Thursday, September 6, 2012

Day 82 - good news, VAD in, dinner had

Today had two pieces of excitement: my bone marrow results came back a day early and I got my VAD. Dr. Hill called me to tell me they were normal just as the nurse was calling me in to pre-anesthesia for my VAD. I did get to talk with him a little bit, but mostly just had to go so I could do my pre-op stuff, i.e., hurry up and wait.

Dr. Hill said the flow cytometry came back normal and the microscope view came back normal except there weren't as many cells as they might expect so something is surpressing my bone marrow, probably the stupid virus. There was NO, not even a speck, of evidence for leukemia resurgence. So, excellent, excellent news. Phew! I am going back to plan A of consolidation #2 on September 14.

I will be getting this consolidation chemo through my brand new port that Dr. Mahon put in today. This was my first time at CMC as a patient and it was as wonderful an experience as I expected. Of course, I knew almost everyone who worked on me today, even in the OR because many of the nurses had worked on the floors before the OR. I saw several of my doctor friends, including Dr. Fahmy. He asked me if I were no longer in practice and I told him I had leukemia which he had not known. CMC clearly takes patient confidentiality very seriously, as he is one of the VP's at CMC and didn't even know why I had evaporated. Impressive. It was delightful to see all my old pals and to feel really well loved, supported and cared for by the people taking care of me.

Dr. Mahon said that Dr. Hill seemed surprised that he just said, "OK, we'll put the VAD in tomorrow." Dr. Mahon and really all the CMC surgeons have such a nice "can-do" attitude. One never feels like they are looking for an excuse to not do something; they answer yes instinctively. Speaking here as a doctor not a patient, it is so wonderful and makes life so much nicer.

Let me tell you about the day. I got there at 2:30 as instructed, hungry and thirsty. They had me put on a gown and wait in the bed. Dr. Mahon had some sort of other case in specials that was taking a longer time than expected and the nurse kept telling me it was a "zoo" today. This is probably about the best one can do. I don't really want to know just before the surgeon takes me to the OR that there were unexpected complications in the previous case. "Oh, he was caught by surprise by that bleeder and, you know, coding a patient takes a lot longer than you might think." Or "he didn't plan the previous case before you all that well and there were several complications that we weren't prepared for."

Anyway, the OR nurse came and interviewed me and was one of my old E200 friends and it turned out also knew Eva who had stopped by to say hi. Then we waited a long time and started to worried that by the time I went to the OR, had my procedure and recovered that poor Ellie would have been alone a long time. So, we enlisted my back up driver, Ana, and Terry went home to Ellie. Soon after he left, Dr. Mahon came in, examined and interviewed me and then the anesthesiologist who was one of the few I hadn't met. He had, however, been at a talk I gave a few months ago about palliative care so that was nice. He told me he thought it was a good talk. He was really interested in how I had gotten my diagnosis, how treatment was going, etc. and we had a very nice chat. I warned him that I was a lightweight for benzo's and he gave me one milligram of versed and I started to tell him the story of how I went to the cancer committee the day I had my suspicious CBC and how the next day everyone kept saying, "did you know you had AML when I saw you yesterday morning?" but I didn't get more than two sentences out. Next time I see him, I'll have to finish the story.

The next thing I knew, port in place, I was back in pre/post. I think I dozed off one more time, then woke ready to eat toast and drink cranberry juice. I dressed, Ana came in and off we went. Home to Terry, Ellie and delicious pizza.

I couldn't figure out exactly where in my day to put this jewel, so the end is as good as anyplace: here's a tip for budding nurses and doctors: "I feel for you, but the people I really feel sorry for are the ones who have to go without drinking for twelve hours" is maybe not the most sympathetic thing to say. A better option might be: "I feel for you; let me see if anesthesia will let you have ice chips." Try it out; it only hurts a little.

