Friday, May 14, 2010

Stem Cell Harvest Day

Today was going to be a long day... and it delivered! Long and FRUSTRATING! It was her apheresis (stem cell harvest) day. For more about that see April 29th posting called “Our Medical Plan.”

We have been pushing Charlotte’s blood counts with a drug called GCSF, after the “mean” chemo drugs were over she starts this to try and boost her system. They monitor her counts trying to get them up to a certain level by a certain day so that they can do a stem cell harvest. Her counts will make a peak and valley kind of chart and we need to time her big “peak” with the harvest day, to make it more fun they only like to harvest three days of the week. The higher her counts the better (and quicker) her harvest will go. So we pushed her GCSF dose up to double this week to try and get her ready in time. Yesterday she was quite low so she had a blood transfusion to give her a boost.

The apheresis procedure depletes platelets so she was given a transfusion of that... unfortunately the blood transfusion took so long that we didn’t get started with the platelets until 9pm! Part way through she had a mild reaction. Poor Charlotte, things have not been going her way. She got really cold and shivery, and they could not get a normal blood pressure reading, everything was unbelievably low... too low even for how she was doing so they were obviously inaccurate. They stopped everything and tried to get her to go to bed, poor rob got stuck with another rough night. (We have been alternating who sleeps at the hospital.) She needed the oxygen on some of the night, a horrible wheezing machine. I don’t think either of them got much sleep.

At 6am the nurse snuck in to get some blood work to send into the lab to check that her counts were high enough to start her “harvest” today. At 8am when the nurse technician was getting ready to go we got a call that the lab did not get enough blood, they would have to re-send samples down to check before we could start. The technician huffed a bit at that, she had come from another hospital, and anticipated it to be a long enough day without these delays I think. She got the machine set up, was very patient with us and answered all of Robs questions, miles of tubes were primed with donor blood. An adult would have enough blood to fill the machine while it filters it and pumps it back in, but Charlotte’s body would be drained too much. Charlotte had an extra IV line put in her arm to administer any drugs during this whole procedure since her main lines would be tied up. For once the nurses got an IV in on their first try! Once her second blood work came back with her counts the technician pulled out her calculator and told us it should take about 5 hours once she is up and running on the machine. I think it was around 11 by the time everything was running and it was actually harvesting her stem cells.

Charlotte was much too alert and wiggly during the first few minutes so she was given some Adavan to help her calm down. We were told that the dose she was given should hold her calm for about 4 hours, she fell asleep for a bit and when she woke up boy was she loopy! It wore off in under two hours and she started wiggling again, this kicked off the machine. So they gave her another dose. But by the time she was groggy, we could not get the machine to draw her blood again! After much flushing of her lines and nurses trying to pull blood, doctors were called and more staff... I think we had 6 or 7 medical staff in the room, and we had to call it quits. This left us all frustrated and deflated, except for Charlotte who was now as high as a kite and giggling to herself. She was a great laugh, she started a game of peek-a-boo around the door, with a big “HI” and waving away each time she peeked, but no one was there. Then her head would flop back over her shoulder to see us and she would have a big smile, then her eyes would focus on something invisible to the rest of us and she would track it around the room saying “hi, hi, hi.” It was much needed comic relief. By the time the drugs wore off she had an amazing appetite and ate more than she has for the last three days combined, that was a plus!

So now we are hoping that her counts will still be high enough to do this all again on Monday. This time we will be in ICU, she will likely have full anaesthetic, and a femoral (groin) line will have to be put in, another platelet transfusion will likely be needed right before, and of course more blood needed to prime the system. We basically start all over. The cells that they did harvest will be kept and used, hopefully that will make Mondays harvest quicker... but that is my thoughts and not anything that the doctor said.

We did a chest x-ray to see if there was something funny with her line. They found a little blood clot in her line, which has since been hit with a “clot buster” drug. Hopefully it will still be clear in the morning.

But it is long past bedtime and since it is my turn here at the hospital I better get some sleep in while I can!

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