Category: Cancer

Apheresis

I’m here at Duke, waiting to see if I’m ready to start apheresis today. I had my blood drawn at about 7:30. At 9:30, they’ll have some counts back. If they’re high enough, I can start. If not, I go back home and come back tomorrow. I don’t have as much bone pain this time as I did last year, but I don’t know how important that is. The nurses said, the more miserable I am, the better. Last year I had 10 days of neupogen shots. This time, I’ve had 5 days of leukine and 2 of neupogen. One of them was just at 5 AM, so it may not count.

pheresismachine.jpg

Bone marrow plasma cells

Martha let me know that there were only 5% plasma cells in my bone marrow, according to the report generated from the bone marrow aspiration done on Monday. That’s the lowest I’ve had since dx. It was 60% then, and was 6% in May when I was at the Mayo Clinic. Before that, the lowest it had been was 20% about 2 years ago.

Leukine

Leukine - sargramostin 500 mcg/mLI’ve been injecting Leukine in preparation for stem cell collection. As is usual for me, I’ve searched the web for as much information as I can find about it, and found this comment from the Non Hodgkin’s Lymphoma Cyberfamily web site to be disconcerting:

Leukine (Sargramostim) Similar to Neupogen, Leukine also stimulates the production of Neutrophils, but it goes one step further and also promotes the macrophages. Therefore it is called GM-CSF (Granuloctye Macrophage-Colony Stimulating Factor) Recent studies have shown that for the purposes collecting enough CD34+ Stem Cells for transplant, Neupogen is more effective than Leukine, and Neupogen plus Leukine offers no additional benefit, but the cost is significantly higher. For more information about Leukine click the link below: http://www.leukine.com

I plan on looking for the studies mentioned, so I can ask my doctor about the choice to use Leukine (5 days) and Neupogen (3 days).

On Thursday, when I started, I went to my local oncologist’s office, where one of the nurses showed me how to prepare the injection. Before, I had pre-filled syringes. I thought I was paying attention, but yesterday it became apparent that I hadn’t been. I remembered Andrea telling me to use a different needle to puncture the vial and withdraw the fluid, which I did. The needle is dulled when it goes through the top of the vial, so the injection hurts more. I can vouch for that. I had a heck of a time getting the Leukine into the syringe. It felt like there was a vacuum in there, and I got nothing but air. I ran over to my neighbor’s house to ask for help (she’s a nurse), but she wasn’t home. Her husband got her on the phone, and she told me to try taking the syringe out and putting it back in and injecting air into the bottle before trying to extract the med. That kind of worked. I was able to get some of the Leukine into the syringe. Some of it bubbled up out of the top of the vial. The needle wasn’t long enough to get it all out it seemed. I think it has something to do with the vacuum effect, and I just didn’t have that bit mastered. I gave myself a shot, and then managed to stab myself in the left middle finger when I was putting the cover back on the needle. I should have pushed the plunger in case there was any Lekine left in the syringe, but all I could do was swear and jerk it back. Anyway, my neighbor said she would help if I needed her. I could ask her to load the remaining 3 syringes for me. The injection part is really easy.

Bone marrow biopsy

hothothot.jpgI had a bone marrow biopsy Monday. I have to say, it was the best one I ever had. That sounds weird, I know, but it’s true. I was told to take a few percocet tablets beforehand and I had some IV Ativan. I don’t remember the trip home. :)

It’s been HOT here lately. Here’s a picture of the temperature thingy in my car. Some of my plants aren’t doing very well. We’ll soon be having a cold snap though. Next week it should be in the 90s. Once kind of nice thing is that the water temperature in the pool was 92 degrees today.

I have my transplant schedule now. I’m starting leukine shots tomorrow, and that will go on for 5 days. Then I’ll have neupogen for the remainder of the time. On the 14th, I’ll have the double lumen catheter put in and then the stem cell collection will take place on the 15th and 16th. High dose chemo (melphalan) will be on the 28th and I’ll have my stem cells infused on the 29th. For 2-3 weeks after, I’ll have what they call “supportive care.” That’s that. It’ll be over before I know it. Right?

