(7/8/08)
Hmmm. . . well I've been delayed again due to low white cell counts. Yesterday was a fun rigamaroll that had me marching around the cancer center trying to figure out some hospital craziness.
I showed up with my mom at about 9am to get my blood drawn. (Before each appointment I need to get my blood drawn so the doctor can see if my counts are high enough for me to be treated.) A simple thing, right? Not so much. First I went to the blood draw lab, but they didn't have my lab form. I usually get the form after my previous appointment, but I didn't have it this time for some reason. So, I went upstairs to the Infusion Treatment Area (ITA), where they do blood draws and outpatient infusions for people with central lines (either a PICC or a port like I have now). In my mind, since I had the port, I thought it'd be easier to get my blood drawn the old fashioned way (but you have to do this at the lab downstairs). So, instead of telling them I had a port, I told them I didn't have a PICC anymore and I wanted to get the lab form to go downstairs to the normal blood draw lab. I waited for a couple minutes and they told me they didn't have the lab form and to go downstairs to the clinic to get it.
So of course I did that, and another fun surprise awaited: there were no lab instructions because my insurance was listed as terminated as of June 23. What the frak? (BSG reference, anyone?) I got on the phone with the insurance company, and they said there was probably a glitch because Stanford didn't put me on the list of students continuing on for the summer, even though the university had already billed me for summer tuition and insurance. Luckily that was easy enough to fix, but it would take a couple days to get it in the system. Meanwhile, we had to wait around while the receptionist (who is exceedingly nice) called around to try and figure out how to deal with the situation. Finally she said I could just go upstairs to the ITA and they could do the blood draw.
Back up the stairs we went, but there were still problems. There was still nothing in the system. Somehow, though, once I told the guy behind the desk that I did indeed have a port, he said I could just wait there and they would get me in. By this time I had missed my 10am appointment, but since the clinic knew things had gotten a little mixed up, I was still able to see the doctor (they're used to this kind of thing I guess). I got my blood drawn, finally, through my port, and went back downstairs to wait to see the doctor.
We ended up waiting for a while in the examination room, and when the doctor came in the full blood results still weren't ready. Of course, when they were finally ready it turned out I couldn't be treated (absolute neutrophils were at 1.3, and they need to be at 1.5 to be treated). Also, my red cell counts were low, so I needed to show up the next day (today) to get a blood transfusion. This was not a huge surprise, since I've been feeling pretty tired the past couple of weeks. It was about 2pm by the time we got out, a good five hours after arriving.
Today was not a whole lot different. We showed up at the ITA at 8am, and first the nurse had trouble finding my orders. Then, it turned out they had to do a blood type check (i.e. draw more blood), and this would take up to (actually more than) two hours. So we went downstairs to the lobby area, where there are some nice cushy chairs, and I basically took a nap for two hours. Finally at about noon, the nurse called me back, and the blood came and we got started at about 12:30. I'm just finishing the first of two bags now, so two more hours and I'm outta here, probably at about 4:30 or 5pm. . . ah, a full day's work. If anyone was wondering how appointments could end up taking such a long time, wonder no more!
Showing posts with label transfusion. Show all posts
Showing posts with label transfusion. Show all posts
Tuesday, July 08, 2008
Monday, February 25, 2008
Like Blood for Chemo
No counts, no glory (2/25/08)
Well, despite having a stellar week in terms of perceived energy, my counts were too low today to go in for chemo. Actually, my red blood cells were so low that I'm anemic and am sitting in the hospital right now getting a blood transfusion. It's not as bad as it sounds - I actually feel fine, despite multiple people having told me that I look pale today. Apparently your counts don't have much to do with how you feel when you're "young" like me.
They're going to give me three units total (I'll probably have to come back tomorrow to finish up) - one unit is about the amount you give when you donate blood. Incidentally, it's also the amount they needed to give me when I had my prostate surgery, though I think that was just the plasma/platelets. The blood they're giving me has been irradiated so that the white blood cells have been killed off. Apparently this is important in case I ever need a bone marrow transplant, as you don't want to have been exposed to anyone else's white blood cells. It's a pretty unlikely scenario, but it's good that they take the precaution.
