Day +8: Absolute Zero

Yesterday Vicki's ANC went to zero. The mouth sores are very painful and today her tongue is so swollen she cannot eat or drink anything. They have started giving her dilaudid for the pain. Mercifully the dilaudid makes her sleep most of the time. She's not alert or energetic enough to check e-mail so if you've been corresponding you might not hear from her for a while.

They also started giving her nupagen injections over the last couple of days. These will stimulate her body to produce blood cells.

Day +7: Monday

Received the following update from V. this morning:
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Today is my 15th day in the hospital (for this visit) and I am starting to feel the chemo side effects stronger everyday. My mouth and throat are sore . I seem to have some bumps on my tongue that are painful. Nothing tastes good, I suspect that is the palifirmen coating my tongue and mouth.

I am still having diarrhea on a frequent basis although they are giving me an anti-diarrhea drug. I am going to try the BRAT diet (Banana, rice, applesauce and tea).

The nurses are all so good to me and make this place so much more pleasant. I am very fatigued. I did not wake up until 9 this AM usually I am up at 5 or 6. Even though I had a good night's sleep I am dreaming of turning off the light and taking a nap!

Day +6: Out of the Clink

Got the news, Vicki doesn't have a C. diff infection. This is excellent news. She gets to leave her room again - not that she gets to go far, but laps around the ward and trips into the family room and day room break up the monotony a bit.

Neutrophils are a type of white blood cell that helps fight infection. Vicki's ANC (absolute neutrophil count) is down to .24. That's zero, 0.24 cells per microliter of plasma. A patient is considered neutropenic at an ANC of 500 and a normal level is 1500+. Again, this is is completely normal for this therapy. It's a sign that her bone marrow has been completely destroyed which is what we want because it means the cancer cells are dead, Dead, DEAD!!!!

Day +6: Imprisoned

V. is imprisoned in her room. She's having bad diarrhea and they're keeping her isolated until they can determine the cause. Most importantly they have to rule out a nasty bug known as "c.diff". You can read more about it at the following link Vicki e-mailed to me: C. diff: A Hospital Germ on the Warpath - AARP Bulletin Today. Vicki thinks it is just a side effect from the chemo, but they can't give her any medication for it until they're sure. It's highly infectious so she has to stay in her room to protect the other patients.

Her blood counts are low enough that they've started giving her transfusions. Again, this is an expected and necessary development from the chemo killing off her bone marrow. We're entering the phase where she will be increasingly fatigued and vulnerable to infection, but so far so good!

Day +4: Did You Get the News? I'm Neutropenic!

One Step Closer to Home
Neutropenia; it's a bad thing, but also an expected result of Vicki's treatment. Her blood counts will need to completely bottom out to insure that the chemo completely killed the bone marrow and all the cancer cells with it.

This does mean that she is more vulnerable to infection and will be more fatigued, but that's why she's safe in the hospital where she can be supported until her body is able to grow healthy bone marrow from the transplant and then start producing healthy blood cells.

Christmas Was a Good Day

Vicki was feeling perky and well today, even well enough to have a goodly amount of her own lunch. It was cold in San Francisco, but clear and sunny, a beautiful day. We had music, nice things to drink and eat, presents, and a few good laughs.

We did skip one tradition, watching Bad Santa. I left the DVD with Vicki to watch later this evening, but only if she promises to wear headphones. Some of the dialogue is too rude to take the chance of somebody overhearing.

It was a pretty darn good Christmas after all.

Day +3: Christmas

That chemo is working hard, giving her a full body burning itch, a thick white coating on her tongue, and assorted other yuckiness, but our girl is working hard at keeping up her spirits.

The Hostess
She has planned a full day of celebrations for Jack and me. She's not doing much in the way of eating these days, but she ordered a big lunch from the hospital menu for us to share. She's planned a word game for us and informed me that she has an electric tea pot and a mini-fridge full of drinks for us as well.

Happy Holidays
I have everything I need and everything I want, save one; for our Dear Friend to be home, well, safe and snug in her own little nest. That will come soon enough. Until then, whatever your tradition or non-tradition, I wish for you what I wish for myself this Christmas day; peace, contentment, and hope.

