Sunday, March 27, 2011

Yesterday's Adventure in Medicine

Boy, was yesterday exciting!  While it would be more fun to save the punchline to the end, it wouldn't be nice, so I'll tell you up front that I'm fine except for a cold.  And I'll tell you how I know that so definitively.

I've been fighting a cold for the last week.  Over the last few days, it had turned nasty.  Yesterday, it turned scary, when my temperature began to creep up toward 100.  That's a scary number for me, so I loaded Robbie up into the van and headed for the near-by Urgent Care, where you can see a doctor on the weekend.  Enroute, I called Georgetown and asked to speak to the hematological oncologist on call.  Dr. Fitzgerald called me back.  She reassured me that the blood work I had done on Wednesday showed that my white blood cell counts were fine.  She told me "Go get your cold treated."  That made me happy.

I signed in at the Urgent Care, giving them my particulars including the chemo drugs I'm currently on.  I suddenly found myself whisked into the back ahead of several people and learned that the nurse on duty was an oncological nurse in her "day job".  I told her what Dr. Fitzgerald had said, but she just shook her head and said, "We really should be sure."  When the doctor came in, after obvious consultation with the good nurse, she said "We can't treat you here.  You need to go to an emergency room and get blood work done."  Crap!  I texted Liz, who was enroute from the airport after a week in Seattle, and told her to meet us at the Calvert Memorial Hospital emergency room.

In the meantime, it's creeping into my head that I might actually be neutropenic--that I might have had a white blood cell crash and that I was in for June 2009 all over again. Crap, Crap, CRAP!

Tim's vision:  I walk into the emergency room.  They take a two-tube blood sample.  After 30 minutes they come back and say that either I'm not neutropenic and give me some antibiotics, or that I am neutropenic, in which case I start driving for Georgetown.  In any case, I'm figuring an hour max at this hospital.

Reality:  I walk into the emergency room (here's where we diverge from Tim's vision).   Liz shows up (thank God), they haul me into the back into treatment/isolation room 11.  They give me a cup to pee in (?).  They give me a gown to put on.   A tech comes and takes me for two chest x-rays.  When I get back, they lay me down on the bed and began sticking electrodes on my chest.  The nurse confirms that, yes, my chest hair is too thick under the one for it to get a good reading, so we have to rip it off, trim the hair and reattach.  I confirm that waxing will never be an option for me.  They draw blood from my left arm, but leave in a catheter (?).   They later come and draw more blood from my right arm.  They make me hawk a loogie into a sample cup--no points for style or distance.

I'm becoming more paranoid and more convinced I'm neutropenic.  Liz and Robbie are in and out visiting.  They even embroidered a germ mask with my name.

Another nurse comes to get arterial blood for a blood gas test.  They draw it from my right wrist.   In case you've never had one of those, they kind of hurt.   I'm really getting paranoid.  Oh, they've now hooked me up to a saline IV.  I starting to feel like Gulliver shortly after he met the Lilliputians.  Oh great!  Now they want a throat swab.

Liz and I are game-planning what we have to do if the news comes back bad.

Finally, about three hours after I arrived at the hospital, a nurse comes in without a mask and says, "You're not neutropenic."  Whew!  Final diagnosis (I'm not kidding):  You have a cough.  A cough.  And an upper respiratory infection (the dreaded URI).   It takes about another hour to unhook everything, get my prescription written, and get out the door.

Let me say the staff at Calvert was uniformly professional and polite.  They did a great job, and as the doctor explained, when they hear they have a chemo patient with a fever coming in, it's like hearing they have an overweight smoker with chest pains.  There are certain precautions they take.

So good news is I know definitively that my blood counts are still good, that my pain threshold is still relatively high, and that I finally got my antibiotics and cough medicine.  The hydrocodone based cough medicine put me enough in la-la land that I overslept and missed choir practice this morning.  The fever has abated and all is (relatively) right with the world.

The End.

Friday, March 11, 2011

Memory Lane

Was just looking back almost two years to my first chemo posting: 

Session One, Day One

Unsurprisingly similar.

Tuesday, March 8, 2011

Chemotherapy, Take 3

8:05 a.m.:  Back at Georgetown, in the Clinical Trials area on the Seventh floor of the Main building in Room 108 (this side of the building has the view of Georgetown I noticed in my very first GTown post), waiting to begin the first cycle of my third round of chemo.  I'm going to be building the blog in real time today, so feel free to check in periodically for updates.  The real fun should begin about 15 minutes after I get my first dose of intravenous Benedryl--hope I don't do the blogging equivalent of drunken texting.

Left the house at 5:20 this morning and got here at 7:25, which is not bad time for this run.  The Trials areas was already open and manned; Miss Marta got my vitals and sent me to my home for the day.

I was here last Wednesday for a trial dose of the trial drug, Ofatumamba.  Took for frickin' ever to get the 1000 ml (that's almost a liter) infused, but the good news is that other than causing a controllable rash (an ITCHY controllable rash) there were no adverse side effects.

