The Halfway Point!

I arrived a little early to my appointment today because my husband had a 10 AM meeting he needed to be at the office for and the hematology center was on the way. When I arrived I asked the receptionist about a sign I had seen in the waiting room mentioning an online portal to view visit summaries, lab results, and future appointment times. She took down my email address and sent me a registration link, which I was able to click on and fill out while waiting for my appointment. Voila! Easy access to all of my lab reports with the touch of a button! What would the world be like without technology?!

The nurse called me back at 10 and placed me in the corner recliner. I immediately plugged in my phone. Upon seeing all the needle marks and petechiae on both of my elbows she decided to use a vein on the back of my forearm. I was nervous about this spot because I hadn’t had an IV there before, but I came to love it. The needle prick was less painful and it was ten times easier to move around. I had almost complete use of my arm. It was also nice to be able to lay my arm flat, rather than turned upright. The only downside was that I could feel the IV when I moved my arm around and it seemed less secure, like it could fall out more easily.

The nurse took a vial of blood to check my numbers and then attached the IV to a bag of fluids. For some reason, though, the tubing/drip was defective and blood started leaving my arm and filling the tubing. The nurse immediately recognized the problem and switched out the tubing. Unfortunately, she needed to unscrew the tube in order to replace it, which meant blood from both the tubing and the active IV leaked onto my arm and her pants when she made the switch. Thankfully, she was quick to get the new tubing screwed in and the IV bag started to drip properly. Crisis averted!

The nurse gave me two Tylenol to prevent a headache and fever and then began my Benadryl drip around 10:20. In the meantime, my numbers came back from my blood work. My hemoglobin dropped to 10.3, which is still a fairly safe number, but it isn’t great that it dropped. Hopefully tomorrow’s number holds steady. My platelets, after one day of IVIG, were up from 16,000 to 33,000! They more than doubled! I can’t wait to see how they look in the morning! This treatment might actually be working!!!

I was excited because the TV was set to USA again and the Law & Order : SVU marathon raged on. About a half hour in another patient asked for a channel change, though, so that was a bummer. I put in my headphones, curled up with a blankie, and fell asleep listening to the Hamilton soundtrack. Benadryl makes me so sleepy!

By the time I woke up it was 12:15 and I was already on my second vial!

10:40 AM – 11:55 AM : Vial 1 : 1 hr, 15 mins
11:55 AM – 1:00 PM : Vial 2 : 1 hr, 5 mins
1:00 PM – 2:05 PM : Vial 3 : 1 hr, 5 mins
2:05 PM – 3:10 PM : Vial 4 : 1 hr, 5 mins
Total time required for IVIG treatment : 4 hrs, 30 mins

Without anything good on TV, the afternoon dragged on once I woke up. I couldn’t manage to fall back asleep. The only remotely interesting thing that happened was that one of the other patients in the room had an allergic reaction to Rituxan. The nurses had to carry her out of the bathroom and call an ambulance. Four EMTs crammed into our little room full of recliners and IV poles to transfer her to a stretcher and wheel her out. I know everyone reacts differently to medications, but I’m glad Rituxan is my last resort and not an immediate possibility – it seems pretty strong. The whole time this was happening I had to use the restroom, but the EMTs were blocking the path, so I anxiously awaited their departure. The rest of the afternoon remained uneventful.

The nurse waited to give me the Solu-Medrol until the end of treatment this time. The drip finished by 3:20. I think she gave it to me at the end today because when she gave it to me in the morning yesterday my hot flashes hit early afternoon while I was still in the chair. She wanted to avoid the reaction I think. Unfortunately all it did was delay the side effects until about 8pm, which meant I got hit with the steroid side effects and the IVIG side effects at the same time.

As I left the hematology center I felt a faint pounding in my head, but it was mostly just uncomfortable, rather than painful. By the time I got home, though, and tried to do some work at my desk I felt shaky and my head was throbbing. I had to lie down in bed for a little while. The headache was only on one side of my head and it felt as though someone was pushing on it. Unfortunately, my nap made my headache worse somehow. I sat at the computer to watch Netflix while I ate dinner, but I had to go back to bed immediately after because the bright screen was killing my eyes. I fell asleep for a little bit. As I am writing this, I have no noticeable side effects from any of the medications. Hopefully I slept them off.

