Wednesday, February 1, 2012
The Plasma Exchange (PLEX) is over and the jugular vas-cath is out!
A large two-port dialysis type vas-cath is inserted into the jugular vein and threaded down to near the heart-lung junction. It is then stitched in place for the duration of the procedure. One port on the vas-cath is for input and the other is for outtake.
Each plasma exchance procedure involves (1) pulling all the blood from my body, (2) separating the blood cells from the liquid, (3) throwing away the old liquid, (4) recombining my blood cells with new albumin, and then (5) pumping it back into my body. The entire process happens continuously and involves about 7 1/2 liters of blood. On the newer, faster machines the procedure takes about three hours. On the older machines, about six hours. This does not count the time it takes to hook me up to the machine and waiting on the albumin to arrive. It is a full-day process.
The exchange basically pulls everything (including medications) out of my system except blood cells. This really plays havoc with my medication blood levels.
After my first day of nausea, they pre-medicated me. I was given Tylenol by mouth, Benadryl and Phenergan directly into the vas-cath--what a rush. About half-way through the procedure I was also given Zophran and calcium as needed. It really helped!
Needless to say, that much "fluid shift" and medication puts one's body into shock. It takes me several days to recover. I have now had a total of twenty-seven PLEX treatments.
I had two really strange occurrences during this series of treatments.
During the 4th and 5th PLEX, my legs really jerked. On the 4th day, my left leg started jerking about 30 minutes into the procedure and jerked for about 30 minutes. On the 5th day, my left leg started jerking again at about 30 minutes and it jerked for about 1 1/2 hours. The RNs had no idea why. It was not a cramp. It was a jerk that spasmed and straightened my leg like I had been hit with an electric probe about every minute. This was the worse jerking I have had and was very apparent. I have jerked over the weekend, but not as bad.
I had a strange experience with my eyes on Wednesday while waiting on PLEX. I had a bright, white, jagged line develop across my field of vision. In both eyes, even with my eyes closed. Below the line, my vision was wavy--like looking down a hot road in summer. The line/wavy vision slowly rose up and went away. The left side of my visual field lost peripheral vision and my left field vision became dark and I could not distinguish items. The Nephrology docs evaluated me and did not see anything of concern at the moment, but said to go to the ER if it happens again. The whole experience lasted about fifteen minutes. My Vanderbilt neurologist has scheduled a Carotid Ultrasound and will followup on this issue.
My last chemo is scheduled for February 6.