Day +12 - Stem Cells, Interluken-2, and a Biopsy

Nurse Sharon

First thing this morning Deb had a biopsy of her back where the rash had appeared yesterday. Three dermatologists and a nurse crowded around her and examined the angry red rash. They cut out a divot of flesh and sent it to the lab. A suture, a pressure bandage, and a set of care instructions later, they handed me the suture removal kit for 12 days from now. Add suture removal to my resume!

Theory is that it is either a reaction to the 'dogs bait' of drugs and chemo Deb has experienced or the first sign of rejection of the Natural Killer Cells now in Deb's body. They don't think it is the later but must let the data speak.

Since I was surrounded by the three dermatologists, they finished Deb and turned on me, rubbing my damaged nose, forehead, bald head, and ears. They want to see me. In my spare time?

When we were able to escape and head back to clinic, we were met by two insurance coordinators that serve as links between UAMS, us, and Deb's insurance company. They had been in the infusion 4 unit looking for us. Their purpose was to tell us that insurance was not going to cover the big procedure scheduled for Friday that was a surprise to us. Deb's third stem cell transplant! Dr van Rhee had mentioned the possibility but we had not gone past that. The stem cells are excess gathered when we first came to UAMS. Deb had two stem cell transplants: this will be number three! Technically, it will be called a 'boost.' The cells have been frozen in liquid nitrogen just for cases like this.

Why? Dr van Rhee understands that Deb's body has been beaten down by all the treatments. Now with the Natural Killer cells establishing beachheads throughout Deb's body, the good doc thinks a dose of stem cells will provide what is needed to repair damage.

A need arose to check Deb's blood gases, so two techs showed up, needles in hand. One of them had butchered Deb's arm trying to find arterial blood last week. She brought her friend and suggested that the friend do this probe. Our nurses universally dislike these procedures.

Another test opportunity arose in the plan to let me roll Deb all over the campus in one day: A pulmonary evaluation in the main hospital. So, off we went.

 Deb actually dreads these more than the painful bone marrow tests. She was put into a glass 'phone booth' and a large tube was thrust into her mouth. Deb huffed and puffed. A computer graphed and recorded a series of tests to determine lung health and the performance of her pulmonary function. When it was done, the tech pushed a button and the computer system automatically placed the results into the main hospital computer system. The results were in clinic before we were.

APN Peggy

We eased back to our assigned room in the infusion center and settled down. Our labs had come back and the big question for our APN was the Interluken-2 shot. 'To give, or not to give? That is the question!'  Peggy consulted with the gurus upstairs and decided . . .{insert drumroll} Not!

Now, as the bottom level of the knowledge-chain, Deb and I wanted to know if this third omission of these painful belly-shots would disrupt the Natural Killer Cell's all-important battle with the dreaded myeloma cells. We were told that it was not a white flag of surrender, but just a slight reduction in affect. While we want all the firepower needed to get this battle won, we welcome not getting the all-night fevers and terrible impact the Interluken-2 causes Deb.

A visitor showed up at our room door. Bob Kohler, the patient who is the architect who designed the eighth floor myeloma clinic that just opened wanted some time with Deb. Bob is considering entering the Natural Killer Cell program. Because he has spent so much time here in clinic and has befriended the doctors, he is extremely knowledgeable and informed about myeloma treatment. He was waiting to see success in the Natural Killer Cell program before tossing his hat in the ring. Deb is test person number six. Deb may be that success, we pray!

Several facts came out from our visit. Bob said that the doctors had said that the goal is a 'perfect-mismatch from a donor.' Sounds sort of peculiar, doesn't it? Mis-match? What would be a perfect one? Bob said a 3/6 match meaning that a perfect mismatch of donor cells is one where at least three of six factors be DIFFERENT in a donor cells to cover what is lacking in the host. Got that? Test tomorrow! This is versus the value of taking inadequate cells from an individual then re-injecting them back into that person.

Tomorrow? Supposedly calm like today. We'll see!

On a final note, thanks to all who sent birthday wishes to Vern. They were much appreciated.

Blessings!


White Count-below 2 is neutrapenic and indicates Deb's vulnerability for infection.
Platelets -a whitish colored component of blood. Low platelets=higher Woozy factor!
CRP -An indicator of relative health. Lower is better. When the number creeps up, Deb could be getting sick.
Day  White Count  Platelets  CRP

0         0.04               29              12.8
1         0.07               15              77.0
2         0.03               42            140.3
3         0.07               27            144.1
4         0.23               52            206.0
5         1.21               33            168.2
6         2.32               26            214.0
7         2.29               11            209.3
8         2.84               25            230.2
9         2.32               12            234.1
10       2.66               24            220.1
11       2.50               15            196.0
12       2.54               28            186.0