Engraftment

The stem cell transplant was accomplished yesterday, 1/25/13. It felt really good, emotionally and physically, to get those stem cells back into my body again. What is going on in the body right now is that the marrow cells exposed to the chemo will continue to die over the next few days and the stem cells replaced into my blood stream will find their way to the bone marrow (where they are happiest) and begin to develop into the various cells necessary, most notably white blood cells.

While the big stuff is over, the critical phase of engraftment has begun. The stem cells need to re-establish the bone marrow. Our routine over the next few weeks will be to show up at the hospital at 9:00 every morning and have an examination and a blood sample drawn. Most days, we walk the 5 blocks to the hospital, and it will be good if we can keep this up. Adjustments will be made daily to the various oral medications I am taking, and if necessary I might have to show back up in the evening for a special infusion/transfusion of one type or another.

This is all in addition to lifestyle modifications and germ warfare equivalent to several chapters of Leviticus, including wearing a face mask, avoiding crowds and social contact, avoiding certain types of food, and cleansing, cleansing, cleansing.

If this proceeds on a typical schedule, I should continue to feel reasonably well for another day or two, while I still have some functioning marrow. By Wednesday of next week, 1/30, I should start to feel really crummy, and that should last for a week. Patients usually have to be admitted to the hospital briefly during this time for infusions or transfusions, but I certainly hope to avoid this.

Hopefully, by Friday, 2/8, my blood counts w ill be up and I will begin to start feeling better. Then, maybe another week of recovery before I am released. This could shorten a little or stretch a lot, but it is a typical schedule. A succesful engraftment with ashortened time frame, no hospital stays, and no transfusions would be appreciated.

Since we seem to be settling into a routine, I will only update the blog as major developments occur. Little news items go onto facebook.  Thanks to all for the prayers and words of encouragement.

Chemo & Transplant

Stem cell harvesting was completed today. With a goal of collecting 6 million stem cells over a week's time, we collected 4.2 million on day 1, and an amazing 10.4 million today. This jumps the schedule ahead 4 days, and means that the next three days will be the really big ones. Wednesday and Thursdays are the days they will kill the bone marrow, and Friday will be the day they reinject the stem cells to get the marrow going again. Thanks for all the prayers. We are truly grateful to God for how well (not necessarily easy) the past few days have gone.

Harvesting - 2

Harvesting

It is Monday morning, 1/21/13. Today is the start of the harvesting phase of the transplant process. As I type this blog entry, my blood is being withdrawn from my body, spun around in a centrifuge at 2400 rpm to separate the stem cells into a thin layer from which they are extracted and stored, and then the rest of the blood is placed back into my body. By the time the process is completed over a 4 to 5 hour period, the machine will have withdrawn, processed and replaced the equivalent of more than 3 times the volume of blood in my body. You'd think all that spinning around of my blood cells would make me dizzy, but I seem to be doing okay.

Our schedule today and for the next few days is to show up at the hospital at 7:00 AM and go through the plasmapheresis process for 4-5 hours. This will go on until they have collected about 6 million stem cells (enough for two transplants). It could be 3 days, it could be 7. They/we just don't know. Today through Wednesday we also have a training class that starts early afternoon.

The weather outside is cold. The high today will be -5, but the wind chill is -33. Carol has some comments about it from our brief walk outside, but this morning we  rode the shuttle from the house, rather than walk the 3.5 blocks from house to clinic.

So many of you have sent me messages of encouragement and have let me know you are praying. I am truly overwhelmed, and grateful for each one.

Boosting

Last night, Carol & I arrived back in Frostbite Falls, MN.  We flew from DFW into Minneapolis-St. Paul (from one twin cities to the other), then caught a shuttle on to Rochester. It is a balmy 7 degrees here at 10:00 in the morning (balmy, as in insane, not balmy sunny and warm).

We have received insurance approval to proceed, so this afternoon, I begin Step 3 of the transplant process, boosting. Today through Sunday, I will receive injections in the stomach of a drug called neupogen to trick my body into producing more stem cells than normal. This will force the stem cells, which normally like to hang around in the bone marrow, out into the normal flow of the blood stream. Other patients tell me it doesn’t hurt, but little do they understand my low definition of “doesn’t hurt.”

After this afternoon’s appointment, I will go over at 6:45 or 7:45 each morning for my injection, and then they will check stem cell concentrations early Sunday evening. If there isn’t a large enough concentration of stem cells in the blood stream by Sunday, they’ll hang a sign (by drug) onto the entrances back into the bone marrow that says “no stem cells allowed,” and they will back up and be forced to accumulate in the blood.