In the morning, I need to remember to ask my doctor for a prescription for painkillers to combat the wicked headache. I also need to double check that I’m not supposed to be taking any steroids at all over the weekend – won’t that send me into withdrawal? It doesn’t seem like a good idea, but if I double check with him and he confirms that I heard him correctly, I’ll trust him.

Two days down, two to go! Halfway there!

The Start of IVIG

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I arrived at the hematology center at 10:00 AM today to start my first round of IVIG (Intravenous Immune Globulin).  They were a little overbooked and didn’t have a chair for me until almost 11 so I had to hangout in the waiting room for an hour.  Once they finally called me back I was able to relax.  They began by drawing three vials of blood.  They ran one of the vials through the machine so they could get a platelet baseline prior to starting treatment.  I had just had my platelet count checked yesterday around 1:30 PM (approximately 22 hours earlier) and the count was 22,000.  Overnight they dropped to 16,000 – UGH!  Good thing the whole point of IVIG is to increase my platelet count!

The nurses started me on an IV drip and gave me two Tylenol pills to take to reduce the risk of headache or fever.  Once the IV fluids finished they switched me to a Benadryl drip.  The Benadryl is meant to reduce the risk of an allergic reaction to the IVIG, but all it seemed to do was make me incredibly sleepy.  Finally, the nurse attached a bag of Solu-Medrol, which is intravenous steroids.  This was in place of taking my Prednisone this morning.  I’ll be receiving the IV steroids in large doses tomorrow and Friday, as well.  Starting Monday the doctor wants to decrease my dose, which means I can begin the process of tapering off the Prednisone!

After the Solu-Medrol finished I was finally ready to begin the IVIG.  The nurse explained to me that I would be receiving four Carimune NF 12gm vials each day.  The first vial is given slowly so that the nursing staff can look for/stop any allergic reactions before they escalate.  Luckily, I didn’t have any adverse reactions and they were able to speed up the drip with each vial.

12:25 PM – 1:55 PM : Vial 1 : 1 hr, 30 mins
1:55 PM – 3:05 PM : Vial 2 : 1 hr, 10 mins
3:05 PM – 4:10 PM : Vial 3 : 1 hr, 5 mins
4:10 PM – 5:05 PM : Vial 4 : 0 hr, 55 mins
Total time required for IVIG treatment : 4 hrs, 40 mins

I knew I was going to be sitting in a recliner for hours, so I brought with me a backpack of snacks and things to do.  I had the essentials – a book, my laptop & charger, phone & charger, and a puzzle book.  I was right next to two open outlets, so I used one and plugged in my phone.  I fully intended to watch Netflix on my laptop the whole time, but the WiFi was spotty (as was the cell service).  Luckily, there was a large flat screen TV in the front of the room that was tuned to USA, which had a Law & Order : SVU marathon on all day.  Watching SVU made the time go by a little faster.  The most tedious part of the whole treatment was simply trying to keep my arm straight.  I have one really good vein that nurses always choose to place the IV in and, unfortunately, it is on my dominant arm right at my elbow.  Because of this, I can’t bend that arm much during treatment or the IV bag/vial stops dripping.  This also means I have very limited use of my dominant hand during this time.  Conclusion: I am not going to bother bringing the puzzle book tomorrow because writing in it will be far too difficult. Since the WiFi is so spotty, I might not bother with my laptop either.  I think the plan will be to just watch whatever is on TV, nap, and play games on my phone.

My husband picked me up from the hematology center a little before 5:30 PM.  I don’t want to jinx it, but it has been about four hours since then and I haven’t had any side effects from the IVIG at all!  It hasn’t made me tired and I never got the massive headache that the majority of patients get.  I finally feel like I was on the right side of a statistic today!  Even if I get the headache after tomorrow’s IVIG, I’m just excited today was side-effect-free!

Here is the schedule for the rest of the treatment:
Thursday, 10:00 AM
Friday, 9:45 AM
Monday, 9:00 AM

Wish me luck!  More to come tomorrow!

The Terrifying Uncertainty

I’m not sure if I’m supposed to be going through the five stages of grief in response to a chronic diagnosis (Denial Anger Bargaining Depression Acceptance), but I’m not. I’m not even going through them a little. Since I have no outward symptoms – I look and feel fine – I spend most days completely forgetting anything is even wrong with me. How can I feel totally fine but not be?  It frightens the hell out of me that my body is attacking itself from the inside and I have no way to monitor it. It is absolutely terrifying.  