Last two lab reports

Before I started my last cycle of Velcade and Doxil, I had blood drawn at Duke. Since then, I’ve had no treatment. I’ve been waiting to undergo high dose chemo and stem cell rescue. These are the values from the last two reports.

July 2, 2007

M-spikes: 0.20 + 0.14 = 0.34 g/dL
IgA: 534 mg/dL [46-287]
IgG: 447 mg/dL [588-1573]
IgM: 25 mg/dL [57-237]
IgE: 11 IU/mL [4-269]
Beta-2 Microglobulin: 1.7 mg/L [<2.0]
IG Free light chain kappa: 0.11 mg/dL [0.33-194]
IG Free light chain lambda: 1.31 mg/dL [0.57-2.63]
IG FLC Kappa/Lambda ratio: 0.08 [0.26-1.65]

August 2, 2007

M-spikes: 0.28 g/dL + 0.12 g/dL = 0.4 g/dL
IgA: 668 mg/dL [46-287]
IgG: 381 mg/dL [588-1573]
IgM: 28 mg/dL [57-237]
IgE: 10 IU/mL [4-269]
Beta-2 Microglobulin: 1.8 mg/L [<2.0]
IG Free light chain kappa: 0.01 mg/dL [0.33-194]
IG Free light chain lambda: 1.95 mg/dL [0.57-2.63]
IG FLC Kappa/Lambda ratio: 0.01 [0.26-1.65]

Duke day

Today I’m at Duke for tests to make sure I’m healthy enough to undergo high dose chemo. I did this last year at WFUBMC, but didn’t go through with the SCT at that time.

Right now I’m waiting to have an EKG. There’s one person in line ahead of me.

This morning I woke up feeling kind of crummy. I have achy muscles and did have a headache. I’m sure it’s that bug bite, and I’m doomed to die a lingering and painful death. Nah, I don’t really think that. I showed the bite on my leg to a PA at UNC on Tuesday, and he said it was a bite for sure. I told him I had done Internet research on various spider bites and had convinced myself that I was going to die (soon). He verified that I AM going to die. We all are.

Now I’m waiting for an echocardiogram.

Back to the muscle aches. It feels as though I spent the day at the gym. We all know I didn’t. I walked and swam yesterday, but that’s something I do almost every day. I’m sure it’ll pass, but I’ll mention it to the doctor when I see him.

Dr. Orlowski is moving to Houston, to head up the MM program at MD Anderson. We’ll miss him. I feel a little less safe than I did before, but I can still email or call him if I need advice. There was a little party for him on Tuesday. J and I brought a pecan pie and some brownies. Rey made flan, which looked like something from a magazine. I was sure he bought it. I bought the pie & brownies, of course. I don’t think I could bake anything even if my life depended on it. Fortunately, my life has never depended on my ability to bake a pie.

I did the 24 hour urine collection to bring along with me. Karen has wonderful descriptions of her own experiences, so go on over to her blog (Adventures of Cancer Girl in my blogroll) to read about it. I’m with her. It’s my least favorite of the tests. I don’t think ANY test qualifies as a favorite. They all include some sort of discomfort or inconvenience. It’s possible that MRI is at the top of the easiest though. I just get comfy and sometimes take a snooze. Anyway, After I was about 30 minutes from home this morning (on my way to Duke), I realized that I forgot the jug. I called my nurse, Martha, and asked if it was more important to have the jug or be on time for my appointment. She told me to go back and get it.

Ok, now I’m all done with the cardio stuff and the pulmonary function test. I did very well, which I attribute to swimming.

Blood has been drawn, and I’m waiting for the doctor. I’ll write more later.

Update

It’s been a while since I posted anything. Time gets away from me.

I have an appointment at Duke on August 2nd. I’ll start all the tests that need to be done prior to SCT, such as bone marrow biopsy (joy), EKG, blood tests and more.

I’m typing this from my new MacBook! I got this so I can do podcasts and videos.

More soon!