Puzzles

I love puzzles...well, some puzzles. I don't care for jigsaw puzzles. They make me feel that my eyes may just drop out on the table, roll on the floor and get stepped on. On the other hand, I start each morning with a game of solitaire on my laptop, a crossword puzzle and a sudoku. By the time I have finished with these, there is enough blood pumping to my brain (well, and caffeine, too, since this process includes a first cup of coffee) that I feel awake and functional enough to begin processing my day. 

In the past couple of rounds of consolidation chemotherapy, a puzzle has presented itself. It is one I desperately wanted to solve, and here it is: 

When I come home from the Club on a Monday, my platelet count is usually in the neighborhood of 200. That is within the "normal" range and presents no threat to my well-being. On the following Thursday, when I generally have my next lab work drawn, my platelet count has dropped to around 100. That, too, is a good number; a little below the normal range, but still high enough that I am not in danger of having a bleeding event. In fact, at this level, I am instructed to continue taking my anti-coagulant medication (blood thinner) to protect against a new blood clot related to my deep vein thrombosis (DVT - blood clot in my leg). 

And then, the weekend comes. During the four days between my Thursday lab draw and my Monday lab draw, my platelet count tends to drop into dangerous territory. In the past, I have landed in the ER on Monday, because my platelet count was so low as to present a significant risk of a bleed. In the last round, my platelets had dropped to 7 by Monday. Danger, danger, Will Robinson!! (for you "Lost in Space" fans). When that happened, it was too late to get a transfusion in the oncology and infusion clinic. I was sent to the ER, where I spent nine hours on a day when patients with Covid19 symptoms were pouring in. 

So, how could this puzzle be solved? I conferred with Kari, the NP at Sunnyside and told her my concerns. She conferred with Dr. Waugh and the oncology staff and came up with the following plan: 

Instead of a lab draw on Thursday (when my platelet count is historically at a safe level), we scheduled one for early Friday morning and tentatively scheduled a transfusion for Friday afternoon, in case the platelet count or RBC count was too low for safety. This plan allows for time to get lab results and order blood products in time for a transfusion on Friday afternoon. As a backup, we scheduled the usual Monday morning lab draw very early and scheduled a transfusion in the infusion clinic for Monday afternoon, when, past history shows, it is virtually certain I will need a transfusion. By having these services already scheduled, I will be able to avoid the waiting and exposure involved with a trip to the ER. 

I am so grateful to Dr. Waugh and her staff for working so hard to make these arrangements. The peace of mind I have from having this puzzle solved is invaluable to me. As it turns out, my platelet count this morning was at 80; too high for a transfusion today, but based on my historical lab results, right on track for needing a transfusion by Monday. That appointment is already on the books. The plan is working. The puzzle is solved. I feel like a human being who is being cared for by a medical team and not like a number being processed like one more bovine in the stockyards. 

The compassion and concern I have received from my medical team has been and continues to be amazing. I give thanks to the Lord for raising up such people to help me in my time of need. 

"Rejoice in the Lord always; again I will say, rejoice. ⁵ Let your reasonableness be known to everyone." (Philippians 4:4-5)

I rejoice!!