Other than that one nurse who I think was trying to be sympathetic, but was just slightly to the side of sympathetic, everyone, absolutely everyone, even the woman who was moving the extra beds around was kind, sympathetic, supportive, even loving. Totally blown away by the great care.

For you, I wish you an experience so much better than you were expecting that you are blown away, too. For me, I'll go with not too much pain and swelling from my new VAD.

Alternatively, I could wish you good news too and for me, I have no further wishes along those lines since I got my good news today.

Wanna see my port? I put it after the jump so you can avoid it if you want to.


Day 82 - Dr Mahon and the VAD call

I am not sure if I'll be energetic enough to update tonight after getting my VAD, but will try. "Posting may be sparse," as they say, while I wear off my anesthesia. So if there is nothing more tonight, it just means I'm sleeping well (again. Last night I slept 10 hours and woke 10 minutes before my alarm--love it!).

I did want to tell you about how my VAD got arranged because it's a pretty good story. First I should tell you what a VAD is, huh? A Venous Access Device is a little implantable device that attaches to a blood vessel on one side and pokes up just under the skin on the other side. Nurses who know how to do the magic with special needles and then access a big vein directly without having to poke me five or six times or to dig around. It is put in under a little bit of anesthesia in the operating room and when it's done and healed will look like some one has left a stack of three nickels under my skin near my clavicle. When I get chemo and blood products, the nurses can just use that instead of giving me an IV (that may or may not last/work very well) every time.

Initially, Dr. Hill, Terry and I decided that I would just get my VAD in Lebanon before my chemo next Friday. Then, when the question of if I'd need chemo early came up (see yesterday's post), we decided to try to get it sooner. Dr. Hill called his usual go-to person who said they were having a bad week and he would do it if it were a real emergency, but otherwise, really couldn't. Dr. Hill knows this guy well enough that he knew what that really meant so we decided I would get it in Manchester. Trouble is, Dr. Hill does not know anyone in Manchester and Dr. Manno was out Tues and Wed this week. It seemed the easiest and most straightforward way was for me to arrange it.

My first thought was that I would call one of the physician assistants for the surgical group in Manchester and ask her to arrange it. Unfortunately, it was her day off. I called one of the surgeons and he also did not answer. I should mention that I am doing all of this while lying on my stomach with the top half of my butt exposed because I am being prepped for a bone marrow biopsy. Finally, I developed a molecule of common sense and called their office and asked for the doctor on call. I felt a little bad about bypassing the normal channels (I try really hard just to be a regular patient), but if the situation were reversed, I would want the doctor who was also a patient to just call me so I decided it was OK to "press one if this is a doctor's office" after some soul searching.) The connection was horrible and I didn't recognize Dr. Mahon's voice at first and half of what he said and I said was lost in static so finally after saying "who is this?" about six times, we figured out the basic players in the conversation.

Next, I had to ask under the same circumstances (while not moving because my backside is now a sterile area) if he could place a VAD. At first he thought I wanted a Hickman (which is sort of like a super-PICC and has a bunch of tubes outside my body--not what I wanted) and I had to try desperately to remember the name for the kind of device I wanted (I failed--still don't know it). All the while, every other sentence in each direction is being lost to static and I am wondering when the first shot of lidocaine into my upper butt/lower back is going to occur. I am imagining trying to speak a coherent sentence without changing my tone of voice while Beth injects.

Dr. Mahon sensibly asked for the name of my doctor and called Dr Hill and not more than ten minutes later, Dr Mahon's nurse called me (I'm still lying on my stomach with a half bared butt, but now there is a big needle sticking out of it) to tell me that I should expect a call from CMC scheduling and that they'd do it tomorrow (now today).

I'm ready! I have not eaten since midnight nor drunk since ten so I am thinking the pillow I just finished would be tasty with a little dijon mustard. I am supposed to be there at 2:30, expecting to get surgery at 3:30 and home for dinner by 5:30, blogging by 8:30 if all goes according to plan. If not, I'll try not to wake the neighbors with my snoring.