The Game Plan

I spoke too soon… treatment will begin tomorrow (Wednesday) at 10:00 AM.  I will be at the hematology center for 5-6 hours a day Wednesday, Thursday, Friday, & Monday.  On Friday the doctor will check my platelet count to make sure the treatment is working.  From what I understand, the IVIG is meant to give a quick boost to my platelets and my numbers should skyrocket.

When I called the hematology office this morning to see if I would be starting treatment today, I was sure to describe my spontaneous bruising.  The doctor had his staff call  me around 1:00 to come in for blood work.  My hemoglobin was up to 11.1!  The steroids definitely seem to be working for the RBCs!  My platelets, however, were down to 22,000.  They dropped 9,000 in five days.  Once I noticed the spontaneous bruising, I had a feeling they had dropped, so I’m not all that surprised. The doctor said that since I’m starting IVIG in less than 24 hours he’s not concerned about the drop, but that if any of the following occur I should go straight to the ER:

  • A large unexplained bruise
  • Bleeding from the gums
  • Nose bleed

After IVIG ends on Monday, the doctor is likely to schedule an appointment with me for Tuesday or Wednesday to check my counts and start tapering me off the steroids.  I am a little nervous about my numbers dropping once I start tapering off the Prednisone, but the side effects are becoming a nuisance and I can’t stay on the medication long-term. The best case scenario here would be a very successful IVIG treatment, 2-3 weeks of tapering off the steroids and getting regular blood draws, and then remission!  If my numbers hold steady as I taper off, I should definitely be set for a while!   Maybe then blood draws will only be once a week or once a month!  Say a prayer that this course of treatment is going to do the trick!

The Treatment Approval!

This morning I called the hematology center to see if they had any update from insurance.  The insurance company had told them it would be an additional 24-48 hours.  They had all the paperwork they needed, but claimed it was still in the “review process”.  I decided to reach out to my company’s HR Director, who was able to get our broker involved.  I heard back from her around 4:30 that the approval went through!  I don’t know what she and the broker did to speed things along, but it worked like a charm!  I am so relieved to know treatment was approved.  By the time the approval was faxed to the office, they were already closed for the day.  My guess is that they will see the fax in the morning and immediately call me to come in.  It looks like treatment will almost definitely be Tuesday-Friday!

The Haunting of the Platelets

My low platelet count is starting to haunt me.  It is affecting more and more things in my daily life.  First, the problem was that I couldn’t commute into the office anymore and had to work from home.  Then, I had to start using a soft toothbrush and electric razor.  This past week I found out I cannot drink any alcohol until further notice, which is basically all people my age do in social settings.  I’m nervous to ask when the alcohol ban will be lifted.  I know my health is most important and I truly believe that, but I hate being told I can’t do something, especially with July Fourth and summer right around the corner.  Today presented a couple of new challenges.  To celebrate Father’s Day, my in-laws and husband and I went to Stony Creek Brewery in CT for a tour and tasting.  I had to sit back and watch as everyone around me drank.  Luckily, I don’t like beer anyways, otherwise it would have been hard to resist.

When my husband and I got back to NJ tonight I noticed a couple of bruises on my body that weren’t there earlier.  I have a purple bruise on my chest and two brown/yellow bruises on my arm.  It literally feels like they appeared out of nowhere.  I didn’t run into anything or bump myself at all.  I tried researching what could have caused the mystery bruises, but the internet told me what I already knew – my low platelets (ITP) caused the bruising. I’m not used to being considered “fragile”.  This just proves, though, that even if I am extremely careful and I don’t bump into anything, I am not immune to bruising.

The Busy Saturday

Around 9:30 I called my insurance company to check on the status of my IVIG request. After being transferred a few times they told me that the request was made on Wednesday (not Tuesday end of day as I had thought) and it takes 2-3 business days to process and approve (Thursday, Friday, Monday). She said to call back Monday and check on the status of the request, but my guess is that the insurance company will approve it Monday and tell the doctor who will then call me asking to start on Tuesday. It’s actually better that I get a full day’s work in on Monday anyways.

At 10:30 I got a haircut.  I hadn’t had one since October!  