So why the super low counts? Apparently another hidden symptom of radiation is that it blasts your bone marrow, and in adults the marrow in the pelvis and the sternum produce most of your red blood cells (RBCs). So when you blast the pelvis you really reduce the ability of that bone marrow to produce RBCs. The bone marrow in our adult limbs is all fatty and doesn't really produce RBCs anymore. Supposedly this is why kids are able to take on more radiation/chemotherapy than adults - the marrow in all their extremity bones is still active and working hard, while ours is old, fat, and lazy. Of course, I don't really feel like an adult, but apparently no one told my bone marrow that.
In any case, I'm told that I'll feel really good when I get through all this blood, so I guess that's a plus. It's always a bit of a mixed blessing to have to delay a week - you want to keep the treatment going but you also want to have some more time to feel good. This time around, another positive about delaying a week is that it'll give things a little more time to heal, which will allow us to actually go back to the other set of drugs for chemo. As my doctor puts it, normally this regimen alternates sets of drugs, so you get a "left punch, right punch, left punch..." but so far we've had to do left, left, right, right, because of the radiation therapy (can't give the left set during radiation). By giving things another week, we'll hopefully be able to alternate back to the other set this time instead of giving it a third right punch. Supposedly it doesn't make too much of a difference, but I guess you want to make sure the heavy left is getting its turn. (For those of you keeping track, the aforementioned right punch is Etoposide/Ifosfamide, and the left punch is Vincristine/Adriamycin/Cyclophosphamide. It's really the Adriamycin, also called Doxorubicin, that makes it a heavy left. It's so heavy in fact that it can cause "radiation recall", in which it actually brings back some of the skin symptoms from radiation. I'm not sure how it does that, but I'm hoping I won't have to find out. Stay tuned...)
Well, despite having a stellar week in terms of perceived energy, my counts were too low today to go in for chemo. Actually, my red blood cells were so low that I'm anemic and am sitting in the hospital right now getting a blood transfusion. It's not as bad as it sounds - I actually feel fine, despite multiple people having told me that I look pale today. Apparently your counts don't have much to do with how you feel when you're "young" like me.
They're going to give me three units total (I'll probably have to come back tomorrow to finish up) - one unit is about the amount you give when you donate blood. Incidentally, it's also the amount they needed to give me when I had my prostate surgery, though I think that was just the plasma/platelets. The blood they're giving me has been irradiated so that the white blood cells have been killed off. Apparently this is important in case I ever need a bone marrow transplant, as you don't want to have been exposed to anyone else's white blood cells. It's a pretty unlikely scenario, but it's good that they take the precaution.
So why the super low counts? Apparently another hidden symptom of radiation is that it blasts your bone marrow, and in adults the marrow in the pelvis and the sternum produce most of your red blood cells (RBCs). So when you blast the pelvis you really reduce the ability of that bone marrow to produce RBCs. The bone marrow in our adult limbs is all fatty and doesn't really produce RBCs anymore. Supposedly this is why kids are able to take on more radiation/chemotherapy than adults - the marrow in all their extremity bones is still active and working hard, while ours is old, fat, and lazy. Of course, I don't really feel like an adult, but apparently no one told my bone marrow that.
In any case, I'm told that I'll feel really good when I get through all this blood, so I guess that's a plus. It's always a bit of a mixed blessing to have to delay a week - you want to keep the treatment going but you also want to have some more time to feel good. This time around, another positive about delaying a week is that it'll give things a little more time to heal, which will allow us to actually go back to the other set of drugs for chemo. As my doctor puts it, normally this regimen alternates sets of drugs, so you get a "left punch, right punch, left punch..." but so far we've had to do left, left, right, right, because of the radiation therapy (can't give the left set during radiation). By giving things another week, we'll hopefully be able to alternate back to the other set this time instead of giving it a third right punch. Supposedly it doesn't make too much of a difference, but I guess you want to make sure the heavy left is getting its turn. (For those of you keeping track, the aforementioned right punch is Etoposide/Ifosfamide, and the left punch is Vincristine/Adriamycin/Cyclophosphamide. It's really the Adriamycin, also called Doxorubicin, that makes it a heavy left. It's so heavy in fact that it can cause "radiation recall", in which it actually brings back some of the skin symptoms from radiation. I'm not sure how it does that, but I'm hoping I won't have to find out. Stay tuned...)
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