Hoping for a solid eight hours for all of us (except those who are supposed to be up all night--I wish you your eight hours when you want them).

Wednesday, September 5, 2012

Day 81 - another bone marrow biopsy

Just to let you know I am bone tired tonight and so this will be very short. I did get the thread last night and finished one of the two ends of the pillow this morning. I am so pleased with it. I won't put a picture up until Tommie sees it this weekend because I want her to see it in person before she sees the picture.

Terry and I went up to Lebanon and got my labs which were just about the same as yesterdays--no worse, but no better. Dr. Hill said that he was pretty sure that this was just due to the virus, but that there was a little chance it was due to leukemia relapse and (of course) that is the kind of thing that is best caught and caught early so we should just do the bone marrow biopsy and then we would know. I tried to talk him into putting it off until Friday, but he pointed out that then if I had relapsed we would have lost several days, maybe even more than two because of the intervening weekend. OK, fine.

Beth, the nurse practitioner did it and I told her I'd give her an A+. There was nothing that was painful about it and she confirmed that it's all in the speed of inserting and removing things from the bone marrow space. There were a couple of times when I said to myself, "that could become pain," but it didn't. Her assistant and I prattled on and on about the best restaurants in the SeaCoast and she told me about a great chocolate and bakery shop near Lebanon. I am hopeful that my love of sweets will return and I can visit there in earnest in a few months.

I would like to write more about bone marrow biopsies and pain, but that is not happening tonight.

Also, just in case I need chemo this weekend (I won't; I won't; I won't; the leukemia is not back!), I need a port placed. The nurses who put in the PICC lines said (very nicely) that they do not want to see me again because my anatomy is too weird. The surgeons in Lebanon said they would be happy to put an access device into me next week, but unless it is an emergency, they can't do it this week. So, I called Dr. Mahon and didn't even have to beg. I am sure it was one of the odder phone calls he has gotten from a patient asking him to put in their own device, but he was very gracious and I am getting my VAD tomorrow afternoon.

I hope you are able to get help getting what you need without having to beg. Thank you, Dr. Mahon.

Tuesday, September 4, 2012

Day 80 - I'd rather have a normal day, thanks.

So, today I had a set of labs done at the NCCC in Manch. Dr. Manno had wanted to follow my platelets and hemoglobin to normal. The labs were a little surprising today; we were not able to follow my hemoglobin or platelets to normal today. Or, more worrisome, even my white cells. My hemoglobin had improved to 10.5, but my ANC had worsened to 1230 and my platelets were still low at 104. My liver and kidneys remained normal. This far out from chemo every time we check my labs they should look more and more normal until the next consolidation and these labs looked less like normal in two of the three cell types. To me this looked like a catastrophe. (Remember I'm good at jumping to the very worst possibility.) I was sure the leukemia was back with a dozen of its biggest and meanest cousins and I was worried. OK, I was more than worried and sure I was heading toward a transplant and all sorts of bad stuff. Maybe I should stop reading the primary literature on AML.

I called Dr. Hill's office and left a message with the secretary. I waited a whole hour and then half an hour more and then I couldn't take it any longer so I called and spoke with Dr. Hill's nurse, Elise. I have spoken before with Elise and she has always been extremely helpful. I think she was impressed by how anxious I was about this and told me that she would be sure that Dr. Hill saw my labs but he would probably be unable to call me back until 4:30. (Note number one, be sure the person taking the message understands the urgency to me of the message. Note number two, it really really does make a difference if you give people a time to expect an answer.) Dr. Hill did call me back at about 5:30 and pointed out that I had had a bad cold last week and that that was probably what caused the drop in my counts. O, yes, that. Remember those quaint old days when I would have some symptom and say to myself, "Something could be wrong with me or I could just be overworking; I'm sure it's overwork."? Now, almost any symptom can and will be attributed to the return of the leukemia. Dr. Hill further told me that he could not promise me that it wasn't badness causing my labs to be weird, but that it was much more common to be due to a cold. In fact, he had seen suppression of cells due to virusses a lot in the past and had seen it due to leukemia relapse much much less frequently.

