Day Zero

For some odd reason they count the days in your stem cell transplant from the day you receive back your stem cells.  So yesterday was day zero.  I got my stem cells back.  The day I arrived and got the subclavian line was day -4.  The days I got the 2 doses of Melphalan were days -3 and -2.  Day -1 was a day of rest, and the day that I really started to feel bad.  First, I threw up my breakfast.  So I only had a few pills for lunch.  Then I had some preventative anti-nausea medicine for supper and I selected the blandest dinner imaginable: chicken noodle soup + macaroni & cheese.  It looked as if that did the trick until a powerful rumbling tossed it all down the toilet.  So yesterday all I had was a little fruit juice and chicken broth.  Those did stay down, thank heaven.

The big event yesterday was the stem cell re-infusion.  Here is the bag of stem cells (down is to the left):

Here is the tube containing the stem cells attached to the subclavian line that injects them into a space just above my heart:

Who is that bald guy?  I appologize for the orientation of the pictures.  I put them into paint and got them all nicely vertical, but somehow they reverted to what you see when I added them to the blog.  Twist your head appropriately to compensate for my incompetence.

Finally, there is the shot after all the stem cells have been reintroduced.  It didn’t take very long.  Let’s hope it has a powerful effect:

They sedate you somewhat for the stem cell infusion.  That plus the anti-nausea medicine made yesterday a pretty low-intensity day.  Mostly I just lay around sleeping and doing nothing.  Brian and Bridget came by and we played some hearts, but they took advantage of my subpar condition to slip me a couple of queens of spades.  You’d think some pity would be in order, but no.

The big news at the end of day zero was that I finally was able to move my bowels.  Not without a great deal of effort, but eventually a substantial, hard mass passed.  Thank heaven!  Now they predict diarrhea!  Drought or hurricane.  All I want is some normalcy.

Obviously today I was ambitious enough to get a blog post out.  I also tried for some breakfast, ordering bland oatmeal + applesauce and asking for some anti-nausea meds ahead of time.  But only the applesauce has made it down, and it does not feel very secure.  So the oatmeal will just have to wait.  In the overall scale of things, a little nausea is not a big deal.  Maybe this is an excuse to lose a little weight.

Finally feeling Low

Today the effects of the Melphalan are finally hitting me.  This morning I ordered a very bland breakfast, as I felt like yesterday’s supper had never really left my stomach.  I had burps & hiccups all through the night.  Well, I got about 3/4ths of a small container of cut pears down when my stomach erupted.  I did make it to the bathroom, but just.  Then lots more than the pears came up as well.  Eventually it was dry heaves, which are a treat unto themselves.

Since then all I have had by mouth is a few pills.  They have switched the ciprofloxacin to an intravenous dose, so it won’t get lost in the next eruption.  I kept the breakfast around for a while, as I assumed I would soon feel better, but that has not been the case.  I tried reading, but I kept dosing off, so I just took a series of naps.  The nurse tells me that she can give me anti-nausea medicine when I order supper so that I will feel like eating supper when I get it.

In addition to the nausea, I am generally feeling pretty low.  No specific pains so much as generally blah.  I spend a good deal of today just sleeping, and the decisions to get up and go to the bathroom or to get up and answer email were hard.  Ambition is lacking.  The doctors & nurses have pointed out that I am quite flushed.  A roseate glow, if you want to put it in positive terms.  And then there is the constipation.  I have not performed a bowel movement since Friday just after I arrived.  I have asked for help in that regard, but the doctors all say the Melphalan is certain to lead to diarrhea, so giving me much more than a stool softener (which really doesn’t do very much) is inadvisable.  Once the runs start, they will be difficult to control, they say.  I am taking their advice, in spite of a bad experience with constipation over the summer.

I can see the wind and the rain out my window, but little affects life here inside the cocoon.  Some of the staff may have to stay here overnight, as the MBTA shut down at 2PM.  If there is a general power loss, the hospital does have emergency generators, but not all the circuits are hooked up to the emergency power.  Some of the reading lights may go, but everything essential will carry on.

