Getting Ready For the Big Day
Yesterday Harvey was admitted to the hospital. This is it. He will stay here and not come out until his brand new immune system is settled down nicely and ready to take on the outside world. I was amazed how little paper work there was, how little hassle. It helps that all the necessary insurance approvals were obtained ahead of time.
The task for the day was getting a handy-dandy double lane super highway catheter put in. Havey has terrific veins – like garden hoses – a very nice side effect of his regular exercise regimen. All these years he has never needed a built-in port. Dozens of nurses had no trouble getting in the iv needle as needed. Yesterday, as he was getting prepped for the catheter surgery, he needed to have an iv put in for the last time so that they could administer saline and mild sedatives necessary before they put in the port. Well, three botched attempts later the nurse trying to get the iv needle in gave up and asked for high tech reinforcements. So in came the specialist from Vascular Access. Basically, they use a small portable ultrasound machine to find good veins and avoid the pesky valves that were giving the nurse so much trouble. Sure enough, the IV went in without further trouble.
Installation of the catheter (double lumen right atrial Hickman catheter) itself was a non-event. It took about an hour and half from start to finish. I do not know if it was the Versed (sedation), fentanyl (pain management), heparin (blood thinner) or the soothing music (Vivaldi), but Harvey came out of there relaxed and sporting two brand new lines with direct access to the right atrium of his heart, murmuring something about drugs and music. Now when they need to draw blood for tests or have to administer drugs to him they don’t have to poke around any more.
Managing a catherter so that it does not get infected or get plugged up with blood clots is an important issue and I will write more about it in a later post. For now, it is good to have this job done and have the port ready for use. Boy, do these guys like to draw blood! Every blood test known to man is run here, everyday. They want to know what is going on inside Harvey at any given time. They also want to know what is coming out of him. The bathroom has special features built in so that every drop of pee and smidge of poo is collected and examined. Later on when he is up-chucking they will want that too. The idea is to make sure they have a good fix on his actual weight and they are aware of any water retention (bloating). Potential infections and liver, kidney issues also give an early heads-up in what our bodies get rid of by these three routes.
Since we have discussed what goes out, it is only fair to discuss what goes in. Harvey is slightly neutropenic, his ANC is just a tad below 1K. Other institutions get all antsy when patients are neutropenic. Neutropenic diet is pretty strict in terms of what you can eat and what is forbidden. U of Minnesota has a very flexible attitude about patients’ diet. Patients can eat and drink just about anything they want to. And their families can bring stuff from home, favorite comfort food, yogurt, chocolate chip cookies, mac & cheese, anything. I guess they would draw the line at sushi. I asked the doctor who came by yesterday why this was so. The answer was plain common sense. Transplant patients are so full of prophylaxis medications, they are not likely to get sickened by what they eat. The vast majority of infections that pose a danger to them are the home grown variety – reactivation of CMV (cytomegalovirus), EBV (Epstein-Barr virus) HSV (herpes simplex virus) – remnants of prior infections that we carry in our bodies for the rest of our lives. Patients going through the massive chemotherapy regimens associated with any kind of a transplant are often nauseated and unwilling to eat. Tempting them to eat better is more important. These guys are really fixated on patient weight. Patients get weighed each and evey day and if they are too sick to get out of bed to get weighed, the whole bed is weighed with the patient in it. For those of us with life long feuds with weighing scales, this may be a bit of a challenge.
Today is the big day in terms of preconditioning chemotherapy. I am told even very manly men cry uncle at the end of the first day. We shall see if the horrid brew wipes the smug look off of Harvey’s face. He is determined to keep his ever so urbane beard and mustache, even though I tell him it will be better to shave it off rather than have it shed like a mangy dog. Harvey says we shall see. I will write soon and give you all the gory details.