Day 58-Day 65

 Day 58-Day 65

Numbers are generally looking good- with a few caveats. The last week and a half of numbers, separated by a "/"

WBC: 2.6/3.2/2.2 Up then down, but still good

ANC: 1539/1996/1078 up then down, but still good

Hemoglobin: 8.0/7.6/7.4 down is not the right direction...grrrr

Platelets: 17/22/22 Yay! Stable!

The girls were down for Mother's day last weekend so it was REALLY nice to have the whole family together.  We are so lucky that we have the only 2 bedroom unit at the Ronald McDonald house here, it definitely helped this last weekend.  Jeremy and Violet drove out to his parents on Saturday, so Maddie, ZiLong and I went to the Oakland Zoo.  The zoo here is pretty different from the Oregon zoo- a bit more on the wild side, some habitats seem to be aiming for a bit more "natural" but some seem not terribly cared for, though their zoo is definitely bigger and maybe that all just gives the animals more space to roam. They had 5 giraffes with a larger space, but probably not significantly larger compared to the 2 at the Oregon zoo.  We never managed to see the elephants, but in general I would say the Oregon zoo probably has more money coming in, which may allow for better upkeep and more modernized exhibits. The Turkey though? That guy is not part of the zoo. He's a wild turkey. In the same way that Portland has feral/wild peacocks, Oakland has feral/wild turkeys.  The first time I saw them, it was a group of three crossing a road. On a crosswalk. I was very impressed.  The rest have not been quite so clever, but this guy was showing off for anyone who would watch. 

Sunday we all had a picnic at a park, where we sat on a picnic blanket, played on the little kid playground because it was the only one with a rubber mat as a base, and carried ZiLong piggy back over the bark chips to the tire swing so Maddie could push him on it.  Bark chips and sand on playgrounds are not allowed, as they could harbor bacteria that could be loosened by stepping on it, and until his immune system is strong enough (probably around September), there are a lot of restrictions.  Dirt is another big no no- so picnics are only allowed with a picnic blanket and lots of hand santizer.  We have many hand sanitizers around everywhere these days!

When ZiLong first went into the hospital on March 3, he had surgery to put in a broviac line.  This is essentially like a "semi-permanent IV" that goes in under his skin and in a major vein and I think into his heart, or into a main vein that goes into his heart.  From this main line he has what are called two lumens, or "double lumen."  Part of getting discharged from the hospital was that Jeremy and I were both trained on taking care of his line and all of the things that entails.

There are four main things we do each week.

1)  Line flushes daily.  Each day we have to remove the protective cap from one line, flush it with saline, clean it with an alcohol pad, wait for it to dry, then flush and seal it with heparin and put a new protective end cap on it.  Then we repeat with the other lumen.  This ensures the line stays clear and no blood clots get stuck in the line  (the picture of the tray with syringes is all we use for a line flush.)

2) drawing labs 2x per week.  Twice per week the hospital tells us which labs to draw (purple vials or green vials, etc) and how many of each.  We remove the protective cap and screw on the "collector" (no idea it's real name) that we then jab each vial into to fill with blood.  We drop the vials off at the lab and they run the tests.  

3) Cap changes- this is done once per week or anytime we draw labs.  The lumens have a small cap that we screw a saline or heparin syringe into, and these caps are removeable.  They are not the "protective caps" that go on the end, but a "portal" to get into the line.  There is a small pressure blocker in each cap that keeps blood from coming out, but anytime we draw labs, we need to replace the "main" caps.  Because this means exposing the open tube to air, we both need to wear masks when doing this and the line itself stays clamped.  We screw the old cap off, screw a new one on, and then unclamp and seal it with heparin before reclamping it.  

4) Dressing changes- once a week or as needed.  The dressing is there to protect where the line goes into his chest, and is a main line of defense for keeping the entry site clean and safe from bacteria.  While the skin seems to be relatively healed around where the line goes into his skin, it's still super important to keep it very clean, so both ZiLong and whoever is doing the dressing change also need to wear a mask for this task.  After removing the new dressing materials from the packaging and removing the old dressing, we have to wash hands a second time and then go through a few steps to clean and prep his skin before adding a clamp called a statlock that locks the "y" portion of the double lumen in place to help prevent it from being pulled in case his lines snag on anything, then adding the dressing. 

There are quite a few more steps to each of these, but they are all basically the same- wash your hands, use alcohol pads for 15 seconds, let it dry for 15 seconds, unclamp things, clamp things, wash your hands some more, more alcohol, more waiting, rinse and repeat.  None of them take us a terribly long time except for dressing changes, but I know ZiLong will be very happy when he can get his line out!