Day +1: Tuesday

Day zero has passed. Vicki received five bags of stem cells yesterday. She's very tired, but she reports that she feels safe, well-cared for, and peaceful. She is expected to get a bit sicker, possibly more than a bit, from the effects of the chemo, but this is the healing phase. She's received all the anti-cancer treatment and "just" has to tough it out and stay infection free while her body heals itself.

Day -1: Sunday

Day -1
Vicki is doing surprisingly well with the chemo which is to say, she's sick as a dog instead of sick as a pack of dogs. She's had quite a bit of tummy trouble and blinding headaches, not getting much food down the hatch, but the medical team is giving her piles of meds to help with the side effects. She's graduated from vicodin to hillbilly heroin (oxycontin), but that's not doing much for the headache so the next step is dilaudid. The big D puts her into loopy land. After I got back from Hawaii she was on dilaudid when she was petting my arm and sighing, "You're so pretty."

Transplant Monday
Tomorrow is day Zero. The stem cells harvested last month will be transfused back into Vicki's body where they will populate her bone marrow with healthy, cancer free cells.

Today there was a visitor to the hospital, a woman who had her transplant three years ago at this time. She brought small gifts for all the patients. One was a coffee mug full of goodies and the other was the hope for recovery.

Psalms 30

When Vicki was at Mt. Diablo one of the nurses read the 30th Psalm with her. Vicki found great comfort and meaning in it and asks that we each read it in the spirit of support and unity.

Psalms 30

1. I will praise you, LORD! You saved me from the grave and kept my enemies from celebrating my death.
2. I prayed to you, LORD God, and you healed me,
3. saving me from death and the grave.
4. Your faithful people, LORD, will praise you with songs and honor your holy name.
5. Your anger lasts a little while, but your kindness lasts for a lifetime. At night we may cry, but when morning comes we will celebrate.
6. I was carefree and thought, "I'll never be shaken!"
7. You, LORD, were my friend, and you made me strong as a mighty mountain. But when you hid your face, I was crushed. I prayed to you, LORD, and in my prayer I said,
8. "What good will it do you if I am in the grave? Once I have turned to dust, how can I praise you or tell how loyal you are?
9. Have pity, LORD! Help!"
10. You have turned my sorrow into joyful dancing. No longer am I sad and wearing sackcloth.
11. I thank you from my heart, and I will never stop singing your praises, my LORD and my God.

Day -4: The Honeymoon is Over

Yesterday's beautiful clear skies are dark gray this afternoon and it looks like we're in for a storm tonight. It's apropos because the chemo has started to do it's wonderful/terrible work.

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Here's a message from Vicki which I am posting on her behalf.
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Last night I got really nauseous. I was given anti-nausea drugs and I got some sleep. This morning I forced myself to eat some yogurt and a boiled egg white. Big mistake. I was doing my laps around the floor when I waylaid by the need to throw up and I did right in the hall in front of the nurse's station. I got more meds and then I slept most of the day.

I did not eat lunch and doubt I can eat dinner. Can't wait until this is over and I am home sweet home!

Day -5 - A routine day

The SF Bay Area is having abnormally cold weather, probably nothing for most of you folks in other parts of the country, but we had a rare hard freeze last night and there's snow dusting the hills. Today the cold was accompanied by beautiful crystal clear skies. Vicki enjoyed the view from her room, watching the fishing boats said under the Golden Gate Bridge on their way out to sea.

She said she heard the prisoner go by or at least hear chains rattling. I asked if she was sure it wasn't the ghost of Bob Marley.

Here's picture of Vicki with her mini-quilt made of photographs from Sea Ranch.

Day -6

Vicki's transplant is scheduled for the 22nd. The transplant is considered day zero so the days leading up to it are -8, -7, etc. and the days after are +1, +2, and so on. Christmas will be day +3. Vicki is looking forward to watching Bad Santa on Christmas Day. She says she's in a private room so there should be no complaints unless we snort too loudly, but I want to remind her of some of the infamous lines from the movie - remember the three B's? Booze, broads, and something I can't post on the blog? We're going to have to keep the volume turned down or else I'm going to have to get the edited version.