He also pointed out that my hemoglobin was improving which is not what we would expect if it was the leukemia causing the drop in white cells (if the leukemia was back, one would expect it to make all the cells decrease) and he reminded me that my leukemia has been very well behaved so far and recurring so early and during active treatment would not be consistent with what we have seen of it so far. OK, deep breath.

I was reminded (and I told him) about how a big piece of what doctors do is holds patient worries for them.  I cannot tell you how much better I felt after talking with him. Now when I have doctor/patient events like this, I try to remember to turn it around and think about being a doctor myself. I can recall having conversation when my patients either said they felt or clearly felt tremendous relief and am amazed that I can do that for someone, too.

The plan is to go to Lebanon tomorrow and re-do the labs there. Then I will see Dr. Hill, we'll look at the results (he'll probably ask the pathologist to look at the smear too) and decide if it looks reassuring or potentially bad. If it looks potentially bad, we'll do a bone marrow biopsy right then. If not, we'll drive home and I will not get another hole in my iliac crest.

I can't remember if I've mentioned that after the whole leukemia treatment thing is done and a couple years behind me, that I have wondered if I would use my bone marrow biopsy scars as the basis for a tattoo. Not quite sure, but maybe and, if so, I have some starts of ideas. The funny thing is I'm not quite sure how many scars I'll end up with so how exactly can I design around that?

So, today was filled with a lot of worry, but I was able to soothe myself pretty effectively with weaving. I am making a pillow for Tommie's office and yikes! it just flew this afternoon although I did seem to do a lot of unweaving and re-weaving. I am really pleased with it so far and cut it off the loom less than an hour ago. I went to finish it and d'oh! I have not a single spool of thread in the house. Not a one! Not even a bobbin that I can pretend is a spool of thread. I am thinking of running up to Walgreen's right now so that I can finish the pillow tomorrow morning before we have to leave for Lebanon. Can you tell I'm excited about it?

Other than worrying and weaving today, I didn't do a whole lot although Ellie and I made a trip downtown after school. She got her usual sandwich from The Green Bean and I got some really delicious fish chowder from Loaf and Ladle. I was disappointed it was not clam chowder before I took my first bite, but that didn't last long. She was not disappointed by her sandwich from The Green Bean. It has three ingredients and always tastes exactly the same.

So, today's news is not the best news I've ever given in these pages, but I'd like to encourage you to think it's going to turn out to be viral. I am really no longer anxious about it and wish that you won't be either. I'll let you know tomorrow if my labs were reassuring or worrisome (or most maddening, in the middle) and if I am the proud owner of a fourth hole in my back or not after we get back from Lebanon which will likely be five-ish.

I know you will be praying and thinking and hoping for me and I appreciate that. Thank you.

For all of us, good news and a surprisingly good bowl of chowder.

Monday, September 3, 2012

Day 79 - another normal day, wracking them up!

Again, today has no exciting activities. I walked with the dog and then with Terry, around four miles all told and wove, sudoku'ed and ate falafel. A well spent and utterly normal day. Maggie was not limping after today's walk. I took her on a shorter than usual walk just to be on the safe side and that or the day off or random chance seems to have helped her.

It's back to school for Ellie tomorrow and back to the NCCC for me. I am really hoping for an uneventful visit with normal labs. Hopefully everyone's back to work and school day will be uneventful--unless you want excitement, then I hope you get it!

Here is a picture of me from 2007. It is the oldest picture of me I can find on my computer.
I think I had just gotten the necklace as a Christmas present. I am not sure why my hair is so desperately in need of a haircut. This must have been about the time I started growing it out and perhaps I hadn't learned about barrettes yet. I thought since the rest of this post is so dreadfully unexciting that I would try to liven it up a bit.