Meanwhile, Barbie took some pictures of the process yesterday.  Here is Barbie in gloves and a mask.  Quite the glamour girl:

Here is the nurse hooking me up to the Melphalan.  Note the hazmat suit she is wearing, in case some should spill.  Clearly nasty stuff.  Especially for women of childbearing age, which the nurses here are:


Here I am peacefully displaying Tom Jones as the poison drips into my system:

Finally here is the nurse, again in a hazmat suit, disconnecting the Melphalan.  The infusion does not take long, less than a half hour.  But clearly it packs a wallop:

Meanwhile the anti-nausea medicine has had the desired effect.  I have been able to keep down my dinner of chicken noodle soup and macaroni & cheese.  Whether that holds true for the rest of the night remains to be seen, as things are still rumbling down there.

Not so bad – Yet

I got the first bag of Melphalan today at 9:15.  Just before it, I got a bag of something to ward off nausea, and so far it has been totally successful. The Melphalan itself took about a half hour to infuse.  Then an hour later they gave me a dose of Lasix.  Lasix is a diuretic that causes you to flush fluids from your system.  In other words, pee like crazy.  They want you to do this to make sure the Melphalan does not accumulate in your kidneys and bladder, where it might do damage.  I am also on a continuous drip of saline solution, so I have lots of liquid flushing through my system.  So far, so good.

I am actually feeling quite well.  They say it takes 5-7 days for the effects of the medicine to take hold.  Melphalan is a derivative of mustard gas.  It causes fast-dividing cells to be unable to continue dividing.  According to Wikipedia it adds an alkyl group to DNA, thus interfering with cell reproduction.  So things that need to be replaced fast, show the effects first.  Your white blood cells live in your blood stream for 3-4 days.  So if their production is cut off, in 3-4 days your existing supply runs out, and your white blood count plummets.  That will happen to me.  Your blood platelets are also short lived.  According to Wikipedia, they last 5-9 days, so they will run out fast as well.  They are involved in blood clotting, so their reduction will make it so they no longer give me Lovanox to prevent blood clots.  Red blood cells, in contrast, live for about 3-4 months, so a lack of new blood cells will not become apparent as fast.  But (again according to Wikipedia), 2.4 million new red blood cells are produced per second in healthy bone marrow, so your red blood counts do drop as well.

Presumably the first dose of has wreaked its destructive effects already.  I just have not yet felt them.

I am learning the ins and outs of being a prisoner in my room.  My particular room does not have a shower.  So to get clean, I lather up a washcloth with soap and do a sponge bath in the bathroom.  Barbie helped by doing my back.  I didn’t do much to the right side of my chest, as the sub-clavian line is still tender.  The meals available from the low-bacteria menu have been surprisingly good.  They have you take something to reduce the possibility of infection in your mouth and throat every 4 hours.  You suck on a tablet and the medicine goes all down your system, keeping the bad guys at bay.  Apparently mucus membranes (which make up much of your GI tract) are fast-dividing cells as well, and they take a hit from Melphalan.  They have special toothbrushes that are extra soft because normal or hard-fiber tooth brushes can puncture your gums, leading to infection.  Similarly, you are prohibited from using dental floss, as normal flossing leads to a spike bacteria in your blood stream, as the teeth are a major source of bacteria, and inevitably you cause bleeding in your gums.

So all is well – for now.  Nurses, interns, & doctors are all monitoring me closely.  Presumably they are doing so for a reason.  I am curious to see what are the first reasons that show up.

Into the Belly of the Beast – or is it the Valley of the Shadow of Death?

Today I have entered the room in which I will live for the next 3+ weeks.  Room 782 in the Feldberg building of Beth Israel Deaconess Medical Center.  Guests must sterilize everything and wear latex gloves.  Initially Barbie was wearing a mask, which made her very hot.  But Dr Levine came in and he was not wearing a mask, so Barbie asked if it was required.  He said it was not, as long as she did not have a cold.