Now I'm waiting for the pomp and circumstance to start.  The needling of the arm, the admis--BREAK BREAK:  we're about to insert the catheter (not there) in a vein in my forearm.  Weird, but even after the last two years of this stuff,  I still can't watch the needle go into my arm.  I've been swabbed up and...Jamela just nailed the vein with absolutely minimal discomfort, drew about eight vials of blood.  There's a lead attached to the catheter that ties into the IV line, and that will stay in place until tomorrow.  I'll break here and share this on Facebook.  Hope this is entertaining and informative today.
8:55:  A big part of chemotherapy is waiting.  Now that they've taken blood, we have to wait for the labs to come back to say I can start infusion.  No big deal now, but later when my white blood counts may be suppressed, I can actually have counts too low to allow treatment.  Only when the labs come back OK will they order the drugs made up.  Unlike Tylenol or Theraflu, chemo drugs are not prepared in advance.  They are expensive and the pharmacy (located here on the seventh floor) will only start mixing when the patient is here and ready to start treatment.  This could easily translate into a couple of hours of sitting around.  Last Wednesday the labs were really slow, which led to my 8:15 p.m. exit.  (I've already appropriated an extra sandwich from the patients' fridge (no I didn't steal it--the hospital provides them) as an emergency back up dinner should I get delayed again.)

Back to the theme of "waiting", the real waiting today will start when they hang the big bag-o'-drugs up on the IV stand, tie it into my arm, then leave it there until it's all gone.  Effectively, I'm tethered to the IV stand from that point  forward.  It gets old, particularly trying to prevent the IV line from tangling if/when you move around.

Anyway, I've got connectivity through my work computer and my iPad.  I'm currently looking at workforce trends and listening to 14th century a cappela choral music courtesy of the iPad's Pandora application (well, somebody's got to listen to it).  It's very calming.
9:50:  Still waiting.  As an aside, one advantage of getting here early?  You get to go around to all the other treatment rooms and steal the good magazines.
9:55:  Mercedes just showed up and we're about to get the party started. Mercedes has promised smooth sailing today and forbidden me from getting a rash.  My blood counts came back and everything looks pretty good.  I'll be getting the Benedryl first, so this could be my last coherent posting for a while. 
10:25:  Finally infusing, but only with the 'prep' drugs--no Bendaryl just yet, though.  I'm getting Zolfram to ward off nausea, then will get my Bendamustine afterward.  Apparently we wait an hour after the Benda before we can start the Ofatumumab.  I've already accidentally hooked the IV line around the arm of the chair, but you get really sensitive to the tug.  No hurt, no foul.
11:10:  Lunch came early today.  Today we are having a brown bag lunch with a tuna salad sandwich, an apple, some Lorna Doone shortbread cookies, a 4 oz. container of cranberry juice cocktail, and a bag of Lays potato chips (yes, all that and a bag of chips).  Also got a spare banana for later and a USA Today.  Not a bad haul.
11:35:  Done with the Bendamustine and starting on the next round of 'prep' drugs.  Still no Benadryl.  Just met Bethany, a nurse who took my vitals.  She normally works down on the 5th floor on the 'non-trials' floor, but is rotating up here every now and again.  Nice to see a new face.  Lunch is done, and if it is followed by the Benadryl, I see a nap in my very near future.
11:53:  Fabulous.  Was just informed that I have to come back on Thursday for a growth factor shot (which will stimulate the production of white blood cells).  Good on some level, but I thought we were going to wait to see if it is necessary.  What this translates into is "Drive two hours, ride an elevator, get a shot, drive home two hours".  As I said, Fabulous.

12:30:  Not sure if they gave me something, but staying awake does not seem to be an option just now.  I keep falling asleep and feel sightly drunk/drugged/sleepy.
12:45:  Surprise!  I did get Benadryl infused earlier.  No wonder I got turned off like a light.  Mercedes just started the 1000 ml bag with the Ofatumumab in it.  God that's a big bag.  Now lets see if I get the rash again.
3:05:  I've been drifting in and out of sleep for the last two hours as the Benadryl works its magic, but currently am fairly awake.  We are up to the maximum infusion rate (400 ml/hour)and I have about 750 ml left to infuse.  So I should be done by around 5:00 p.m., a much better time than I anticipated going into the day.  So far, no rash and no itching.  I'm still managing to get some work done, though I've been getting assists with logic from one of my staff.  We're working on a moderately tricky workforce policy and my mind isn't quite keeping up.  Thank heavens K4 is keeping me straight.
4:45:  If my infusion bag was a peanut butter jar, it'd be about time to start scraping the sides and bottoms--almost done.  Looks like I have about ~50 ml left, or about 7 minutes worth to infuse.  Not a bad day so far.  I actually got a fair amount done.  As we speak the alarm on the pump is beeping, bringing in Mercedes to check on me.  She agrees with the 7 minute estimate.  We're going to leave the catheter in and use it tomorrow.  I used to do this routinely for two days, so one day is no big deal.
4:55:  AND we're done.  At least for today.  Mercedes unhooked the IV then injected an anti-coagulent to keep it from blocking up.  We've wrapped the catheter in gauze.  Now all I have to do is clean up my scattered accoutrement and head for Jim and Elena's (though I may walk the campus a little first).

Hope you gained some insight into a fairly standard day of chemotherapy.  I'm lucky in that I have almost no bad side effects to deal with, but it's still a long day.  Tomorrow should be fairly short by comparison. 
10:45: Postscript. In bed at the home of my friends Jim and Elena. Had a wonderful dinner, much beer and wine, and a great conversation with their daughter Tayrn. Greatly enjoying and appreciating their hospitality. Signing off for the day--thanks for coming along. (Now if I just had some intravenous Benadryl.)