Stem Cell Extraction: Day 1
Neither of us slept well last night. Understandably.
It was an early morning start with an 815 appointment at the Ambulatory Care Unit. Stacy was Karl’s Nurse today. She took his vitals and started his IV, which was attached to a bag of fluids first. As that started she asked to see the calendar that Dr. Jones gave him yesterday so she could double check that all the appointments were listed the same as she could see on her system. No problems there. Then she completed a questionnaire with Karl for Public Health so that a request would go to them to start injections over the weekend.
Pam the pharmacist came in shortly after Stacy had things up and running to talk about these injections. Neupogen. Those are the ones that his drug company won’t cover. They stimulate young blood cell production, and therefore are an essential part of this process. Go figure why they aren’t covered. Anyway, Pam explained how he would access them, and said that since Karl has been giving himself the Lovenox injections for seven months, Public Health may well show him how to do these himself. Wait and see on that.
A bag of dexamethasone was added in after an hour or so. Twenty minutes to create a couple of days of energy high! While that was dripping into Karl’s veins, Stacy checked on the levels from the blood work in Clarenville last week. His neutrophils were down to 1.1, and the Myeloma markers rose by 0.6 (we need these to drop), but otherwise his levels were within the normal range.
Then the Dex came off and the high dose chemo went on. Before she attached the bag, Stacy gave Karl a Golden Nugget, which is slang for Zophran, an anti-nausea medication. She explained that it is best to take this before you feel nauseous, and that the chemo would make him nauseous. She expanded by telling him not to try to feel strong and resist taking this medication, because if he did he would likely be quite sick, and may well get sick anyway. If he does feel sick he can take Metonia along with the Zophran. Metonia is the anti-nausea medication that was prescribed by Dr. Manning back in round one of chemo. To date Karl has only had to take one of these.
The high dose chemo is actually cyclophosphamide, which Karl had in rounds one through four of CyBorD. Except now the dosage is much higher, and it is given intravenously rather than orally. Basically it is given to kill his bone marrow so that there is lots of room in the marrow for new young blood cells to grow when he is given the Neupogen. It’s these young blood cells that will be harvested in twelve days and then frozen until they are needed for the transplant. Neat huh?
So the cyclophosphamide, aka high dose chemo, aka poison, dripped into Karl for two hours. This was paired with a bag of fluids, which continued to be given after the cyclophosphamide bag was empty. Why so much fluid? Cyclophosphamide at that dosage is very hard on the bladder, so the goal is for it not to sit in the bladder long as it is being metabolized by the body. If you take lots of fluids intravenously and orally you pee a lot, which flushes the bladder. It was recommended that Karl get up frequently tonight to pee and drink more water to continue this flushing process. So with this flushing and the Dex I can see another sleepless night ahead...sigh.
At 230 we were finished at the hospital for the day. Yay! We had to drop off prescriptions for more Golden Nuggets that he will need over the weekend, and codeine, which he will also need over the weekend when he starts the Neupogen. More about that when we get to that point. I have to go back to the pharmacy to pick up the prescriptions now. After I get back we are planning to veg and hopefully get to bed early. Hopefully no nausea for Karl! I’ll report back on that and whether or not we got any sleep when we finish at the hospital tomorrow.
One day down!
It was an early morning start with an 815 appointment at the Ambulatory Care Unit. Stacy was Karl’s Nurse today. She took his vitals and started his IV, which was attached to a bag of fluids first. As that started she asked to see the calendar that Dr. Jones gave him yesterday so she could double check that all the appointments were listed the same as she could see on her system. No problems there. Then she completed a questionnaire with Karl for Public Health so that a request would go to them to start injections over the weekend.
Pam the pharmacist came in shortly after Stacy had things up and running to talk about these injections. Neupogen. Those are the ones that his drug company won’t cover. They stimulate young blood cell production, and therefore are an essential part of this process. Go figure why they aren’t covered. Anyway, Pam explained how he would access them, and said that since Karl has been giving himself the Lovenox injections for seven months, Public Health may well show him how to do these himself. Wait and see on that.
A bag of dexamethasone was added in after an hour or so. Twenty minutes to create a couple of days of energy high! While that was dripping into Karl’s veins, Stacy checked on the levels from the blood work in Clarenville last week. His neutrophils were down to 1.1, and the Myeloma markers rose by 0.6 (we need these to drop), but otherwise his levels were within the normal range.
Then the Dex came off and the high dose chemo went on. Before she attached the bag, Stacy gave Karl a Golden Nugget, which is slang for Zophran, an anti-nausea medication. She explained that it is best to take this before you feel nauseous, and that the chemo would make him nauseous. She expanded by telling him not to try to feel strong and resist taking this medication, because if he did he would likely be quite sick, and may well get sick anyway. If he does feel sick he can take Metonia along with the Zophran. Metonia is the anti-nausea medication that was prescribed by Dr. Manning back in round one of chemo. To date Karl has only had to take one of these.
The high dose chemo is actually cyclophosphamide, which Karl had in rounds one through four of CyBorD. Except now the dosage is much higher, and it is given intravenously rather than orally. Basically it is given to kill his bone marrow so that there is lots of room in the marrow for new young blood cells to grow when he is given the Neupogen. It’s these young blood cells that will be harvested in twelve days and then frozen until they are needed for the transplant. Neat huh?
So the cyclophosphamide, aka high dose chemo, aka poison, dripped into Karl for two hours. This was paired with a bag of fluids, which continued to be given after the cyclophosphamide bag was empty. Why so much fluid? Cyclophosphamide at that dosage is very hard on the bladder, so the goal is for it not to sit in the bladder long as it is being metabolized by the body. If you take lots of fluids intravenously and orally you pee a lot, which flushes the bladder. It was recommended that Karl get up frequently tonight to pee and drink more water to continue this flushing process. So with this flushing and the Dex I can see another sleepless night ahead...sigh.
At 230 we were finished at the hospital for the day. Yay! We had to drop off prescriptions for more Golden Nuggets that he will need over the weekend, and codeine, which he will also need over the weekend when he starts the Neupogen. More about that when we get to that point. I have to go back to the pharmacy to pick up the prescriptions now. After I get back we are planning to veg and hopefully get to bed early. Hopefully no nausea for Karl! I’ll report back on that and whether or not we got any sleep when we finish at the hospital tomorrow.
One day down!
High dose cyclophosphamide, my first concern was that it was the same drug that was discontinued when my monoclonal protein levelled off, so I asked the question. My Doctor chuckled and said, not with this dosage, get ready for some serious treatment.
ReplyDeleteOnce again, I was expecting it to be a rough few days with a six hour iv concoction of dexamethasone, cyclophosphamide and fluid injections. And once again, the side effects were relatively mild compared to my expectations, the worst being the dex affecting my sleep.
Now we wait 4 to 7 days for the cyclo to beat the pulp out of the myeloma cells and harvest the very new, young stem cells from my blood.
And I still don't understand.........
ReplyDeleteI went through seven, 28 day cycles of chemotherapy with needles, pills and iv's, and the Dr chuckled when I brought up the mega dose of cyclophosphamide. It leaves one wondering if the seven months of treatment can be replaced with one megadose that only needs a couple of weeks. hmm?