The bone pain from the Neupogen got quite severe for Kim on Wednesday and Thursday so Kim called up the doctor to find out what to do. Kim's normal doctor wasn't around that day, but the on-call doctor was able to fax a prescription for Tylenol 3 (with codeine) to our pharmacy and that stuff did the trick for the pain.
Yesterday Kim was supposed to get a bunch of tests done at PMH in preparation for the stem cell transplant including a dental check up, blood tests, a lung test and a heart test. However, Kim's normal doctor at St. Michael's returned from her absence and was concerned about the bone pain Kim was having. So, just as we were leaving for the tests at PMH we got a call from the doctor at St. Michael's asking Kim to come in for an exam to rule out other possible reasons for the pain. We had to quickly call up the co-ordinator nurse at PMH to figure out what to do about all the other tests. The co-ordinator nurse proceeded to call Kim's doctor at St. Michael's and they ultimately decided that Kim should still go to PMH in the morning for her blood tests and dental check-up but then go to St. Michael's in the afternoon for the exam. There is still plenty of time for the heart and lung tests so those are being rescheduled.
Anyway, everything went fine in the morning at PMH. The dentist was super friendly and helpful and the blood test was fast. The problems started when we got back to St. Michael's. The doctor gave Kim a thorough exam and concluded the pain was probably just a delayed reaction to the Neupogen, but she ordered a CT scan anyway just to be sure. She wanted to be extra-cautious in order to avoid any problems that might delay the transplant procedure.
Kim may be mildly allergic to the contrast dye they inject when they do CT scans. On one of her first CT scans she got a very very light rash. Unfortunately any reaction requires that in the future a very strict protocol be followed before the medical imaging department will do the scan. This normally involves taking steroids 13 hours in advance and Benadryl 30 minutes in advance. Unfortunately, the doctor wanted the scan done immediately so that we wouldn't delay any of the critical stuff happening next week (third round of R-GDP and insertion of the Hickman line). So the doctor called up the medical imaging department and talked with the doctor there about how to get around the standard reaction protocol. They determined that it would be acceptable for Kim's doctor to give her steroids by IV and then Kim could immediately go up for her scan and the people at medical imaging would give Kim the Benadryl by IV just before they were ready to do her scan.
This all seemed reasonable since they had done something similar when Kim needed a CT scan during her last hospital stay. So Kim got her steroids and then we went up to get the scan. They immediately sent us back to the doctor though because medical imaging is a big place and the people we talked to claimed that they were unable to give Kim the IV Benadryl (they were not aware of Kim's doctor's pre-approval for this). So we went back to the doctor (who was pretty angry about our treatment at medical imaging) and she gave Kim the IV Benadryl. Then we went back to medical imaging where we were told to wait for our turn. All good. Unfortunately a trauma case came in through the ER and Kim had to wait longer than expected for her scan. So by the time Kim's turn came for the scan it had been too long since she received the Benadryl and they had to give her more. Generally things like the trauma are the reason you try to get the medical imaging department to give you the Benadryl since they know when the scan will actually happen. Frustrating!
Anyway the scan eventually happened but on the first try the tech forgot to unlock Kim's IV properly and the line burst splashing the dye all over Kim. Sigh.
We eventually got out of there though, and after a frustrating amount of traffic we got home. But at home we found our driveway blocked because a car accident had happened literally in front of our house. There were three police cars and everything. The accident looked extremely minor but it took them forever to clear it.
The good news though is that today Kim's bone pain has mostly gone away and she hasn't had to take any of the Tylenol 3 since Friday morning. So it seems like it really was the Neupogen and not anything more sinister. We'll get the results from the scan on Monday or Tuesday likely when Kim goes in for her third round of R-GDP.