Wednesday 28 March 2007

The results are in ...

I've gotta put another entry on - to save you from having to see my bloody cakehole every time you pop by. Must really put you off your sandwiches.

Back to my clotting factor level testing - oooh hurrah you cry!!

I was told by the nurse when taking my blood on the Friday, that it may take some time for the results to be ready. Ok I thought, and rang on the Monday.

Nothing, obviously, but I just wanted to know when it was likely to be - "try later in the week" I was told.

So I did ... and early the next week ... and later the next week. Apparently the lab would have made me a priority if I was an in-patient and they needed the results. Fair enough. As it was, I was merely a woman bleeding like a pig from her nether regions unable to go to work or do diddly. Not to worry, I've got all the time in the world.

The following week I thought best not to harass the nurses too much, it's not their fault it "isn't on the computer yet". I thought, they'll call me when the results are in, they know I'm sat at home waiting.

On the Friday I cracked and rang again. "The doc's going down there himself to chase them up." Brilliant, and will he ring when he has them? "Oh yes, we'll ring you" - great.

The following Monday having not had a call, I rang again to be told that he was busy today but he'd be in touch tomorrow.

And he was.

Hurrah!

The results were in and this is what he said (please forgive my non-medical interpretation and lack of detail dad):

My factor VIII levels were looking good following the treatment.
30 mins after the injection of 2000 units my factor VIII was 81%
24 hours after the treatment my factor VIII was 71%
That was great, hardly any reduction over a full 24 hour period.

My RiCof activity was less rosy and fell off between 4 and 8 hours after the injection:
1 hour after treatment the activity was 100%
4 hours after treatment the activity was 75%
8 hours after treatment the activity was 37%
12 hours after treatment the activity was 21%
and 24 hours after the activity was negligible.

This could well explain the problems I'd been having, and the fact that my bleeding could start up again having appeared to have stopped.

My doc admitted he didn't know exactly what RiCof levels were needed for me to have a clotting effect. He was thinking because I'd had a poor response to treatment in the past that I could have had an inhibitor - which means your body itself limits the effect of the treatment. However, based on these results his opinion was that if I'd got an inhibitor we'd see a drop of in the activity between 2 -4 hours not 4 - 8. It was maybe just that my activity levels weren't so easily controlled.

He suggested more frequent injections whilst bleeding might be beneficial - which is what I'd been after for months - but he was concerned that too much treatment could dangerously elevate my Factor VIII levels. I didn't ask what this could result in but I presume some kind of thrombosis maybe?? That would be ironic. I'll ask next time I see him, I thought.

He suggested I try:
2000 units one evening
then
1000 units every 12 hours for the next 48 hours
then
2000 once daily from then on
and assess what effect it had and give him a bell.

So that's what I did ...

Saturday 24 March 2007

Happy Bloody Birthday!















Was slightly over zealous when brushing my teeth last night.

Couldn't sleep with a mouthful of blood. Not into spitting :) so swallowed a load of blood and a large number of sloppy clots. Nice.

Had enough by 4 a.m. and got up to have jab. Took a few photos thinking I'd stick one up as illustration. Now realise I need to find one of me looking half decent to compensate for this monstrosity....


2000 units later and am all clotted up and ready for sleep.

An hour later I find myself lying in bed with:
'Always look on the bright side of life,
dee dee, dee dee, dee dee, dee dee'
going round and round my head.

Maybe it's because I booked tickets to see Spamalot the other day? Maybe it's because it's my birthday today? Maybe it's because I'm a Londoner?

'Life's a piece of sh*t,
when you look at it,
deedle, deedle, deedle, deedle dee ...'

Thursday 22 March 2007

Nightmare on Shrubbery Street

We go to bed. Usually around 9 p.m.

I have a hot water bottle. Ade sets his alarm, he slaps the side of the clock so the alarm remembers to go off.

We curl up, all cosy. My back to his front. He holds me tightly, the only time he does is in bed. I am happy and comfortable.

His breathing slows and becomes steady. As he goes to sleep he twitches. Like a puppet being pulled by invisible strings. Jerk - his elbow flicks upwards. Jerk - his hand leaps an inch and back.

As he relaxes, I tense.

I become conscious of my legs - they are aching. My ankle - it throbs. My shoulder hurts. I have things crawling on me - gotta itch.

I free my arm from under his and grapple for my calf. I itch and the crawling sensation subsides. That's all it is - a sensation. Then another, on my back.

Can't move, don't want to wake him up. He needs to sleep.

It irritates me. I try to reach down my back but cannot get to the spot. Dammit.

I gently lift his arm. I've got to move. Roll carefully onto my back. His arm still on top of me. I can stretch my aching legs out.

That's better, much better. I relax.

Two minutes pass.

God, my ankle is throbbing.

