Thursday, May 26, 2011

PowerPort Implanted

I was in for out-patient surgery today and had a Bard PowerPort implanted in my right chest.  As I mentioned in previous post, the PICC line I had was too much trouble to maintain for the 6 months that I will need chemo.  My wife drove me to the hospital where they started about 8 AM in an outpatient room with all the vital tests to prove I could continue.  At 9 AM, they moved me into an operating room where they prepared me for the surgery.  Interestingly, they transferred me from the gurney to the operating table using a hover pad, an air mattress with many holes in the bottom.  They inflated it with air and just floated me from one to the other.

The procedure went well though I don't remember much since I was sedated.  I now have an incision about 2 inches where they placed the port with catheter under the skin and a little incision about 4 inches higher where they inserted the catheter into my right jugular vein,  No stitches - all held together with superglue.  The catheter continues over to my left where it ends in my superior vena cava, just like the PICC line did. The port is a duo version so that it can support two needles at once and will be used for all future blood draws or any infusions included the chemotherapy.  My first use will be blood tests again on May 31 with chemo planned for June 3.  There is nothing that I need to do at home to maintain it.

I was back to my out-patient room by 11 AM, had some lunch and my son picked me up at 12:30 PM.  Home now and feeling good.  Just bothered a bit by dry eyes, a little blurry vision and my first eye floater in about a year.  Hope that clears up.

Thursday, May 19, 2011

Hodgkin's Lymphoma

A lot has happened in the last 5 months and I am going to try and catch up. Key development was a diagosis of Hodgkin's Lymphoma on May 19th.

I was hospitalized for 9 days starting Feb 8 due to a bad bout of diarrhea.  After about 12 hours and about as many trips to the bathroom, I was so dehydrated that I could hardly stand.  My wife called 911 and I was taken to the emergency room and then checked into the hospital.  Turned out it was some bug that cleaned out my whole GI tract.  I was on liquid only diet for days to allow healing and the a BRAT diet (Bananas, Rice, Applesauce and Toast.  I was never so glad to get out of the hospital and stopped on the way home for a Big Mac.

Again on March 15, I had a night of diarrhea again though not as bad as the previous time.  I was able to walk and my wife was going to drive, but then called 911 again for an ambulance to the emergency room.  Thankfully, after some fluids for my dehydration, I did not have to stay at the hospital.  Unfortunately, I got stuck with the ambulance bill which I am still disputing.

Then on April 20, I woke up with weird, rapid heartbeats.  I have had short episodes in the past that would come and go, but only observed once when I was in the emergency room for something else.  This time it didn't stop and after an hour I had my wife call the doctor.  I had enough strength to walk so she drove me to the emergency room where they diagnosed it as Atrial Fibrillation.  I was checked into the hospital and monitored by EKG and had an echocardiogram. The next day I had a TEE (Transesophageal Echocardiogram) to check for any blood clots in my atrium.  Since no clots, I had a Cardioversion, a procedure that shocked my heart into normal rhythm.  I walked out of the hospital feeling normal in a couple of hours.  The next day, I noticed the outline of the shock pad on my chest.        Only ongoing treatment so far was that I went back on Coumadin blood thinner to avoid possible clots.

During these months my Alkaline Phosphatase was increasing, indicating something was changing with my liver.  Doctors increased my Prednisone from 20mg every other day until I was back up to 40mg every day.  An MRI of my abdomen was scheduled for May 3 to check out the cause.

I had been suffering from a sinus infection for 4 weeks when I was put on a 10 day dose of Augmentin on April 28.  By May 7, I was feeling well enough to attend an all day tech conference, Mother's Day and especially on May 9, my 63rd birthday lunch with my sisters and cousin.  It was 4 years ago that I had my BMT on my birthday.

While I had some temperature fluctuations with the sinus infection, on Wednesday, May 11, I started having shivers and sweats at night.  On Thursday, I was very tired and on Friday morning decided I had to get into the doctor.  In the meantime, the results of the MRI had indicated some suspicious lymph nodes near my liver.  After initial checkup at the BMT Clinic, they checked me into the nearby hospital.  Because I had been on Coumadin, they could not take a biopsy of my liver and lymph nodes until my INR clotting rating dropped to at least 1.5.  They did all kinds of other tests - blood, urine, stool, Xrays, CT scans while monitoring my condition.  I continued with the temperature fluctuations from below normal to as high as 103.2.  Tylenol was effective and I learned to anticipate it coming on to address before it got that high again.

So on Thursday, May 19th, my INR was low enough to do the biopsies of both my liver and the lymph node.  They did this with the use of a CT scanner, using a live CT images to guide the needles to their target.  I had to lay on my stomach for two hours while worked through my back.  They would alternate between getting a CT image of where the needle was and pushing it in a little further.  Took many iterations in and out.  I was sedated, but saw some of the procedure on the monitor.  The result was that the lymph node showed I have Hodgkin's Lymphoma which just happens to have temperature fluctuations as a symptom.

Before treatment, I had to have more tests to set a baseline and prove that I was healthy enough to proceed.  On Friday, I had two bone marrow biopsies, one on each side.  They were checking to see how my BMT was holding up and whether there was any trace of Hodgkin's in my marrow. I also had a Pulmonary Function Test and a full torso CT scan that showed a few more enlarged lymph nodes.

On Saturday, I had a PICC line inserted in my left upper arm.  The PICC line goes into my arm, up over my shoulder and ends in the superior vena cava entrance to my heart.  This line was required since smaller peripheral veins cannot handle the chemotherapy which was started at 7pm.  The regimen used was ABVD, commonly used for Hodgkin's treatment.  My main reaction to the chemo was severe chills afterward, to the point that my teeth were chattering.  A dose of Demerol took care of the chills, but left me with the sweats.  I slept well then and had a good Sunday.

On Monday, I had training for flushing the PICC line plus advanced diabetes management.  Before all of this, I would check my glucose level before breakfast and take an injection of Lantus.  While in the hospital, they checked before every meal and give insulin based on glucose level plus what carbs I had just eaten.  I now have to do both at home as well.  After my final training, they discharged me with a stop at the pharmacy to get a whole lot of additional medications to take at home.

On Tuesday,  I had a followup appt with the BMT Clinic to get an injection of Neupogen which should stimulate blood cell production to counteract the chemo effects.  While there, I complained about the PICC line extensions added so that I could reach and flush them out. I had these lines hanging down to my wrist and had to keep them netted up on my arm.  Doctor decided that I should have a portacath installed.  That will happen on Thursday, May 26, but they removed the PICC line immediately.

All in all, I am back home, sleeping in my own bed, typing this on my Mac computer and not feeling to much worse for the wear.  I walked through the valley of the shadow of death with the BMT and have had four good years.  While I have a few more complications now, life is good.  Thank you, God!