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I chopped my hair to shoulder length (a little past) and then went to lunch at Panera with my mother-in-law and sister-in-law. After lunch we walked from Panera to the mall entrance and my heart started fluttering. The pulse oximeter read 155+. It scared the hell out of me. Once I finally calmed down, we went into the mall to shop for a couple of hours. After being in there an hour or so I started to get very sweaty and overheated. Sweat was literally pouring off of me and running into my eyes.  I sat down in front of a fan in the changing room for ten minutes and drank some water.  Finally, my pulse returned to normal and I was able to continue shopping.

When I went to go to bed tonight, my husband’s heart was fluttering and he was having chest pains and vomiting so I took him to the ER in Milford. Luckily, everything looked normal and after a bag of IV fluids he was feeling better. The nurse and I spent most of the time talking about my condition instead. I keep forgetting the rarity and severity of my illness until I start describing it. Doctors and nurses seem fascinated by my condition, which I am not sure how to interpret.  I talk about my treatment and diagnosis so casually and openly.  It’s hard to know if I still haven’t really absorbed any of it or if I’m being optimistic for the first time in my life.  Regardless, I am glad my husband is okay.  After the month I’ve been having, it was nice to not be the one in the hospital bed.

The First Good Day this Month

I had a lot of trouble concentrating today. I anxiously awaited a call from insurance all morning approving my IVIG treatment.  Since the call never came, the earliest I will be able to start is on Tuesday.  Since I had to cancel Chicago anyways, though, Tuesday-Friday 9:00 AM-2:00 PM wouldn’t be the worst thing.

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On a happier note, today was the best day I’ve had all month.  Everything about my diagnosis has been confusing, overwhelming, and frightening, but today was wonderful.  John & I drove into the city and parked near 30 Rock to go to the taping of The Tonight Show starring Jimmy Fallon. The taping was an awesome experience and at the end we even got to high five Jimmy as he ran up the aisle during the closing credits. We watched the show when it aired tonight and you could see us on screen!  Appear on national television?  Check!  

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In addition to that, my husband and my mother-in-law gave me an early birthday present – a t-shirt blanket made from all of my old college and sorority t-shirts!  I had originally asked my husband for one back in August 2013 when we were still dating.  We had just moved in together and I thought it would make a perfect birthday present.  He never ended up doing anything with the box of shirts, though, and I started to think he never would.  It made it ten times more exciting not knowing it was happening!  It was a total and complete shock and I am absolutely in love with it.  Today was a nice change of pace!

The Platelet Check

Today the doctor’s office called a little after noon and asked me to come in for a CBC blood panel to check my platelet count resulting from Tuesday’s transfusion.  Within ten minutes I had grabbed an Uber and was on my way to the office.  They took two vials of blood and then I met with the doctor.  My hemoglobin went up to 10.7 (half a point increase), but my antibodies test came back positive, which means antibodies are still latching on to my healthy RBCs and destroying them.  This was further solidified by the fact that the doctor said I’m still in hemolysis.  I am hoping the IVIG will still be just as effective while in active hemolysis.  I would hate to know what my hemoglobin would be at without the Prednisone.  Somehow, with the Prednisone, it does seem to be going up!

My platelet count from today was up to 31,000, which makes perfect sense.  The doctor predicted with the one unit of platelets that my count would rise from 13 to around 30.

The plan at this point is to stay on the steroids and hope that insurance approves the IVIG treatment late today or early tomorrow.  Not sure when the tapering off will begin so I am trying not to worry about it.  The doctor and his staff keep repeatedly calling my insurance company for approval, which is nice.  It’s nice not having to do that myself.  Assuming it is approved by end of day tomorrow, the office will call me and set up a time for me to come in on Monday for my first dose.  Treatment will likely be Monday-Thursday, 9:00-2:00.  I won’t know until the end of the first treatment if I am going to be able to work from home in the afternoons.  The doctor said that 40-60% of patients, the majority, experience painful headaches following the treatments and spend the afternoon and evening lying in bed on prescription painkillers that he prescribes to help manage the pain.  Here’s to hoping the pain isn’t too bad and that I am able to work for at least a few hours a day. 

Also I asked the doctor a few of my questions:

Can I still fly to Chicago next weekend?
No.  Because of the IVIG and the probable headaches, he doesn’t think it’s a good idea to be too far away or to take a plane.  

If the IVIG doesn’t work, do we need to resort to Rituxan?  If so, how soon will that be?
Since Rituxan can cause reproductive problems, it might not necessarily be the next step.  He said he often tries IVIG a second time first, but that it isn’t worth talking about unless we need to take that step. 

