Monday, November 26, 2012

What's your favorite dressing?

Buck Dressing Change, originally uploaded by Buck Cash.
I like Bleu Cheese. Second choice is Italian, then Ranch. But today's dressing of the day is the one that keeps the site clean and covered on my tri-catheter entrance into my chest. :)

Saw the doctor today and all went well. He gave me an exam and had a look at my last PET Scan and declared that it was "negative - you're in remission", which was really good news!

Then Anita (my patient advocate at Karmanos) changed my dressing, which is what the photo is of. My mom took the photo with my smart phone.

Tomorrow, I'll be admitted into the hospital at Karmanos at about 1:PM to begin my 3 weeks of intense chemo and stem cell transplant. After that, a week at Aunt Aggie's (where I'm staying while in the Detroit area), then another doctor visit, and hopefully then just follow up visits back home in the Petoskey area.

At the end of that whole process, I'm looking forward to a good, long remission - 20 or 30 years would be good! ;)

Also worth mentioning, the recent bout of night sweats only lasted a couple nights.  Now I have a theory about night sweats, and it goes like this:

When my cancer is getting out of control, my white cells go into overdrive trying to fight it, and I get night sweats.  When people get sick with a cold or the flu, they end up in bed and their white cells go into overdrive trying to fight it, and they sweat.  When I was getting the Mozobil injections specifically to bring my white cell count up, I felt fine, but still had night sweats.

Could it be as simple as saying that night sweats are caused by / evidence of high white cell counts?  I think maybe the answer is yes.  And since I've asked every doctor along the way what causes the night sweats, and none knew, I feel like I may have made some kind of simple discovery here.

Anyway, there ya go...  I like to solve puzzles.  :-)

I'll update again when I'm settled into the hospital and have more to chat about here.

Tuesday, November 20, 2012

A slight delay

father son retire 5994, originally uploaded by Buck Cash.
Saw the doctor and someone from Pharmaceutics yesterday.

The Pharm guy explained all about my upcoming chemos and stem cell transplant; What they are, how they'll be administered, what side effects to expect, etc. It was all pretty straightforward, fairly familiar territory for me by now.

The stem cells are to help me recover because these aggressive chemos will really wipe out my white cells immune system like crazy.

The doctor looked at the site on my chest where the port was removed and the triple line catheter placed. They're not pleased with the way it looks, and weren't happy that the procedure to do both is more than he asked for or anticipated. The surgery should have just placed the catheter on the other side of my chest. Instead, with both the removal and replacement, the site is excessively bruised, red and looked infected even, which is why they gave me the antibiotic drips.

He doesn't want to take the chance that my body is fighting to restore that area at the same time that my chemo is taking out my immune system, so we've got a week's delay to me being admitted. It was intended that I'd go in today to begin the chemo, etc. Now we're schedule for a week from today, on Tuesday the 27th, 2012.  Between now and then, I'll also be taking some antibiotics orally to try to clean that site up.

I'll see the doc again on the day before that, Monday, to reaffirm that we're ready to go forward.

Probably nothing more to add till then, so have a happy Turkey Day to you all, and I'll update again when there's more to talk about.


Saturday, November 17, 2012

Stem Cell Collection

Stem Cell Collector 0317, originally uploaded by Buck Cash.
So, I've been pretty busy since the last update!

With my memory like swiss cheese lately, I completely forgot to collect the urine for testing starting on the 8th, so that will actually start tomorrow, Sunday, 11-17-2012, to be turned in on Monday morning at The Dresdin Clinic at Karmanos.

I've been giving myself Neupogen injections twice per day since last Saturday (Friday? - Swiss Cheese...). They were 2 shots in the morning and 2 more in the evening, totaling 1560 mg per day. I did my last 2 this morning.

On Tuesday, 11-13-2012, I had surgery to remove the port and install a triple line catheter in its place. That left me feeling pretty bruised and tender for a few days up on my right collarbone area. We were hoping stem cell collection could begin the next morning.

The routine then for the last few days, since Wednesday, has been to get up at 5:am, leave for Karmanos at 6:am, arrive there at 7:am and spend the day doing what needs to be done, ending about 7:pm, getting back to the house at about 8:pm. In other words, long days.

The Neupogen shots were to build up my white cell count to the point where they could collect my stem cells, so each morning first thing upon arrival, I'd get LABS drawn and tested. That would take about 3 hours to get the results back, time spent in the family waiting room watching TV.

If the results come back with the white count too low, I'd have to hang around to get a shot of Mozobil at about 6:pm, then get monitored for reactions for an hour. Thus the long days; the first few days labs came back with low counts, so no stem cell collection.

