The day after

When they first admitted her, Emma's hematocrit was at a level that didn't NEED a transfusion but was close. They typed and cross matched during the night, and the doctor said to wait and see. They ran a blood culture and virus scans. They took her temperature a lot.

The Emergency department was completely out of Emma's size of port access needle. She has a power port and takes a 22 gauge 3/4" needle. They used a 22 gauge 1" needle that necessarily poked out of her chest a little more. This morning they were having trouble with the improvised needle and replaced it with the correct one. So there, a bit of trivial medical hardware distinction that almost nobody on the planet will ever need to consider.

During her birthday, Emma's temperature was going up and down quite a bit from the 98s to a high of 100.2 Fahrenheit. Never a fever; but flirting with it. She tested positive for two different viruses. They have her on an antibiotic, not for the virus; but because they don't KNOW that she DOESN'T have an infection. [Yes I used a double negative. On Purpose.]

Infection and central line should never mix. This is the point of the hospitalization with a fever and low ANC.

This morning, Emma's counts show her ANC rising, but her hematocrit dropping. Rather than waiting for Monday, they will transfuse today. When they send her home, she will have her port still accessed for 8-hour I.V. antibiotics. We'll have some regular blood tests happening to indicate when to stop with the antibiotic.

We expect that Emma will come home this afternoon.

We are loving all the spring and the lovely weather and the end of flu season, coupled with Emma finishing the heavy parts of chemo. This hospitalization reminds me that we aren't out of the woods yet.

Incidentally, for those who read these posts by email rather than on the blog, I added more of Emma's birthday story to the previous post, with lots of pictures. Blogger doesn't send out updates, just new posts. Anybody who is reading this on the blog and thinking, "hey wait, I want updates emailed!" just let me know. I'll hook you up.

Blood and Platelets

Emma's pale face may not always register, since Momma and Daddy see her every day. Maybe she has been extra pale over the last few days. She definitely had some new awesome bruises. Add a couple nosebleeds and we made a phone call.

Emma was planning on a blood count at the lab today in preparation for chemo tomorrow, but we came to clinic instead in case she needed platelets. 

As it turns out, Emma was particularly sensitive to last week's methotrexate.  All her counts plummeted.  For another first,  she needs both blood and platelets today.

Emma's ANC is low:100. A couple weeks ago she topped out at 9000. Below 500 is really low. If she gets a fever below 500, she is admitted to the hospital.

She won't get chemo tomorrow... it will be Tuesday,  instead.

Port access was great. Dr. Afify is great. We met another therapy dog: Roxy. Transfusions take enough time to chat with other kids and families,  to do a craft or two,  and to catch a couple Barbie movies.

Friday Transfusion

Emma had a platelet transfusion Wednesday, so I didn't suspect low platelets, the typical culprit in bloody noses. One in the evening and another during the night. Clinton elected to work from home in case Emma needed to go in. The boys would be fine watching movies and trying to distract him a bit.

After three 15-18 minute bloody noses, we called the clinic. "Come in," they said. And then she had another bloody nose. They ordered Plateletes for her just in case she needed a platelet transfusion.

It takes a bit of time. Think of any doctor's office when they "fit you in." Waiting room, vitals, room number 5. Tell the nurse why you're in and discuss symptoms. Right?

Port access is a sterile procedure that takes a few minutes. Take the  blood sample to send off to the lab. Wait a bit for the doctor. When he comes, go over the current symptoms. How to handle bloody noses, try Afrin, use it this way, not too much. Like this.

The labs came back, and sure enough it wasn't low plateletes; however, her hematocrit was pretty low and they recommended a full transfusion. For that, though, she needed her blood types and cross-matched because they do it every time. That took a couple hours, and then her blood was ready. They take a couple hours to give blood because it would be bad to shock the system. After a transfusion, they need to watch for adverse reactions for at least 30 minutes.

10:30 untill 4:30. That's a full day. I am so grateful that Clinton's job allows him to work from home while supervising the boys' naps, movies, and meals.

Day 3

After a transfusion on Wednesday, Emma's heart rate dropped like a rock and it has been steady in the fifties for a couple days. The theory? Her heart has been working so hard long enough on anemic blood that now, with all those red blood cells bringing all that oxygen, her heart is totally coasting. probably will even up after a few days.

No fevers again for the second day. That is pretty awesome.

She is still pretty seriously low on immunity, but the doc let her go for a walk after visiting hours tonight, provided she wears a mask. Yes, the photo shows two masks: she likes Mickey better; but the green one is the required level of filtration.

She is cleared to go home tomorrow after her next dose of chemo, provided she responds well to that. Cross your fingers and hip hip hooray!

Chemotherapy Day 1

So this is the official day 1.
Emma has had several extra things given by IV and mouth.
Steroids, anti-nausea, anti-cancer, fever reducer, and a bag of blood. Well, truly, the blood transfusion is still going on... that's a 2-hour thing. It's kind of interesting to see the end result of a blood drive.
I haven't given for a while, what with a 7-month old baby. But seeing the bag hanging there and providing her a very needed transfusion makes me want to drop by the red cross and give a pint.
Day 1.
The first segment of treatment is called induction, and runs 29 days. After they are happy with her reaction to the day 4 drugs, we get to take her home, and then much will be outpatient.
Our list of possible side effects would make a really cool speed-talking caveat on a drug commercial. "Ask your doctor if Chemotherapy is right for you..."