Cytopenia

It has been wonderful being home, after being away for a month and a total of 24 days in the hospital (24 days!!!).

I have had some very exciting news from Dana Farber. My free light chains (one of many myeloma markers) have completely normalized. My heavy lightchains have gone down by lalmost half and my M-Spike is also down by almost half.

Lisa, Erica, and Kirsten “watched” me this week while Scot worked. Next week (my last week that I am required to be watched) Erica and Sarah are on duty. Sarah will take me to my Dana Farber visit on Thursday (bone marrow biopsy, blood work, EKG, and 2 MRI’s because insurance is denying the PET scan again).

I’ve been feeling pretty well. My legs have been sore, I think from laying in a hospital bed for all that time. The only remaining bone pain seems to be my lower back. I had aggressive lesions at L1 and L5. I get tired and nap every afternoon.

When I am not at home being watched I am at Smilow (3 days a week) getting blood work and transfusions as needed. This is because of my lingering cytopenia. Here is some information about cytopenia from Healthline:

Cytopenia

Cytopenia occurs when one or more of your blood cell types is lower than it should be.

Your blood consists of three main parts. Red blood cells, also called erythrocytes, carry oxygen and nutrients around your body. White blood cells, or leukocytes, fight infection and battle unhealthy bacteria. Platelets are essential for clotting. If any of these elements are below typical levels, you may have cytopenia.

Types

Several types of cytopenia exist. Each type is determined by what part of your blood is low or decreased.

  • Anemia occurs when your red blood cells are low.
  • Leukopenia is a low level of white blood cells.
  • Thrombocytopenia is a deficiency of platelets.
  • Pancytopenia is a deficiency of all three parts of the blood.

The symptoms of cytopenia depend on which type of the condition you have. They can also depend on the underlying problem or condition that’s causing the low blood cell counts.

Symptoms

Symptoms of anemia include:

  • fatigue
  • weakness
  • shortness of breath
  • poor concentration
  • dizziness or feeling lightheaded
  • cold hands and feet

Symptoms of leukopenia include:

  • frequent infections
  • fever

Symptoms of thrombocytopenia include:

  • bleeding and bruising easily
  • difficulty with stopping bleeding
  • internal bleeding

My hemoglobin held from my transfusion at the hospital last Friday, until this Friday. My platelets did not fair as well. They were 24 last Sunday, 11 on Wednesday (I received a transfusion of platelets) and 10 on Friday (received more platelets). My ANC (absolute neutrophil count – what they follow for the leukopenia) has been ready at 200 even as I give myself Neupogen shots every day.

I did some research and found a study with this chart showing how long it takes CAR-T patients to recover from low blood counts.

The research nurse at Dana Farber threw out 2 months as a time frame. We’ll see.

What it means for my day-to-day is that I have to flush my trigger-lumen central line every day, give myself the shot of Neupogen and go to Smilow 3 days a week. If I need a transfusion the visit can be 4-6 hours.

Trying to be patient, but you know that’s not exactly my forte!

Let me also take an opportunity (again) to thank everyone who has reached out, sent food, babysat me, sent other gifts and treats. I am so blessed to be loved and cared for by so many. Everyone’s generosity has been mind blowing.

It’s Frankensteen…

Day of Surgery, Tuesday, February 5th

Awake before 2:45 am alarm (Scot was already up for over an hour). Showered and hit the road right on time at 3:30 am. Chose to take the Merritt Parkway, which turned out to be a mistake as a dense layer of fog covered the windy unlit highway. So, just an added ounce or two of pressure on a fun-filled morning!

We arrived right on time at 5:00 am, just when the valet parking opened, went through security, had our passes printed, and then it was up to admissions on the 3rd floor. We were met there to be taken for my pre-op MRI. I suppose I was fairly relaxed as I fell asleep twice during the MRI!

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6:35 am post-MRI waiting to go to pre-op

Typical pre-op meetings and questions: nurse, neurosurgery resident, anesthesiologist, and surgeon (Dr. Sisti). Then at 7:30 am, pretty much right on time, I kiss Scot goodbye (the nurse takes his cell phone number and tells him when he should expect to hear reports, etc.) and they walk me down the hallway into the operating room. Along the way they realize they have not given me a cap for my hair, so as we walk I am trying to stuff my gigantic mass of hair into one of these caps. (I realize now that they probably took it off almost right away, so what was the point?)

