Threatdown number 1!

It has been pointed out to me by one of my astute friends that bears are, in fact, omnivores. So, I guess I dodged a bullet on that one. I guess Colbert is right - Threat # 1 - Bears!

This Thursday, I took a day off and drove with Jane to Richmond to MCV. It was great to see downtown, Broad street, and the old hangout spots. Things have changed a lot in the city since I was there as a kid. But this was no sightseeing trip - our mission was to find out more about the transplant program at VCU. 

I think I've described the premise of this kind of treatment. But if you're new, (or if I haven't), here goes. The official term is 'high-dose chemotherapy with stem cell rescue'. The idea is that even with an effective chemotherapy treatment, such as the one I just finished, a cancer is not especially prone to remaining in remission. A good way to deliver the killing punch to such a cancer is to treat it with some hard-core chemo. The problem is that this level of chemo tends to destroy not only the cancer, but the patient's bone marrow as well. To keep the patient alive, it's necessary to regenerate the marrow by infusing a quantity of stem cells into the patient. These aren't fetal stem cells, but rather cells collected from the patient's own bone marrow or blood. If the patient donates these cells to him/herself, this is called an autologous stem cell transplant.

In my case, because there was extensive involvement of the lymphoma with organs outside the lymphatic system, there is a good probability that the cancer will return.  The doc estimated that this will boost likelihood of my remaining in remission by about 30%. That number sounded great to me, and so we're going to move foreward with plans to do it.

As a side note, I was finally congratulated on getting through the initial chemo, and the oncologist at VCU did use the word 'remission'. That made me feel pretty good, even though his plan he proceeded to describe wasn't so inviting.

So with the rationale for participating in this treatment out of the way, he proceeded to describe the procedure. 

In summary, here it is: 

1- I'll be assessed, to make sure the chemo to date hasn't made me unsuitable for the procedure. Being as healthy as I perceive myself to be, I think I'm a pretty good candidate.  It sounds like you'd need to be pretty sick to not get this one. I'll go to Richmond to get lots of pokes and prods at MCV for the assements.

2- A week or so later, I'll be given drugs to make my bones produce additional marrow, and push this marrow (in the form of stem cells) into my bloodstream. This will be an outpatient activity I'll do in Richmond over a few days.

3- My blood will be collected over the course of a few days and run through an apherisis machine (a centrifuge of sorts, as I understand it). This will separate the stem cells from the regular blood. The resulting cells from this will be collected and frozen.

4- I'm admitted to the hospital for the super-chemo. Over the course of the next week, I'm given 10-20 times the dose of chemo I received during my initial R-EPOCH therapy. The idea is that this will kill all of the lymphoma cells which might be hiding out in the marrow. This will wipe out my marrow, as well.

5- No marrow - no blood cells, no immunity, no oxygen to tissues, and no immune system. This is not a state you want to remain in for long. At the point at which the chemo has passed from my system (a day or two later), I'll be given back those frozen stem cells. This starts what I'm told is called 'Day 0'. This is when the fun really begins.

6 - It takes some time for the marrow to grow, and for the 3 weeks following Day 0, I'm to remain at MCV under supervised medical care. This is good, cause it sounds like I'm going to get all kinds of drugs to keep me from getting infected. And if this period is anything like my original post-chemo period, it promises to be pretty unpleasant.

7 - At day 21  or so, I'm released under my own recognizance to an apartment in Richmond. I'm to remain here for at least 3 more weeks. The doc says that this is absolutely necessary, as it's very common for infections emerge at this point. I need to be within 30 minutes of the hospital for this period. Woohoo - Shockoe bottom - here I come! :) 

8 - I get to go home. This is going to be nice, since I'll have been away from my family for almost 2 months. But for the next month or so I have to stay at home. No going to the office, and I'm to have no contact with anything remotely unclean. No trash, no cats or dogs, no snotty child kisses - nothing. 

9 - I follow up with my primary oncologist, and get released to go about my life as though nothing had happened. :)

So there you go - a simple 9-step program to get everything back in order. Sure, it may be a little more complicated, but now we have a plan. We'll find out more in the coming weeks. Thanks again, as ever, to all for your support, kind words and friendship!

Cells - I expect you all to cooperate!