Finally, on Friday, my counts were up enough to proceed with stem cell collection, and into a bed I went, and the stem cell collection machine operation was explained to me, which I found fascinating.

Fresh tubes are installed for each use. One tube brings the blood out of me, another tube introduces an anti-coagulant so that it doesn't clot in the tubes or machine anywhere, a third puts the blood back into me, and a fourth introduces a bit of anti-coagulant again before it goes in me for a smooth flow.

The pumps move the blood and anti-coagulants in a totally regulated manner in and out of me and through the machine. The blood never actually touches the pump mechanisms in any way.

Inside the machine, the blood goes into a centrifuge, which separates the components of the blood by weight into layers. The layer of stem cells is then pumped out into a collection bag, and the rest of the blood is pumped back out of the centrifuge through a tube that wraps about a dozen times around a device that re-warms the blood so that it doesn't shock my system or be uncomfortable as it's returned back into me.

The process takes several hours from start to finish. All I had to do was relax in an almost lying down position, read, watch TV, surf the net, etc., while it ran the process. Then it's back to the waiting room to wait a few hours more for the bag of stem cells to be counted. If there are enough, I'm done with that part of it. If not, another shot of Mozobil at 6:pm, monitor till 7:pm, then repeat the whole thing the next day.

It took two days of collection, Friday and Saturday, which is today. So, the collection part is over.

I was told that this part of the process could lead to fatigue, cramping, easy bruising and bleeding, so I'm not to exercise or bend over or do anything stressful, etc.

So far, I feel just fine, as usual. A little tired maybe, and have had night sweats the last couple of days, so I'm sleeping with towels again. But that's about it.

I think I covered about everything. If I remember anything I left out, I'll edit or include it in the next update, which will be after I check into the hospital on Monday and get all set up and settled in and have anything new to talk about.

Till then, see ya on FB or something!!

Thursday, November 01, 2012

Transplant Schedule Determined

Pulmonary Testing Booth 0203, originally uploaded by Buck Cash.
Yesterday, I had to go in for several tests at Karmanos so that the doctor could determine what, how and when my stem cell transplant would proceed.

I had chest X-Rays, a full set of Labs, echo-cardiogram, EKG, and a pulmonary exam. The phone booth looking box in the photo is where you sit for the pulmonary exam.

The pulmonary exam consisted of a series of breathing normal, sucking hard, blowing hard, breathing shallow, breathing deep, a breathing treatment, then more of the same. It took about 45 minutes.  Here are a couple more photos of the booth:

In the end, the doctor determined that my lungs are too messed up from all the years I smoked to use an outside donor, including my sister Trudy. So, I'll go with a different transplant donor: Me.

With that decision made, my treatment regimen is called, R-BEAM. It stands for:

R - Rituximab (Rituxan)
B - BCNU (Carmustine)
E - Etoposide (VP-16)
A - Ara-C (Cytarabine)
M - Melphalan (Alkeran)

I've got the full schedule here, and it all starts on Thursday, November 8th, 2012.  On that day, I'll begin collecting my urine for 24 hours in a big collection jug which I'll turn in the next day at Karmanos.  Then, on Friday, November the 10th at 8:AM, I'll check into Karmanos for two 780 mg shots of Neupogen. I'll treat myself to 2 more at 8:PM. For the next 2 days, I'll administer the same amounts to myself - 4 shots per day.

On the following Tuesday, November 13th, I'll have surgery to install a Trifusion Catheter into the left side of my chest, opposite the port that's installed on the right side of my chest.

The next day, Wednesday, November 14th, I'll check into Karmanos at 7:30 AM for stem cell collection. For two more days after that, I'll repeat as necessary.

The Monday after that, on the 19th, I'll go in for Labs, Dr. visit and a visit with the pharmacist to talk about the chemo that's next.

On Tuesday, the 20th, I'll start the chemo with a Rituximab (Rituxan) infusion.

On Wednesday, the 21st, I'll continue the chemo with a BCNU (Carmustine) infusion.

On Thursday, the 22nd, I'll keep it up with an ARA-C (Cytarabine) chemo infusion. Same thing on the 23rd, 24th and 25th.

On Monday, the 26th, we'll change things up with a chemo infusion of Melphalan (Alkeran).

On Tuesday, the 27th, I'll have a day of rest from it all.

Then, on Wednesday, the 28th, it's...


From there on out it's all about recovery. I'll spend the next week or couple of weeks or maybe even a few weeks in the hospital working on getting my counts back up.  The time just depends on how long it takes to get my blood back on track.

On the 6th day after the transplant, Tuesday, December 4th, I'll start injecting Neuprogen shots again to help with that recovery process.

So, that's the plan, man! I'll update as this thing progresses!