I flex it out, crackcrackcrack. Sounds like tinfoil being scrunched. Feels like there are strings inside the joint and they are catching and releasing as I stretch.

I have to keep moving it to ease the ache. Each time the grinding gets worse. Where are the pipes and the monkey? I could play myself a lullaby.

No good. I turn another 45 degrees. Onto my other side, facing Ade. My knees can't move, his are there. I wriggle. Try to get comfy.

He sighs. Rolls over onto his other side. I wrap my arms around him. That's better.

Two minutes.

Boy, my shoulder is hurting. Feels diseased. Definitely not right. I move it a little. Does that help?

Nope. Still hurting. Can't breathe too deep without getting a spasm of pain. Breathe shallowly, try not to disturb Ade.

Roll onto my front. Stretch both arms out beneath me. Head on pillow face down, turn it to one side.

Shoulder subsiding. Can relax. Breathe deeply now. Better.

Hmmmm. Lying with toes pointed and ankle flat to bed is not good. Ankle cannot bend out that far. Push myself down a bit. Toes now over end of the bed. Ankle bent. Better.

Argh - toe caught cold metal bedstead. No good. Pull foot back under duvet. Nice and warm.

Arms have gone totally numb. Better than aching I suppose.

No, have to move. Make the final turn back onto left side. Where I started from.

Now back to back with Ade. Better. Not so likely to wake him if I need to move.

Oooo legs aching. Something crawling on back of my arm. Itch and it goes. Bones feel like they are rotting. Extend legs, stretch them right out.

Still aching. Curl them up. That seems to help. Knees sticking out over side of mattress. Can feel edge of mattress. Little ridge round edge. Sticking right in me.

Gotta turn over.

Revolving like a woman on a spit.

All night.

Ade sleeps through, thank goodness.

Tuesday 20 March 2007

Testing, testing...

Firstly I need to apologise to those of you who have been waiting for me to post about what happened at the Friday 24 hour levels testing thingymebob. I'm sure not that many of you have been checking my blog out, waiting with hooks all tentered and breath carefully bated. I'd know if I had one of them site meter doodah's which tells you how many visitors you've had - I'm sure someone can tell me how to acquire on of those - Jae?? :>

Secondly, I wanted to thank my friend Kitty and cousin Beth for ringing me after my last blog, asking if I was ok and when I said 'Fine' asking me if I was really ok?? I appreciated that. I think I've put my mum into panic mode and she thinks I'm not coping but I'm just trying to be honest and real about how things are, and they aren't always easy.

That said, I'd know if I was depressed, I have been before when I was on the Hep C drugs and I took anti depressents for a while. Now my main problems are physical not mental and I feel able to handle things mostly so please don't feel too sorry for me.

Back to my visit to the hospital in January.

I had to not have any treatment in the days running up to the tests to avoid affecting the results. Luckily other than a 24 hour gum bleed I had no problems that needed treating. I also didn't have any tranexamic acid, which bleeders can take to help stop clots from breaking down too easily. I have to say I don't find that stuff works that well for me but I avoided it anyway, to be on the safe side. I wanted to go to the tests with my very own levels all intact and unadulterated by anything else.

I also, luckily, had not started another period because bleeding heavily would have affected the results apparently.

Anyhow, I turned up at the hospital at just before 9 a.m. - the best thing about this being that I got a parking space right outside - notoriously tricky at any other time of day, even with my little blue badge.

Having gone up to the clinic on the third floor, I was greeted by the ever cheery Jill, one of my clinical nurse specialists. She's ever so nice and suggested that I use the social workers room when I wasn't in the treatment room, if I wanted a sleep or to read my book. Rather than sitting in the waiting area which is pretty dark and uncomfortable, and obviously full of other ill people!

She took blood to test my first set of levels prior to giving me any factor, then gave me 2000 units of factor VIII, and then straight after took the first of 8 lots of blood over the next 24 hours.

Half an hour later at 9.30 she took the next lot.

Then half an hour after that.

Then I had another two hours to wait, so I went and got a cup of tea from the cafe and had a teacake.

At about 12 noon Jill was ready with her kidney tray full of stuff to take my next donation for the labs. Each time a couple of test tubes worth was taken, good job it wasn't any more as I was already feeling pretty woozy. Saying that, they had also tested if I was anaemic prior to the levels testing and my blood count was 11.5 - pretty good really given how heavily I'd been pumping it out recently - and I think mainly down to the very good iron supplement I've been taking - Spa Tone it's called, highly recommend that if you're anaemic...

After that one I wandered off downstairs to get some lunch. The cellar restaurant is on the second floor - only kidding, it's in the basement obviously hahahahaha. So I went down to that as they've got a better choice of institutionalised meat and veg. In order to get there you have to walk through a low ceilinged corridor that you come across people pushing cages of suspicious looking items, body parts I like to think. And there are lots of filthy pipes dangling from the ceiling - definitely the sort of place you'll run into porters with pickaxes or psychopathic surgeons with scalpels.

