Tuesday, November 2, 2010

Day 5/Extraction-Part 1

I'm already anticipating that this will be a forever long post, because the last few days have been nearly novel-length, and they were just about my injections! Wow, it's crazy for me to think that this is really all over. But we'll get to all of that later, let's rewind back to yesterday morning.

I had to be at the hospital at 6:45am to get the whole process started. That meant that the rest of my family had to be ready to leave with me at 6:25am because I was getting dropped off at the hospital. I could have gone all by myself, but I knew this would be a bit tough on my body, so I thought it was best to be driven home. Jon-Michael and I got up and got ready, and got Caleb ready-poor kid was pretty tired, but excited to go to the before school program, so that got him going. Bryce spent the night at my parents house. Built in babysitter, plus he didn't have to get up early.

I met Patty, the CMDP director, in the hospital lobby and we went up to the infusion center of P/SL. It was the same place I had been getting all of my injections, plus, it was just down the hall from where my father-in-law spent his last few months.

The infusion center is basically a bunch of curtained rooms, and two private rooms with beds for stem cell extraction. Apparently, most of the extractions done there are by patients donating to themselves. Obviously, only in certain circumstances is that feasible, but I found that very interesting. Cases like mine are less frequent, maybe once a month. I got settled in my private room, which had a tv and dvd player, a private bathroom, a bed, and a bunch of machines.

I got settled in and things got started right away. I had to sign a few more consent forms, answer more questions about how I was feeling, and get my final set of filgrastim injections. But by then, the effects were last thing on my mind. By the time I started feeling the anticipated irritation in my stomach, my blood was already moving out of my body.

The first thing my nurse did, after the other stuff, was check out my veins to determine where blood would come out and go back in. My best looking vein is in my right arm. I already knew that, but I was hoping they could figure out a way to use my left arm, since I'm right handed. Oh well. So the return line needed to be somewhere in my left arm and they did that first. My nurse started with a vein just above my left wrist. It wasn't meant to be, because my vein immediately blew. I knew that wasn't going to kill me, but the nurse seemed a bit stressed about it, mostly because she had to pull the needle out right away, and stop the bleeding, and she couldn't reach everything she needed. Fortunately another nurse came in and was able to help out. So she tried one in my hand. Same result. As I mentioned in a previous post, I'm prone to fainting. It's kind of embarrassing, but I think a lot of it is mental. So I'm sitting here, listening to my nurse be frustrated that she blew two of my veins, after two exceptionally painful sticks, and by some miracle, I'm able to remain calm, and more importantly, conscious. (I don't watch them stick me, because yuck!) But after that, I can look at it. It was actually interesting to see everything that was being done, once the needle parts were over.

I didn't really know what it meant when she said she "blew the vein," so I asked! Beware, if you get queasy...although I'm sure I've already made you sick if that's the case! Apparently, it's when the needle tears the vein instead of just poking in it. The thought makes me shudder, and I've still got small bruises as reminders. Since it was turning out to be difficult to stick me, the supervisor came in and did the return line in my elbow. It was significantly less painful, and she said, "That went in like butter!" Kind of an icky visual as it regards a needle going in my body, but I can see why she said that, being on the receiving end. I had to get a bunch of vials of blood taken from there to check various levels in my blood, and for some other things I don't know about...but there were 7 or 8 of them. Then I had to get the big important extraction needle in my right arm. The first nurse did that one, and it went in just fine, thank goodness. Once everything was placed and taped down, they turned on the machine. 8am on the dot.

I learned that I personally have approximately 4,749 ml of blood in my body. (Calculated based on my height and weight.) Since I'm not an expert in metric, I had to look at it in familiar terms. That's about two and a half two liter bottles, like pop bottles. Does that seem like a lot of blood, or not very much? Can't decide...weird to think about though. The nurses were great about explaining things. They don't get healthy donors in there very often, and the sick ones apparently aren't as interested in the whole process. I told them I have been blogging about it, so I think they were being extra helpful. My nurse told me that my entire supply of blood would have to be cycled through the machine 4 times. Apparently the machine isn't 100% efficient, so it would take more than once through the machine to glean all the peripheral blood stem cells needed from my blood.

