A Little Light Reading

Random Stories from 3 East
I’ll be writing a bit more these first few days when I have energy.  Typically thoughts hit me at random times during the day and I’ll jot down a note to myself if it’s something I think I should post.  Considering I can’t leave the unit and I’m in my room most of the time, material is a little rough to come by so the bar for posting is pretty low.

Is That a PICC Line or Are You Just Happy to See Me?
When I was admitted on Thursday I received a PICC line.  I was kind of hoping for a port again, but that might happen later.  I guess I can’t get stem cells through the type of port I had last time, so there wasn’t much sense in placing it.  I’ll have the PICC while I’m in the hospital and then they will most likely take it out at discharge.  I’ll have labs twice a week while I’m an outpatient, so I’ll get stuck twice a week, but I just alternate arms and thankfully I have good veins

Getting Kinky in My Hospital Room
This topic probably isn’t what you think it is.  Then maybe again it is.  Apparently IU Health switched to a thinner PICC line in November.  Now, I can’t say for sure that the switch was done to save money or improve care, but I do have it on good authority that these PICC lines are thinner.  Usually thinner means cheaper, but you can draw your own conclusions.  Well after receiving chemo on Thursday night, they couldn’t get my normal saline to infuse.  Radiology was called for a STAT chest x-ray and sure enough the PICC line had kinked inside my vein (The PICC line is inserted in my upper arm, then winds it’s way through a bunch of veins I can’t pronounce.  It ends near my heart).  They weren’t able to unkink it so they ended up having to start an IV so I could continue fluids and get chemo in the morning.  Later in the day on Friday the vascular nurses came up to get me unkinked.  They told me I’d feel the line in my chest and hear weird noises in my head (as opposed to the weird voices).  They took a 10 CC syringe, had me breath in deep and then pushed the plunger in as quick as they could to try and get the PICC line to unkink.  I felt some twisting in my chest on each attempt and true to form the 3rd time was the charm.  I felt a big wiggling sensation and then the saline was able to flow.  Another STAT chest Xray confirmed it was unkinked and it’s worked fine ever since.

Doctors Should do Doctor Things and Let Nurses do Nurse Things
So backing up a little bit, after my PICC line kinked I mentioned they had to start an IV in me.  In walks a Resident and a Nurse.  Dr. Resident (I can’t remember his name) introduces himself and tells me that he and the nurse will start my IV.  I thought this a bit weird and didn’t pick up on the fact that what he meant was he wanted to be the one to practice starting an IV on me.  He was nice, I was vulnerable, so I let him do it.  The first time he tried, the vein blew right away.  My nurse was on the other side of the bed giving instructions and was nice enough to even mark my vein with a pen so he could see exactly where to insert the needle.

So Dr. Resident, undeterred from his first blown IV decided to try and start a 2nd one.  The nurse marked my vein for him and with a little trepidation, he tried again.  To his credit, this one didn’t blow right away.  We actually thought it was good at first and the nurse ended up hooking me back up to the IV pump and they left the room.  However, pretty quickly I started to feel some pain and I noticed a bubble building under my skin where the IV was.  I clamped the line off and the nurse came back in, but this time without Dr. Resident.  The nurse had a new IV in me in no time flat, and this one worked flawlessly.  I appreciate Dr. Resident’s desire to learn.  Not many Dr.’s would probably bother starting an IV, so kudos to him.  But in reality, it’s best to leave most medical procedures to the experts…you know, the nurses.

The Oddities of Modern Medicine
Earlier I mentioned that I had to have a STAT Chest Xray ordered.  I have no idea how much a STAT Chest Xray costs, but I imagine it’s more than 2 tums.  The reason I’m drawing this comparison is that when I needed a STAT Chest Xray, the nurse could order that via protocol (meaning she didn’t have to contact a doctor).  However, when I was having some reflux and asked for tums, she had to call the resident on call and have him place an order for 2 tums.  Yes, an order for 2 tums.

And the Powerball Number Is
So throughout this journey, I’ll keep you updated on my blood counts.  Last time around I always introduced my blood counts with the title “And the Powerball Number is” (or something close to that).  Reason being is they write the numbers on a board for me and as each one goes up, it’s kinda like the old days when you’d wait on the Powerball numbers to pop up so you could see what they are.  So here are my numbers

6/3: WBC 2.4, Hemoglobin 12.7, Platelets 103
6/4: WBC 2.2, Hemoglobin 12.3, Platelets 103
6/5: WBC 3.9, Hemoglobin 11.6, Platelets 101
6/6: WBC 3.7, Hemoglobin 10.7, Platelets  98

For me, normal WBC is 3.6-10.6, normal Hemoglobin is 13.4-17 and Platelets should be 150-450.  However my platelets have always been a bit lower (usually 130’s) since my first battle with Leukemia.

More About Those Numbers
Oddly enough, in some other cancers, they won’t give you chemo if your counts drop too low.  However, since I have blood cancer, the whole idea is to kill my blood cells and the Leukemia cells at the same time.  So my numbers will go down.  I’m not quite sure how much though.  When I was admitted in December of 2012, my disease was much farther along.  I was admitted with a Hemoglobin of 10.7, Platelets at 14 and an ANC of 0.2.  Damn, I forgot to mention my ANC.

ANC Numbers – 6/3: 1.4, 6/4 1.4, 6/5 3.1, 6/6, 3.1

Now my WBC and ANC are spiking a bit because of the chemo.  They should come back down.  But starting chemo with platelets at 103 and ANC at 1.4 is a LOT better than starting at 14 and .02.  The hope is that I don’t get a neutropenic fever, and thus could be home sooner rather than later.

While We’re at It
I’m going to need blood transfusions along the way.  Those transfusions will come from blood bank, so don’t worry about needing to give me some of your juice.  However, if you want to donate on my behalf to help someone else out, I wouldn’t say no.  I’m not sure if I remember the numbers exactly but I’m pretty sure I receive Platelets if they get below 10 and whole blood if my hemoglobin gets below 7.   If my platelets get too low (and 10 is really really really low to begin with) I will bleed out of my orifices and potentially internally was well.  If my hemoglobin gets too low, then my blood can’t carry oxygen to my organs, which poses its own set up problems.  I’m always a bit nervous to receive blood, but the blood supply is very safe these days.  It would be nice to keep the transfusions to a minimum though.

That’s It for Now
I do have more stories I need to write, but will save some material for later.  To give you a little tease, I still need to tell you about Communion, Baseball and Condoms…

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