Was the large platelet drop due to my alcohol intake this past weekend?
Unfortunately, the answer to this was yes.  He thinks the drinks I had at the wedding and the night before definitely were the cause of my platelet drop from 44 to 13.  It sucks knowing I did this to myself, but at the same time, I thought maybe there was a small chance the alcohol would react with the Prednisone – I had NO idea that the alcohol would thin my blood and drop my platelets.  I can’t beat myself up over an honest mistake.

The New Hematologist

I decided on Thursday evening, after my rude encounter with the staff at the hematology office, that I needed to find a new hematologist.  I know I am going to need to see this specialist for a very long time and I refuse to settle.  I want a doctor I can trust.  Thankfully, I found that today.

I called the old doctor’s office this morning around 10:30 hoping to get my numbers from last week so I could share them with the new doctor. The receptionist said “oh. Nobody called you?!” and then proceeded to tell me the results were finalized yesterday and I needed to come in right away because my platelets weren’t responding to the steroids. At this point I was fed up so I said I’d call back to schedule an appointment. My hemoglobin was up to 10.4 from 8.7, but my platelets had only gone from 41 to 44. These results were a week old at this point and I was just finding out about them. This only served to solidify my decision to switch hematologists. 

I worked from home today because I had an appointment with my new hematologist at 11:30.  The office was easy to find and spacious. I filled out some paperwork and was taken in the back around 11:50 to have my blood drawn and my vitals recorded. The nurse took three vials of blood and immediately ran one through a machine that spit out a reading in less than five minutes!  Do you know how amazing it was after the fiasco with my original doctor to know my numbers before leaving the office?    

By the time the doctor met with me, he already had my counts.  My hemoglobin dropped ever so slightly to 10.2. This drop wasn’t that worrisome or significant, but the steroids should have at least kept my numbers stable. He then explained my condition to me and discussed that yes, figuring out a treatment plan is important, but so is taking ten steps back to figure out why this condition started in the first place. Until we know what caused it, it’s very hard to stop it. He then got very serious and said “you might want to conference in your husband for this part”. He proceeded to tell me that my platelet count was at 13. 13?!  How did it drop by 31,000 in one week?  Seven days?!  The thing that REALLY concerned him and, in turn, frightened me is that the number was able to drop so much and so low while on high dose steroids that were meant to do the exact opposite. 

Because of my dangerously low count – at 10 and under some people start spontaneously bleeding internally without any cause or underlying injury – he said the first step was to send me to Jersey City Medical Center for an immediate outpatient platelet transfusion. By the time the hospital finished registering me it was past 3:00. The infusion center drew my blood to send to the lab for cross matching. I couldn’t get platelets until I had been matched. Matching takes the lab about an hour and then the transfusion takes about an hour as well. Unfortunately, the infusion center closes at 4:00. The nurses called the doctor to ask if I could do the transfusion tomorrow morning at 8:00 instead and he said that it can’t wait. He told them that if they can’t do it today I would need to be admitted. Getting admitted would suck for two reasons – it would mean staying overnight even though I just needed a quick one hour transfusion & it would mean another $500 admission fee.

Luckily, the lab was able to rush match the blood and had the platelets to the nurses by about 3:45. One of the nurses graciously offered to stay past her shift to administer the transfusion, even though she doesn’t get paid overtime. The platelet bag finished around 4:30 and I was able to head home.

Here is the plan put in place by the new hematologist:

  1. Look at my blood smear under a microscope to see if there were any Giant Platelets the machine weeded out and didn’t count.
  2. The platelet transfusion – Check!
  3. Begin IVIG (pending insurance approval, which takes 24-48 hours). He wants to have me do IVIG four days in a row (excluding weekends). He said it takes about five hours each time and it involves being hooked up to an IV for those five hours. 
  4. See how the IVIG works. If it works, I can begin tapering off the steroids, but he will have to closely monitor my hemoglobin to see if it starts dropping. If the IVIG doesn’t work, he wants to do a bone marrow biopsy to see if my bone marrow has stopped producing platelets for some reason.

He has me out of work until after IVIG is complete. I can work from home, but he doesn’t want me commuting into the city on the train. All I would need is for one person to accidentally elbow me and I could very likely start bleeding internally. Unfortunately, there aren’t usually any visible signs of internal bleeding until it’s too late.