Having avoided all the murderous members of hospital staff I found myself a reasonable looking bit of battered fish and chips and sat myself in a corner with my book. Nobody bothered me and I was able to while away a good hour there.

Back upstairs Jill told me she had got me booked into the ward for the night. My final injection of the day was not due til 9 p.m. and the next one needed to be taken at 9 a.m. on the Saturday. I much preferred the idea of staying a night on the wards than driving 25 miles home after the time I was normally in bed and driving back in at the time I was normally recovering from not sleeping that well overnight. I had brought my pyjamas and toothbrush in, just in case.

Two more hours were spent in the little social workers room, it had a desk and a sofa with arms that folded down so I could get very comfy. It was bloomin hot in there - it's too tricky to turn the heating down to a reasonable level and you gotta keep those germs nice and toasty so's they can breed. I had the window cranked open and was still struggling to stay awake. I'd got my boots off and feet up when Jill popped her head in to see if I wanted a cuppa - ooo yes please.

At about half three Jill took me round the corner to East 3 A, the ward where I'd be spending the night, and left me in the day room. I waited there for another hour or so, reading the magazines and listening to one doc quizzing another about a condition they'd just seen. He did quite well incidentally, no idea what it was they were on about tho. Think they thought I was a staff member - pretty idle one as I was just sat there, because when two other patients came in they tootled off smartish.

At 5 p.m. a nurse came in to take me onto the ward and take some more blood. Ward was ok, only four beds in there and one of those had curtains drawn around it. They said visitors were welcome any time really so I gave Ade the hubby a ring and he said he'd pop in after work and bring me bedsocks - ahhh.

No-one was too chatty so I got myself settled and was offered some nice(?) indeterminate stew for tea. Decided that I'd had too much lunch and opted to eat some of the semolina pudding and a banana. Yummy.

The lady in the bed next to me - with the curtains - had people with her but didn't sound too clever - literally. The nurses kept trying to talk to her and work out what was wrong but all she'd do was moan. They'd ask her was she in pain - uuuuur, was the response. Do you need more painkillers - uuuuur. You can't have any more because you wouldn't swallow the last lot - uuuuur. We'll try and sort you out some more iv morphine - uuuuur.

Poor thing. The trouble was different nurses would come and ask her the same questions, promise they'd get a doc to see her so she could be prescribed something iv, and then they'd forget and another would turn up asking the same questions. I felt like sticking my head in between the curtains and shouting - just give her something godammit!! Not sure why I didn't, guess it's just that English tendency to avoid getting involved in someone else's life if at all possible...

She also had at least three relatives with her at any one time so it was hard to see why they weren't doing more to communicate on her behalf.

Ade turned up with some socks and some flapjack, which I offered to the diabetic opposite and the lady on nil by mouth. Didn't try the moaner. Polished it off myself.

After my final jab for the night I settled down for a fairly sleepless night, what with 'uuuuring' on one side and some sort of generator outside the window on the other I managed dribs and drabs of sleep before being awoken quite late for a hospital at 7 a.m.

I was delighted to have my final bloods taken shortly after 9 a.m. - they obviously wanted my somewhat unwarranted bed back - and legged it, in the way of a bleeder with one arthritic ankle, limply for the exit.

Jill had said the results might take a little while to get, so I decided to ring first thing Monday, on an optimistic whim. I'd be interested to see what they said as I don't remember ever having my levels studied this way before....

Tuesday 13 March 2007

P P P P P P Patient Power!!

So, the hubby and I went off to QE in January determined to get some answers.

What I really wanted was for them to run some tests to see how my factor levels were affected by the injections. Did my clotting factor levels rise and by how much? How long did they last at elevated levels and when did they decrease so far as to be irrelevant?

We went into the doctors office - 'How are you?' he asked, 'Oh fine!' I replied.

Ade shot me a pointed look.

'Umm, not feeling that clever really, but not too bad you know, haha. How are you?' I asked.

What wrong with me??? So much for telling it like it is and wielding my right to get some answers. As Ade put it afterwards - he's not going to think you've got any problems if you're laughing and joking like everything's ok.

I know this but am just not able to sit there and reel off how I really feel, how crap everything actually is. How I struggle to get out of bed in the morning because I'm so tired and that walking up one flight of stairs leaves me breathless, and that injecting so many times each month is getting more and more difficult cos my veins are getting knackered, and that bleeding this much is stopping me from working, shopping, getting on with my life. I have effectively chosen to feel this way by wanting to have children, I feel guilty that I am using all this treatment because I know it costs a bomb and the NHS is in the red. I also think that if I were to let it out I might collapse in a little heap and start to blubber like a baby and frankly, that wouldn't be much use to anyone.

