Tuesday, November 1, 2011

PICC Lines and Platelets

I had to get my PICC line pulled yesterday. Due to a computer glitch, it didn't happen until the end of the day, which led to a bit of interesting thinking about blood counts. I'm going to try to get more exact information today.

I'm sitting at the hospital with a platelet count of "<5." How much less than five I don't know, but you should see ... Well, just a minute, and I'll show you.

Platelets, as you may know from this blog, are the cells that make your blood clot so you stop bleeding. Anything over 150 is "normal," but most people have a count over 300. Mine, as I said, is something less than 5. It's common for people with such a platelet count to get red spots all over their body. It happened to my friend Jerry when his platelet count hit 4. (Jerry, by the way, is due back Wednesday to begin the transplant testing if his mouth has healed well enough from his dental surgery.)

They were worried about this redness! It was much worse today. Even more oddly, I never had a PICC line in my left arm. My computer somehow mirror-imaged this picture!
Anyway, they sent me home Friday telling me to keep a careful eye on the PICC line because of its redness. On Sunday it was worse, so on Monday morning I sent a message through the great and previously reliable "MyHealthAtVanderbilt.com" web site. It's also the place where I can read my own blood counts. I gave the nurse practitioner a very thorough description of how it looked. That was easier to do with words than I expected.

I didn't get a response to that email, but I did get a response to one I'd sent over the weekend. I figured that they had debated whether to deal with the PICC line, then decided to wait until my appointment today. I didn't give it another thought.

At 4:30 pm or so, I got a call from Vanderbilt asking whether I'd gotten a message from them. I told them I hadn't, so the person told me that Meghan wanted me to come in so she could see the PICC line. We hopped up and drove in, hoping to beat Nashville traffic. No problem, it was all against us.

Meghan took one look at it and said, "Pull it."

I asked whether we could check my blood counts already, since my platelets were already at 33 on Friday. I'm still officially at the height of chemo, so all my blood counts should be crashing. My white blood cell count, for example, is now 0.2, which is basically nothing. I'm being very careful about everything I touch.

She agreed, and another nurse took blood before she took out the PICC line. We then patched up the hole in my arm, which didn't stop bleeding very well. In fact, I just left the gauze and bandage on my arm all night, and you should see ... Oh, that's what I was going to say above. You should see what that bandage did to my arm with no platelets. I'm unusually sensitive to Band-Aids in the best of health, but here, look at this:

The circular part with the hole in the middle is where the PICC line was. Above and below it are bruises just from the Band-Aid being on overnight. Yikes.

Okay, so I'm in a room, and I'm just getting platelets (and I got that hole in my arm wrapped rather than bandaged). They're orange, but I'm told that if they get platelets from a pregnant woman, they'll be green!

They type platelets. I'm A positive. However, it's not necessary. You can get platelets from anyone.
I asked the nurse here how dangerous it was to have platelets under 5. She said something to the effect of, "Oh, it's dangerous. If you fall or bump something you could bruise badly, and if you cut yourself it could be hard to stop the bleeding."

So I asked her how low is too low, and she said that there are signs and symptoms. There's some term that I've now forgotten for the second time for little red spots breaking out on your body. The other sign, of course, is bleeding that can't be controlled.

So I asked her that if I saw the little red spots on my body, should I go to the emergency room. She said, "No. Just call in and ask what they want you to do."

Okay, so my interpretation of all that is that a platelet count of next to nothing is dangerous but not officially an emergency.

I guess this is a medical blog today. I feel great. I get winded crossing a room, but my red blood cell counts aren't that bad. Well, for a leukemia patient on chemotherapy, they're not bad. No pains. We're still in perfect fall weather. Hard to picture a better day.

Oh, one last thing ...

The platelet count didn't show up on MyHealthAtVanderbilt.com until about 10:30 last night. Like I said, the count was simply "less than 5."

I'm not a doctor. All I know is that my friend Jerry had blood spots all over his body when his platelets were 4. Mine were apparently 4 at best!

I told myself, "If this were an emergency situation, Meghan would not have sent me home. She had to know this was possible. She also didn't flinch at the thought of someone have red spots on their body, and she casually looked to see if I had any on my arms or lower legs earlier today. Jerry, too, waited overnight after he had those red spots, and he was just fine."

Nonetheless, I had to ask myself if this was the kind of thing you at least call the emergency room about.

I don't know what you do in such situations, but I ask God what to do. It's served me well for nigh on 30 years now. I really felt like I just needed to relax and go to bed, but your head and your gut don't always agree on such things. I can choose not to worry, but that doesn't mean I can just lie in bed and fall asleep.

I ended up getting a late night email from a missionary friend in Mexico. I emailed him right back and asked him to pray that I would rest. I told him my conscious mind wasn't worried, but that didn't mean my gut would let me sleep. Then I settled on the couch to read The Shepherd's Castle by George MacDonald, one of my favorite authors.

Fifteen minutes later, I was exhausted. I checked my email on my phone to see that my missionary friend had not only prayed for me, but he had typed a prayer back to me in an email. I sent him short thank you, then slept soundly till this morning.


  1. I am glad you got some sleep. In my prayers, Kitty

  2. WHOA PICC line arm. Ouch! The red spots are called petechia (sp?). I still remember telling you that's what I thought your "rash" was in the very beginning and asking if you had taken a lot of aspirin... little did WE know, eh? :P I love you and continue to pray for you.

  3. The arm doesn't hurt a bit. Hannah was just reminding me yesterday that I didn't go to the doctor after that "rash," proof to her that I can't be entrusted with my own care.