Harvest Time

Friday through Monday I had double Neupogen shots.  Neupogen [Filgrastim, a granulocyte colony-stimulating factor (G-CSF)] may be very like a substance naturally generated by humans, but a lot of it certainly makes you feel weird.  First, the bone pain the doctor had warned about was real.  It was not significant during the day, as anything going on took my mind off of it.  But during the night when it was the main event, if I hadn’t taken a pill for it, sleep was unlikely.  I took pills each of the nights.  The pills last ~6 hours, so they wore off by morning.  Second, the body was aware that something was not normal.  I was aware that my heart was beating in a way that was just different.  I was simply more aware that my heart was beating.  The nurse Monday said it was because the blood was a different consistency.  Whatever it was, I felt that my heart was beating stronger.  It felt as if my heart was simply working harder.

I hope that cows on various dietary supplements, steroids, and antibiotics don’t feel as weird as I did.  At least I could ask questions and find out why I felt that way.  Clearly cows don’t have that option.

Friday my white blood count was 700.  Don’t ask what the units were.  The normal range is 4,000 – 11,000.  Anything under 1,000 is considered dangerously low, neutropenic.  By Monday, that low count was reversed: 51,000!  Clearly the Neupogen did its job over the weekend.

First thing Monday morning they took some blood for blood counts, gave me a couple of pills to make the day pass without worries, and then gave me yet another shot of Neupogen.  A specialist came by to explain exactly how she was going to put a line in my neck.  Specifically into my interior jugular vein.  The hospital had the courtesy to ask me to sign a legal document authorizing them to do that.  I was instructed to wash my chest and neck area twice the night and morning before with Hibiclens so that my skin would be germ-free.  She washed it yet again with another antimicrobial agent, and did the deed.  Actually, I don’t remember much of the procedure.  I was unable to see what she was doing, so it was just a series of different pressures on my neck.  There was a gauze pad that she discarded with some blood on it, but nothing spectacular.  All this happened on the second floor.  I got there on foot.  They took me back to the 5^th floor in a wheelchair.

Here is a shot of the line, once it was hooked up to the Pheresis machine.  It started out with just a short couple of tubes to which the rest of the spaghetti was hooked up.  The tubes were about 3-4” long.  One with a blue cut-off valve, the other with a red cut-off valve.  Anyone was working around the tubes wore an elaborate mask that extended with a clear plastic sheet to cover their eyes.  This was to prevent their breath from escaping from the mask and polluting the area of the line.  Apparently if you get any germs in your interior jugular, they go directly to your heart, where they can have nasty effects.

All these photos are courtesy of Barbie, my faithful Amanuensis.  She was studiously working with her scores and recordings when not recording what was happening with me.

At any rate, Christine, my Gryzmish 5 nurse (how’s that for the name of a hospital building?), spent a good 10 minutes hooking my up to the machine, adjusting the machine to pick up just the right distillation of blood cells, and testing the results.  Here’s the machine itself:

Here is Christine and me later in the morning when she took my blood pressure and temperature:

Here is what they were actually collecting:

Eventually, the bag got fairly full.  After about 3 hours of collecting, Christine called it a day.  She sent me home with instructions to be ready to take another Neupogen shot that night, if needed.  But at 4:50 Christine called to say that they had collected enough stem cells.  The goal had been to collect 10 million cells.  They actually got 9.1 million, and Dr Levine decided that the additional 900,000 was not worth hooking me up for another session.

Actually I had not gone home.  Barbie dropped me at our son Brian’s house in Jamaica Plain, so that I could get into the hospital easily the next day.  I would go in either for another round of stem cell collection or to have the line in my neck removed.  Barbie had gone home to Stow because she had students to teach and a chorus rehearsal to direct.  I was instructed to come into the hospital between 9:30 & 10 Tuesday.  Monday afternoon I took a nap.  Then I helped Brian fix a window that was not shutting.  Tuesday morning we got started fixing a closet on the 3^rd floor where I will be staying for 2-3 weeks when I am released from the hospital after the stem cell transplant.  A shelf was overloaded, and because it was not anchored on studs, it pulled out of the wall and crashed to the floor.  We got started, only to realize it was 9:15.  

I wanted to walk to the hospital (as Barbie had done on Monday), to gauge how long it would take me.  Unfortunately, it took me almost an hour, whereas it had taken Barbie only 45 minutes.  At any rate, I didn’t get to Gryzmish 5 until 10:20.  As a result I missed getting first shot at the neck line lady.  She got tied up in a procedure that took more than an hour and a half, so she couldn’t undo my line until noon.  By that time Barbie had arrived, intending to just pick me up.  She had to stay as we waited for my line to come out, and then to wait for 30 minutes to make sure the wound didn’t bleed through the bandage.  Finally, we were given strict instructions on how to dress the bandage and how important it was not to do anything foolish that would increase the pressure in the neck and cause the puncture in the vein to reopen.  No bending over, even to put on shoes.  No lifting of anything.  If I felt a sneeze or a significant cough coming on, I was to apply counter-pressure on the bandage.  Naturally I followed all the instructions, and the wound is healing nicely.

So the harvesting of stem cells is over.  It feels great to be off the Neupogen.  The son of some friends of ours down the street donated his stem cells for an allogeneic stem cell transplant.  That’s when the patient receives someone else’s stem cells.  [I will undergo an autologous stem cell transplant, where I receive my own cells back.]  I now appreciate what our friends’ son must have gone through.  I’m complaining about the process, and it is for my own benefit!  But it is over, so now we get ready for the next stage.  That is the stem cell transplant itself, for which I will go into the hospital on Friday, 10/26.