Blood and Nesting

Blood Numbers

Platelets Today:  It has been one week now since the last round of Pam's outpatient chemo ended and, just like clock work, her blood counts are all coming down.  Her platelets are getting dangerously low, so she will be getting a unit of platelets today.

You might remember that platelets are the critical portion of your blood cells that enable clotting, so not having platelets is dangerous because even small cuts or internal injuries can cause serious bleeding problems.  Pam is getting small petechiae (peh-TEE-key-ay) on her legs and arms now, which is another sign that her platelets are too low. Here is an article on low platelets that shows a picture of petechiae.  (Feel free to throw around the word petechiae at your next cocktail party... for example, "That painting is only a pastiche of petechiae on a fair skinned irish boy.")

Pam's son, Nate, is up for a visit from Eugene, so I have asked him to take his Mom up to get her platelets.  It will be a good chance for them to catch up.

Red Blood Next: Of course, Pam is also getting anemic again and will require a couple of units of red blood very soon, probably Monday or Tuesday this week.

White Blood:  The number that we look at closely is called the ANC, or Active Neutrophil Count.  This is a count of the normal white blood cells that are actually doing their job fighting germs.  Pam's abnormal leukemic white blood cells are nothing but big useless blobs.  An ANC below 1.5 is abnormal.  Pam is at .9 right now and when her ANC gets below .5 she is considered neutropenic and we have to be VERY careful to try to keep her from getting an infection and being put back in the hospital. Ultimately, she will get to the point that her ANC is undetectable, and she will begin to build her white count back up. But she has to do it on her own.

Nesting

Pam went into a full fledged nesting routine yesterday.  She is, understandably, getting anxious about the stem cell transplant and the 100 day critical period following discharge from the hospital.  There are all kinds of things that we need to have ready for her return home, including lots of disposable stuff like paper towels, paper plates, disposable disinfectant wipes, etc. The instructor at the transplant class said "You can save the trees later." I keep telling her that I will have plenty of time to get this stuff together while she is in the hospital, but:

1. She knows I will put it off until the last day or so before she is discharged;
2. She has a justified lack of confidence in my decision making when it comes to purchasing even simplest household stuff.
3. She enjoys shopping anyway.

She even has to throw out all of her makeup, lotions, potions, and other female necessities and get new stuff to use when she gets out.  We also need, believe it or not, a dedicated storage cabinet just for her medications and medical supplies and the storage cabinet is not supposed to be in the bathroom or the kitchen. The AVERAGE number of prescription medications after transplant is 20, so she will get one of those super-jumbo pill boxes when she is discharged.

Transfer of Care

Dr. Weinstein, Pam's primary oncologist who has been taking care of her since July, will continue to monitor things as Pam recovers from this round of chemo.  We have an appointment with Dr. Holtan at OHSU on Monday, Jan. 14th and we should have a pretty good idea of the timing of the transplant by that time.

Now that the transplant is finally on the horizon, I have got to admit that I am getting a bit nervous myself.  I swear that hill up to OHSU is growing a little every day.