 Friday, I am also to have a palindrome installed, which will be a couple of tubes coming out from a central vein in chest, to facilitate all the blood working coming up. It is also referred to as a “central line,” not to be confused with an Illinois Central Line, or Southern Central Line.

If all goes according to plan, we will begin Step 4, Harvesting the Stem Cells, on Monday.

Tuesday Afternoon (Happy & Sad Stories)

On the brief visit we just had to Mayo Clinic in Rochester, we were kept pretty busy rushing between appointments and testing at the clinic. On Tuesday afternoon, however, we did get a chance to visit with some of the other guests in the Gift of Life Transplant House. Most of the stories have happy endings. Many of the patients are there for a stem cell transplant, using their own stem cells, and the history of success is very high.  Others, though, for various reasons, cannot use their own stem cells and must rely on a donor. Their success rate is not so high, and on Tuesday one resident got the news "We're sorry, your body is rejecting the donor's marrow. We've done all we can do, and there's nothing left to try," and his reply was, "I just want to go home." We visited with his sister/caregiver that afternoon.

And then, there are the situations where even the happy story is integral with a tragedy.  Some of the patients are receiving transplants of heart, lung or liver, and there is the awareness that although they are alive and have survived the transplant process, it was at the cost of some other person's life. Sometimes, the organ recipient will read or hear in the news about a specific young individual's life cut tragically short by an accident, and know they are alive because that youngster has died. They share the emotional mixture of joy and sadness, and gratitude and guilt.

Late Tuesday afternoon, we had to run back to the Mayo Clinic, then wandered the shops of the downtown area after dark. The picture to the right is of Carol at our dinner in a well-recommended Italian Restaurant named Victoria's. That's an odd name for an Italian Restaurant, but the food and the atmosphere were superb!

Synopsis of Step 1

Just now have time to give you a little update on the completed Step 1 (Assessment) at Mayo.  Monday and the first half of Tuesday were filled with all sorts of tests and sampling. They took 13 separate samples/tests, including a sample of the bone marrow and numerous X-rays. We had a brief break on Tuesday afternoon, then all day Wednesday was spent meeting with the RN who will be the transplant coordinator and the doctor in charge of the procedure.

 

The upshot of it all is that my heart and lungs are in great shape, and the other organs such as liver and kidney are in good shape, too. The skeletal frame is also in good condition, with still no sign of damage from the disease. Cancer activity in the bone marrow is at 20% - 30% (20% - 30% of the cells are affected by the cancer).  This is still significantly less than the 65% at diagnosis, but up from the 12% at last measurement 3 years ago. The M-spike indicator of the cancer showed no increase from last November at Mayo (7 weeks ago), but I'm a little unsure of those readings.

 

Carol & I decided to return to Texas for a week of working while in Step 2 (waiting for insurance to approve further procedures). If all goes according to plan, we will head back to Rochester on Wednesday afternoon, and begin Step 3, which will be several days of injections to boost stem cell production, and getting fitted with hardware called a palidrome (sp?), which is flexible tubing inserted into a major vein in my chest to allow for extensive blood work in Step 4.

 

Thanks for prayers, friendship and concern.

Home Sweet Home

Our home while I am receiving treatment at Mayo is the Gift of Life Transplant House, 705 Second Street SW, Rochester, MN  55902.  Here are some photos of the house. The first was taken at 6:45 AM while I was walking the 3 1/2 blocks to the Mayo Clinic. The second was taken on the way back home shortly after noon.  Also ,here is a like to the house website. The picture on the website is of a second, newer house right across the street. http://www.gift-of-life.org/

















The portion of the house shown was originally the residence of Dr. Edward Judd, the first doctor/surgeon to join the staff of the Mayo Clinic after the two original brothers. We are staying in a new wing added onto the house at the back. 

Step 1

The stem cell transplant is a multi-step process. On Monday, Tuesday and Wednesday of this week we are in step 1, which is testing, testing and more testing to evaluate the stage of the cancer and detemine my viability as a stem cell transplant patient. They have sampled and tested all sorts of things, including a bone marrow sample on Monday.  After 3 days of testing, we begin a week of waiting on the insurance company to approve the process (step 2). During this week, we plan to return to Dallas on Thursday, 1/10, work for a week, then come back to Rochester on Wednesday, 1/16.