I lay down on the table, they tell me they will give me something to relax, adjust pillows and put an oxygen mask over my face and tell me to take deep breaths and I’m out.

I now know that part of the pre-surgical prep included stapling the surgical drape – to my scalp! And pinning my hair back, also with staples into my scalp. So strange to think that stapling things to your head is the way they do that!

At approximately 1:30 pm Dr. Sisti came to the family waiting area to report to Scot that the surgery was successful, they removed the tumor, one of my olfactory nerves was totally crushed, the other one was slightly pushed to the side and that it was very close to my optic nerves.

Waking up in recovery, I suppose is what one might expect post-brain surgery: pain and nausea. Scot just told me the other day that I looked at him and said, “Whose idea was this?”

Visiting rules in Neuro ICU are quite strict, a 30 minute visit every 2 hours. And I would say with good reason. Attempting to engage with a visitor while in intense pain and being extremely nauseous is quite difficult and not helpful. You know what is helpful? Pain meds and and anti-nausea meds which induce sleep. Sleep is very helpful. Not being awake – very helpful. Dilaudid, fentanyl, and zofran were my friends. And the nurses. The nurses were amazing.

Sarah and Scot made the call to keep visitors to the hospital to just family. Definitely wise.

Wednesday, February 6th

The next morning the surgical resident, Dr. Smith, came to visit me, ran me through the neuro tests (this happened many, many times a day during my hospital stay): shining a light in my eyes, follow the fingers, how many fingers here, how many fingers there, how many fingers here, lift your feet up, push against my hands, pull my hands, etc. He left but came back a few minutes later with one more thing: had I smelled coffee yet? I had not. Did I have coffee? Well, I did have a cup of instant Maxwell House they had given me (I was thinking perhaps some of the nausea and headache was caffeine withdrawal, at this point I was 2 days with no caffeine, far from my normal), but I told him it was disgusting and does not really smell like coffee under normal circumstances. However, he was holding a Starbucks cup, so I asked if I could smell his coffee. He kindly complied – and I could smell it – success! Olfactory senses intact!

The next big event was getting moved out of Neuro ICU. Unfortunately, there were not any rooms available. They moved 6 of us to another floor, but not to regular rooms. The increased nausea while physically moving on the gurney was unpleasant, like seasickness, I had to close my eyes.

My first visitors on Wednesday were Kyle and Andreah. Poor things couldn’t find me since the hospital didn’t have an updated record of my location. Somehow they found a helpful person who not only knew where I was but personally escorted them to me. I am afraid I was not really any more exciting to visit Wednesday morning than I was Tuesday post-op. They sweetly kept telling me not to try to stay awake. I think their visit ended with me vomiting. Good times.

Here I am Wednesday morning in my fancy turban. I have to say part of me liked the look – wide turban with curly mop sticking out of the top!

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I’m not exactly sure what the blister on my upper lip was from, assuming the intubation.

Next visitors were my mom and sister Kirsten. They were NOT happy with my situation, still on a gurney with my feet hanging over the end of it, and not in a room. They immediately took action, making phone calls, finding people, I don’t even know what they did. First, the hospital was able to scrounge up an actual hospital bed for me, one where my feet did not hang off the end. I had not realized how much I was missing being able to control the angle and positioning of the bed. Laying only on your back is not comfortable, and requires a lot of adjusting. When I was on the gurney I had to ask the nurse to adjust the back for me.

Nausea and pain continued pretty consistently on Wednesday. The nursing staff alternately thought the nausea/vomiting was a reaction to the anesthesia, or from the opioid pain killers. I suppose we’ll never know which it was.