Sunday, September 2, 2012

Day 78 - Eva and my sudoku addiction

Last week I found out that there were going to be a whole bunch of hard sudoku puzzles released today  for the purpose of people trying out for the U.S. sudoku team. Actually they were released yesterday which means that I didn't get to try out for the team (which is OK because I don't want to go to Croatia Oct. 1-4 as I have recovery from consolidation to do--not that I would have made it anyway, but a gal can pretend). But...the puzzles are still available. If you want to download the puzzles, you have to make yourself a login. I don't know if you will get a bunch of mail from the puzzle association or not. I haven't gotten any yet, but I registered just today.

Ahem, not that I'd notice for sure, because once I got my hot little hands on those puzzles, I stopped long enough to do about the minimum possible. I had a really nice visit with Eva, made dinner for Ellie and hung out a bit with her and Terry and ate my own dinner (delicious falafel from Eva--thank you!). Not much else. I am not sure I checked my email, went to the bathroom, took the dog out, etc. Sudoku is a tremendously guilty pleasure for me because I could easily become one of those people who sits in front of their computer for 23 out of 24 hours a day and I recognize that as a bad outcome. It is incredible to me how I am really quite disciplined in general, but have no ability to withstand the charm of those little empty boxes.

Back when I was working, I used to try to limit myself to one puzzle a day, but honestly I just couldn't do it. I really had to stop altogether or I'd find myself up at 0300 doing "just one more puzzle." I'm sure I could have stopped any time I wanted. Actually, I'm not sure that I could have and it really just worked out best if I didn't do any. Now that I have more time during the day, I have been limiting myself to the three in the NYT and have actually been thinking that they are pretty easy and not that much fun to do. Then, this huge collection of first rate puzzles comes along. Fortunately, it is very limited so I will waste two or three or four days on it and then emerge bleary eyed with sore hands and poor personal hygiene and then return to the world of the respectable. This is incredibly pathetic, but absolutely true. I hope you do not think too much worse of me for it.

I also did the tiniest bit of weaving today and decided not to walk the dog because the last two times I walked her she ended up limping later in the day (ok, it is also self-serving because sudoku). We'll try again tomorrow. I did walk myself a little bit with Eva (the usual 1.8 miles to the end of Swazey parkway and home).

I continue to feel great and hope you do, too. I wish you a happy Labor Day; hope you have a three day weekend and that you feel appreciated for all your labor. For those of you who are in unions, especially if you are working to make your workplace or the world better, thank you. A final plug: if you are at all a sudoku fan, do check out the puzzles; some of them are really first rate.

Saturday, September 1, 2012

Day 77 - totally normal normalcy

I continue without medical news. Dog walking (she stopped limping and then started up again after the walk), weaving (was able to get by without more heddles, just barely), going to Kittery with Terry to visit the Beach Pea and his studio complete with a new kiln (our usual Saturday morning activity) and a walk with Terry and Ellie in the evening. Also, the usual sudoku and NYT crossword (couldn't do it without googling).

I feel great. My taste is still goofed up; I really liked the idea of a chocolate croissant from the Beach Pea and was thinking my taste buds were returning to normal while I crunched through the tiny chocolate drizzle, but when I got to the chocolate in the inside, it just didn't taste right. It's so funny because my brain says, "Yes!" over and over although more dimly than it used to and then, the reality disappoints. Last night, I saw a really delicious looking desert go by and overheard the people eating it gushing over how good it was. I said to myself, "I think I'll get one of those" and then realized a second after that it would in all likelihood taste like saccharin. I was also able yesterday to jog a little bit (I do mean "little," my distance was measured in steps, 120-140, three times, but still). All of my punctures are healed with quite colorful scars, but they're all completely closed. I think I am firmly into normalcy at this point and I get to have fourteen days of it!

Continued normalcy for me, and if you like your normalcy, lots of it for you, too. If you are ready for something abnormal, I hope you get the best kind of it.