites from Qdoba on my way home tonight. That helped brighten up her day.

Lucy's next blood testing will be on Tuesday. She was originally scheduled for one on Monday and another on Tuesday, but the two blood tests are combined now. We can't wait for Tuesday because that is when her Lovenox cuts back to one injection per day. It appears she will be receiving injections for at least 30 more days. I do hope that she eventually goes back on Coumadin.

Laissez les bons temps rouler!

Well, maybe not today. Lucy woke up with stomach problems this morning and was running a mild fever spike because of her blood clots. Her mood wasn't very cheery and she was fairly wiped out. Alimta is fairly well tolerated, but it still can cause a bit of stomach distress and wipe out. That's why she has to take the oral dexamethasone (steroid) twice a day for the day before, day of and day after chemo. The past few months have seen her face a number of challenges and it takes its toll. My guess is today's stomach problems were a direct result of her breakfast choices. She hadn't had Lucky Charms in several months. The whole grains sometimes cause a bit more fermentation in the gut when one is not used to eating them. She started feeling better later this afternoon.

Her first shot Lovenox shot went better than yesterday's. We're probably figuring out the right timing and rhythm. The humorous thing about the Lovenox self-injection guide is the phrase "think love handles". Lucy doesn't have any. Heck, I've dropped 54 pounds in the past year and barely have any remaining.

We hope Lucy will be feeling up to visiting her dad tomorrow. Her left leg circumference was almost a full centimeter smaller than yesterday's measurement. Her discomfort is now mostly from both ankles and seems to be joint pain rather than tissue pain. The pain killers are still effective and she is using fewer of them.

I must be suffering from chemo brain by proxy. I forgot to mention Lucy had a coworker stop by Thursday morning with some homemade soups. Her coworkers have been so wonderful and supportive! They have made meals and sent cards and flowers. It's nice to know there are some good companies left.

And on the subject of chemo brain, I managed to mangle the "Comfortably Numb" lyric yesterday. Sorry about that! How I managed to turn "just a little pin prick" into "you'll feel a little pin prick" is beyond me. I'd like to say "Damn you autocorrect" but I wasn't posting from an iPhone. I have an Andriod phone and there doesn't seem to be an equivalent, perhaps thankfully.

For those of you that are able, we hope you enjoyed a walk today. Lucy should be able to be walking normally soon.

"OK...just a little pin prick..."

Lovenox was not what was referenced by the lyric snippet from Pink Floyd's "Comfortably Numb". Lucy survived my first injection attempt and I still have my nine fingers. We found some advice on the Lovenox web site along with a handy PDF to assist with the injections. We'll be glad when Tuesday gets here. She gets reduced to once per day starting Wednesday.

Lucy has her appointments scheduled for the next three weeks. I think the phone got a workout today.
Lucy's left leg looks better than yesterday. The erythema is smaller and a bit less red. Her right leg is back to normal except for some flaking skin. We took measurements of both calves so we have a reference point as was suggested by Dr. Thurmes. I'll be taking twice daily measurements until her leg gets better.

Lucy's dad had minor surgery this afternoon. His surgery got bumped for an emergency, so it started at 3:00 instead of 11:00. Lucy had a Neulasta shot appointment at 4:30 so we couldn't make it to the hospital tonight. She remembered how out of it she was when coming out of general anesthesia, and how it was nice that people cared, but she would rather have had some time to get reoriented and rest up. We're going to visit him tomorrow. It sounds like he might be getting released tomorrow late afternoon.

It was a very nice day outside today. We hope you had a chance to enjoy it.

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!

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 4^th. Her next scheduled Taxol/Avastin treatment was scheduled for January 5^th. 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 12^th.

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 12^th, she had a blood transfusion on January 13^th. The Alimta treatment was rescheduled for January 18^th, and the next INR test was January 16^th.

The January 16^th 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 25^th, 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 18^th. 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.