When I was first unable to work in January and had to keep in touch with work to tell them how I was, I found it hard to talk to my boss Lou and tell her how I was feeling. When I did try she would tell me that I shouldn't worry about work and concentrate on getting my health better and that upset me, because it was so supportive and kind.

I'm usually pretty good at telling it like it is when people ask me but somehow I always feel the need to appear that I'm coping and getting on with things, which mostly I do, even though sometimes I don't and perhaps this is more the case when I'm coping less - if that makes sense???

When I talked to the nurses at the hospital I can tell them easier how I am and show them my 'bleeding diary' - a lovely chart showing how many tampons and towels I'm using and how heavily they are saturated - eeugh. Maybe because my doc is a man, I feel like when I try and give him these details to explain how bad things are, he doesn't necessarily want to hear it? It might be me, maybe I'm embarrassed to tell him? I don't think so, I've generally found it easy to be open with docs over the years. I think it is the not coping that makes me more desperate to appear to be coping...

Looking at my little bleeding diary (created by ZLB Behring to tell new patients a little about vWd and heavy periods) it states:
'A period usually lasts for 3 - 7 days. Although the amount of bleeding will vary from woman to woman, and may even vary from one cycle to the next, blood loss for most women is minimal, usually only 4-6 tablespoons during an entire cycle.'
Now I've never measured my blood loss with a kitchen utensil but I can assure you that I'm dispensing measuring jugs not serving spoons. My lowest number of days was 10 and my greatest 21, so I can safely say I can tell you that I'm having excessive bleeding.

This is what I told my doc. His thoughts were that if the treatment wasn't helping then it could well be because there is another underlying cause for the heavy bleeding. That maybe so, but I still felt it was worth assessing how effective my doses of factor VIII were being. After a little pushing by Ade and myself he agreed to do a 24 test of my levels following 2000 units of Factor VIII - hoo ray!

Because at the time of the appointment I wasn't bleeding, I know!!, I was keen to have the tests done asap. And as I wasn't at work I could come in whenever they could fit me in. We arranged that I'd come in for 9.00am that Friday, a prospect that I didn't relish being unable to get out of bed in the morning, but one that I sure wasn't going to turn down.

Monday 5 March 2007

Prophylaxis

Well, after some time and experimentation I thought we might finally be getting somewhere with my bleeding control.

I've been taking prophylactic injections to manage my periods ever since coming off the pill last year. My specialist initially advised me to try 1000 units of Haemate P every day while I was bleeding. Haemate P is heat treated factor VIII concentrate and one bottle contains 500 IU of factor VIII and 1200 IU of von Willebrand factor:RCoF (ristocetin cofactor activity - don't ask me to explain this, I'll look it up! This link has some info on the pathology of vWd: http://www.massgeneral.org/pathology/coagbook/CO006200.htm).

I can't have recombinant (synthetic) factor products because they don't contain any vW factor and wouldn't be of much use to me. What I need is the factor VIII, the vW factor and the RCof activity - all of which can be found in heat treated factor VIII concentrate. My specialist at the QE was confident that 1000 units per day would be enough to calm down the bleeding. I wasn't entirely sure. I've had problems in the past where - even with treatment - I continue bleeding; with gums and nosebleeds and when I've had surgery I have stopped bleeding, only to start again with a vengeance.

For the first eight months of 2006 I injected 1000 units, about 40ml once dilute, every day of my period and felt that whilst it might not have been quite as horrific as when I was a teenager, I didn't feel it was making a huge difference to the amount I was losing. It became hard to carry on at work because I was bleeding so often and so heavily. I kept having to run from my desk to get to the loo, excusing myself pretty sharpish whenever I felt anything flooding out. I carried a handbag everywhere that weighed a ton due to the amount of sanitary stuff in it.

At the Haemophilia Society AGM in September I spoke to a friend of mine who is a clinical nurse specialist, she said in her opinion I wasn't having nearly enough factor to control my bleeding, confirming what I thought. However when I spoke to my doctor he wasn't keen to do any testing of my levels - to really investigate how my factor levels were affected by the treatment. He did suggest that I try 1000 units for 7 days and then do 2000 per day after that until it stopped. His concern was that
with increased factor my factor VIII levels would be going too high and that there could be other reasons why my periods were so heavy. Fair point I thought and tried the new regime.

The first month it seemed to really do the trick. 9 days of v heavy bleeding, clots and flooding as per usual but then after three days of 2000 units it slowly calmed down and then stopped. 12 days! Yippee, I thought, we've done it!

The next month it had exactly the same effect, 10 days bleeding in total - still heavy but sooo much better for my sanity and sanitary. Hehe!

The next month I hit 10 days with gusto, 12 days still bleeding, 13, 14 with no sign of stopping, until boxing day when I finally clammed up. What was the bloody problem now??

I was due to see my specialist again in January and I was intending to use my 'patient power' ....