There is a prisoner on the floor there are 2 or 3 California Dept of Corrections guards on duty at all times. Vicki asked Jack to bring up his Red Ryder BB gun just in case a shoot out develops! She didn't mention whether she expected Jack to stand guard duty outside her room or if she wanted the gun for her own use. Those nurses and doctors had better watch out.

On the previous hospitalizations she needed to wear the hospital gowns for access to the port in her arm. With the line her her neck she can wear her own jammies and t-shirts and things and says this makes her much more comfortable, although she complains that the bath towels are the size of a paper towel with less absorption. What does she think this is, the MGM Grand? I didn't notice that she minded the hospital gowns that much anyway, what with their air conditioned backs and her penchant for unrepentant flashing.

She has the same attending physician as last time and likes him a great deal too.

All in all, things are moving along as expected.

(ad)Mission Accomplished

UCSF Round 1
The first trip to UCSF was to get a infusion of palifermin to protect against mouth sores from the coming chemo.

After the infusion V&J called the main hospital to see if V's room was ready, which it was not. The hospital said the room would not be ready until 3PM. Since it was only 10AM and pouring rain on our coldest day so far this winter, the McF's decided to go home.

It's a good think they did because they later called from home and the hospital told them it would be 5PM then 8PM. When they arrived at the hospital at 8PM the room was still not ready. This is worse than checking in at the MGM Grand in Las Vegas and they don't even have Wheel of Fortune or cocktails.

UCSF Trip 2 - The Human Pin Cushion
After getting the dreaded catheter in her neck, they still needed another line to check out V's busulfan level so she got poked 4 times in my arm and once in each foot (OUCH) before they brought a nurse from ER who got me on the first try in her arm.

Monday Morning - Staring the Honeymoon
This morning they started the busulfan which V. will get 4 times a day for 4 days. The nurse Vicki calls St Agnes (had her several times last visit) says the first part of my stay will be a honeymoon period. Vicki says, "I sure hope she is right. But we know what comes after the honeymoon OH NO!" After the busulfan she'll get the stem cell transplant and the real fun will start.

More Head Dents
Vicki adds "I have already bumped my head on the bleeping TV! And a nurse was in the room but I talked her out of any further action!" Last time Vicki whacked her head on Ivy and they had to do a head CT. The tiny television hangs down over the bed on a movable arm so there are numerous head denting opportunities.

All Systems are Go

Vicki is recovered enough from her cold and bronchitis that she'll start the next phase of her treatment on schedule this Friday. She gets the neck catheter and starts her injections in preparation for admission on Sunday and starting the Big Chemo.

A Nasty Cold and Preparing for the Next Round

You'd think that a person with cancer would get a pass on ordinary stuff, but Vicki came down with a cold around Thanksgiving. She was very careful about going out and about, but it's everywhere at this time of year so short of staying hermetically sealed in a bubble it's pretty hard to avoid. It progressed into a case of bronchitis so the docs got her going on antibiotics and she's starting to feel better.

Chemo goes after all the fast growing cells in the body. While that's good for killing cancer, it does a number on fast growing healthy tissues such as hair, skin, and mucus membranes. Late this week Vicki will start a series of injections which will help build up the mucus membranes in her mouth, nose, and throat. The purpose is to limit the extent of the sores that are expected during this next intense chemo.

This week Vicki learned that she'll need another catheter in her neck, similar to the one she needed during the stem cell harvest. This was upsetting news because the previous one was painful, but the transplant coordinator assured her that this one will be better. This is necessary because the catheter in the neck provides more access to larger vessels making it possible for her to receive fluids, transfusions, medications, and intravenous feedings all at once.

Bone Marrow Monday

Patient Consent, page 2 of 7: "After a four to six week rest period at home I will again be evaluated to make sure I am still in complete remission adn to make sure that my internal organs (heart, liver, kidney and lungs) are in satisfactory condition to proceed with further intensive treament."

Vicki had another bone marrow biopsy yesterday, one of the first steps in preparing to return for the second phase of treatment. She said that this one wasn't as bad as the previous two. I suppose it's all relative as the previous two were at the northwest corner of Hideous and Excruciating.