Somewhere between all the needles and the explaining, I got to order breakfast. I've heard the breakfast burritos are good...it's true! And I got some fruit and milk. Things were running really smoothly, and my nurse was making various adjustments to the machine as it got going, so I was happy to just watch and answer questions while I waited for my breakfast. Another interesting tid bit is that white blood cells are actually white! After extracting my blood the machine spins it to separate it. The red cells are the heaviest, then the white, then platelets and plasma. I think. Maybe the last two are reversed. (Haha...it was still too early for me when the nurse told me all of this!) Anyway, the stem cells are in with the white cells, so that is what is routed to the collection bag. The rest is routed back into my body. You could see that in the collection bag...it was white (yellowish) liquid! The nurse told me that they take some of the red cells too, just to make sure they are getting the entire level of white and stem cells. So the end product looked all red.

At 8:30 or so, another nurse came in to give me a calcium push (a syringe injected into my return line). They give patients calcium to offset the effects of a drug donors are given during the extraction to prevent clotting. I was watching her and she would push a little into my return line, and then let my blood pressure fill it with blood and then she would push more in, and then let some blood back into the syringe, and so forth. I didn't question what she was doing, because I figured there was some purpose to that, besides, I suddenly felt very hot. It was like a hot flash, and I could feel it all the way down in my feet. It was the most bizarre feeling, because it came on so quickly. As she was injecting the calcium, she said she lets it dilute quite a bit with my blood because if you do it too fast, the patient start getting hot flashes! Well, I knew exactly what she was talking about! It went away after a minute or so, and I was fine. Then she set up a calcium drip in my return line for the remainder of the procedure.

Well, that calcium drip started a whole new round of problems. Besides separating my blood, the machine monitors the pressure and speed that the blood leaves and returns to my body. After the calcium drip was set up, the pressure in my return line was too high. I don't know how or why that happened, and apparently neither did the nurses! Apparently, medicine is as much an art form as it is a science. So removed the calcium drip. While nurses were switching dials and adjusting the return line in my arm and all sorts of other things I didn't really understand, my breakfast arrived. Since we couldn't risk it getting cold and my "usable" left arm was being worked on, I got spoon fed my breakfast. It's really quite funny. The nurse who did that was really sweet and we managed to not spill a single drop on me, in spite of my reclined position.

The only way to stop the high pressure in my return line was to turn down the speed on the machine. That was a potential problem, because if I didn't have a high enough amount of stem cells, it would take too long to get them all out of my body. We were on a deadline to get the stem cells out the door and on airplane to where ever my patient was. One of the tubes of blood that was taken earlier was to check the amount of stem cells in my blood. The nurses decided to wait for that result and see if my levels were high enough. If not, they would have to find another vein to put the return line. You can imagine how thrilled I was. But the nurses were equally concerned because my other two good options were not options anymore. They decided they would try higher up on my wrist vein (which was still tender a couple inches up the vein from the initial stick) if they needed to move the return line. Fortunately, the results came back and I had a good saturation of stem cells in my blood, so they could leave the machine at a slightly lower level and not stick me again!

It was 9:30am or so by the time everything slowed back down. I was left to relax, or watch tv or whatever I wanted at that point. I brought the BBC America version of Emma which was 4 hours long. It was the perfect time to watch it! I had a nurse put it in for me, and then she left to attend to other things. Unfortunately, after the lengthy previews were over, the dvd just stayed at the main menu! And I didn't have a remote for the dvd player! I didn't want to be obnoxious and yell, and I didn't think that warranted pushing the "call nurse" button, so I just laid there and watch the main menu screen. Unfortunately, it wasn't that interesting, but it has charming music. By the time the nurse finally came back in around 10 am, I had to go the bathroom, so we decided to do that first, and then start the movie.

As that experience was an adventure in and of itself, and this is so long that no one has probably read to this point anyway, I'll continue the story tomorrow. But if the bathroom experience doesn't make you want to keep reading, or if I haven't made everyone ill with my descriptions, I'll have a couple more pictures tomorrow! (And I have to save something interesting for tomorrow because most of the rest of the time I was just watching the movie...which is awesome, by the way!) Until then, thanks so much for reading my blog. I'm glad I can share this amazing experience with you.


Shannon said...

Thanks so much for sharing this experience! I can't wait to read more!

Pilar said...

I want to read more too.