Shortly after my mom and sister left, they moved me up to a semi-private room where I was immediately assaulted with a wall of tv screens, mine and my neighbors, with both volumes up. I had not realized how I was enjoying the lack of stimuli. Sadly, my roommate had been in the hospital for a month post-stroke. She was somewhat non-compliant and a fall risk as she often tried to get out of bed on her own. It turned out that she had a one-on-one aide to make sure she didn’t do that. This added further to the commotion/noise as the aide watched tv all night, snacked and had visitors herself.

Sarah in the meantime had been keeping watch and managing things via phone from home, talking to nurses and eventually Dr. Sisti late in the day on Wednesday when she called the nurses’ station and he happen to be in the room with me. When she expressed concern about the pain he told her it was likely from the pressure bandage, they agreed that he would loosen it, if I got a black eye, so be it. He cut it a bit to loosen it but left it on. I don’t recall if I had immediate relief but I can tell you that on Thursday I finally felt a little bit human.

Another interesting thing Dr. Sisti said to me when he asked me how I felt and I said “meh”, he asked, “Do you feel like you had major brain surgery? Be cause you did!” I feel that up until that moment he had somewhat downplayed the surgery.

Thursday, February 7th

Thursday my dad and Andrea came for a visit, and I was happy to have some company that I could finally engage with – I think I might have even been up in a chair! They also came with a bag of candy which was also good timing as I finally felt like I could eat something.

Sarah also decided that she was tired of being long distance and took the day off of work on Thursday to come a little earlier than planned. (To complicate this, Kensley got sick with a fever and Andreah saved the day and came to East Haven to babysit! It turned out that poor Kensely had a double ear infection and the flu.)

Also Thursday morning, the surgical resident removed the bandage completely and I had my first look at my staples/surgical site. (See title of blog above.) I was a little surprised to see the staples beyond my hairline, somehow I had the impression that everything would be back behind the hairline.

Also note the lovely neosporin hair gel (blech!). I would not be allowed to wash my hair until I got home.

Sarah arrived and got to know the goings on of my roommate and her husband as well as I did. I suppose it was entertaining if nothing else! It was good to have her company, but I was also glad she had the chance to hang out with her cousins for dinner and an overnight.

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It’s funny how being a little bit swollen makes you look younger! Smooths away some of those wrinkles 🙂

Heading home, Friday, February 8th:

Sarah’s training as my daughter really came into play when she asked a few key questions, at the right time, of the right people to get me discharged and us on the road by 12:30 pm on Friday!

I was finally able to get a good look at the surgical area after washing my hair on Saturday.

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The closest I came to a black eye, a little bit of green and yellow

Home life these last two weeks has been pretty boring: resting, Tylenol, daily walk, more resting, thinking about updating the blog, being too tired to update the blog, rinse, repeat.

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Making it work with staples still in for a visit for Andreah’s birthday

Had the staples removed at Dr. Sist’s office last Thursday, February 14th. He advised me that the meningioma is determined to be a grade II meningioma because of the “microscopic foci of brain invasion”. What this means to me mostly is that the follow-up (MRI) starts in 3 months instead of 6 months.

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Staples removed, enjoying some time with this little nugget

Most difficult limitations are not being able to drive and not being able to lift more than 10 pounds. The 10 pounds comes into play mostly in that I can’t pick up Kensley, finding all kinds of work arounds without actually telling her that I can’t pick her up! And I guess the wound is not very noticeable since Kensley has not mentioned it – and she misses nothing!

In the meantime, I started back in with my multiple myeloma treatment last week. Monday, I have my semi-annual appointment at Dana Farber and Thursday it’s back to New York Presbyterian for my post-op release from Dr. Sisti and treatment at Smilow. And then Monday the 4th, if all goes as planned I’ll be back at work.

The love and support from far and wide has been heartwarming and healing: visits, flowers, cards, texts, emails, Idaho breakfasts (!), all of it. Thank you one and all.

365 days past and leaping into the next 366

(I haven’t been blogging much lately for two reasons. One, there isn’t much to say; that is there isn’t much going on in my multiple myeloma world. Two, I’ve been very busy with everything else – a hectic fall photography season and the holidays. So two “good” reasons.)

So this past year has been, well, huge. Just a few days over a year ago I told my kids and my family and friends that I have multiple myeloma. A year ago on  January 5th I started treatment. I got the flu. I had a weekend hospitalization with a neutropenic fever. My daughter got married. I was hospitalized for 5 days for DCEP treatment. I bought a wig. I lost my hair. I had a stem cell transplant. My daughter got pregnant. I went back to work. My son got a dog. I had a busy fall season of photography shoots and editing. My hair started to grow back. I started maintenance therapy. And then the holidays.

The coming year is already chock full of things to look forward to:

  • Sarah’s baby shower
  • A trip to Naples, FL, staying with Dennis and Ruth Ellen and vising many others
  • The birth of my grandchild (sex currently unknown)
  • Graduation of two of Scot’s daughter’s (Maia (college) and Tess (high school)
  • A cousin’s daughter’s wedding in GA
  • Another week in the Hamptons
  • Our wedding (Scot and I)

And the ongoing maintenance therapy. And hopefully that is all on the myeloma front.

And of course the ongoing hair saga. More on that later.

As I wrap up this past year I want to thank everyone again for their love and support. You are my strength.

Attitude and Support

Attitude and support, support and attitude – they go hand in hand. I am fortunate to have a wide and deep variety of support. I have my family – parents, my kids, siblings, aunts, uncles, cousins, and my husband’s family. I have friends who are like family who I have known my entire or life or 37, 34, 0r 25 years. My book club peeps, my work friends, Trumbull friends, my kids’ friends, basketball friends, friends who are cancer survivors, friends who  are getting cancer treatment, and my Facebook friends. And there is my boyfriend who supports me in so many ways, literally nourishing me, body, heart and soul.

I have been listening to a guided imagery from Health Journeys and a section of it goes like this:

“as the expanding circle of light approaches you with its generous energy, and gently surrounds you, you become aware of a warm presence surrounding you. And looking around in this remarkable light you can see that you are encircled by gentle loving beings, immediately recognizable as allies, loving friends with special gifts and powerful abilities, a whole circle of smiling well-wishers in the bright humming light….all gathered around you, warming you with their protective presence, nodding and smiling.”

I have absolutely no problem, seeing this, feeling this and seeing all the faces, feeling the love and support, because I live it every day.

This week I have received it in spades. Lisa drove me to Boston and stayed overnight to visit the second day, Alison came for a 6 hour visit today, Scot came up and surprised me for a quick 2 hour visit (plus the 2 1/4 hour ride up and back), Sarah comes on Saturday and will stay with a friend to visit on Sunday too.  And then Scot comes back to pick me up on Sunday. I have received loads of emails, texts and phone calls. My nephew Hunter sent me a youtube playlist of videos to cheer me up. Everyone keeps asking if I am bored – I actually don’t have time to be bored!

This support allows me to maintain a very upbeat attitude. The staff here has been regaled with peals of laughter from my room, me with a friend, me alone with a silly video from my sister.  I’ve been trying to maintain some fitness walking laps in the hallway, or like today dancing laps in the hallway with my headphones on.

I had a ton of delays before they finally got the treatment started at 5:00 p.m. yesterday, more than a full day after I was admitted, But I really didn’t get too aggravated. I try to be understanding while staying on top of what I need,  My attitude is appreciated by the staff, who have really been terrific here. It is service like you would expect in a fine hotel.  Every time anyone comes to my room it’s, “Do you need anything?” or “Is there anything I can do for you?”

The love and support from friends and family on top of the confidence I have in my doctor and care team here leaves me generally feeling calm, secure and peaceful.

Don’t get me wrong, I have my moments, I worry about the future, I have mourned the impending loss of my hair (just trying to come up with a solution now) and stress sometimes over all the self-management of my care that is required.

Because, you know, it’s always something…

Today it was chemotherapy and an ever-growing list of other meds (including finding an anti-nausea med that is working), laughing at cat videos, delivery of my bubbly water and a stack of magazines, dancing in the hallways, surprise visits, a completed crossword puzzle or two, godiva chocolate and love from everywhere.  I’ll take it.

Now if I can just figure out how to get some sleep between the dexamethasone and all the necessary overnight visits from the staff!