Here are Barbie & I just after we arrived at the hospital:

As you can see, a dramatic reduction in hair in the last week.

Moving in was not a trivial event.  We had to wash, dry, & pack in plastic bags all clothing I wanted to have available.  Any slippers had to be “new”.  You are allowed a laptop & cellphone, but they had to be wiped down with sterilizing towels.  Books and magazines don’t need any special treatment, as apparently germs are not carried by paper.  My body was the item that had the most treatment.  I was under instruction to take a hibiclens shower Thursday night and Friday morning.  Well, when I went to find the hibiclens (a special anti-bacterial soap) Thursday night, it was nowhere to be found.  I distinctly remember leaving it on the edge of our tub.  But it wasn’t there.  Then we remembered that I had to take a morning shower the last time I was admitted to the hospital, on 10/3.  We had to get there early, so we stayed over at Brian & Bridget’s.  So that was where the hibiclens ended up.  So I substituted antiseptic wipes for hibiclens. We went to a play Thursday night in Lowell, so on the way back we stopped at a CVS and bought yet more hibiclens.  So this morning I took a full hibiclens shower.  Then when I arrived here at Feldberg 7, they had me wash my chest with a special anti-bacterial soap.  Not hibiclens, but the same active ingredient.  Eventually, when the surgeon was ready to do the line insertion, he did yet more cleaning of the area.  So, I who am not normally so clean, am spick & span clean now.

The big event today was the insertion of a sub-clavian line.  That is a line that goes in under your clavicle.  And the line follows a vein all the way to the blood vessel right by your heart, the vena cava.  A surgeon came in and turned my room into an operating theatre.  He administered novacain to my right shoulder/chest, so I didn’t really feel anything.  He explained that someone in the 50’s came up with the idea of inserting a flexible wire into the vein you want, and then putting a larger tube in over the wire.  Finally, you take out the wire, and you have the tube where you want it to be.  When it was all done, they took an x-ray to confirm it was in the right place.  They brought in a portable x-ray machine, so I didn’t have to go out into the germy world.  The x-ray showed the tube looping around and going all the way into my chest, right by my heart.  It feels generally sore there, but I am now receiving fluids through it, so it must be working fine.

Here is the view from my window on a sunny day:

Here is a bald guy pointing at the calendar:

Barbie gets credit for the photos.  She is documenting the process.

And here is a view of the room itself:

A nice room, but pretty small for a 3+ week stay.

Dr Levine came by to see if everything was OK.  We got talking, and he mentioned that places like The Mayo Clinic do stem cell transplants in an out-patient clinic.  They have the patients very close to the hospital, and they monitor them every day.  Should they get an infection, they admit them into the hospital and take appropriate measures.  But if not, they stay as out-patients and cost less.  When the insurance companies force the Boston hospitals on the issue, then the BI will adjust their policies.  Meanwhile, the in-patient procedure is safer.  So being a prisoner is a good thing.

So far nothing foreign has been introduced into my body, except for the plastic tube in my vein.  Tomorrow morning, probably around 9AM they will start the chemo.  Melphalan is an aggressive drug that attacks all fast-dividing cells.  I will get it tomorrow and Sunday.  Then a day of rest.  Tuesday they will reintroduce my stem cells.  So all this lies ahead, in the near future.  I am apprehensive, but hopeful that they can mitigate the nastiest side effects.  Time will tell…

Really Losing It Badly

You really know you are losing something when you see it circling the drain:

I thought I had weathered the Cytoxan administered at the start of the stem cell collection process without any serious side effects.  After all, that was over 2 weeks ago.  But Thursday I noticed that my hair felt different when I shampooed it.  And you see the aftermath of a shower on Friday above.  Combing my hair is like brushing the hair of our 11 year old yellow lab Colby who is currently deep into shedding season.  It results in a shower of loose hair that can get into just about anything.

So far I am not yet bald, but that does not feel as if that is very far away.  If I pull it, hair comes out is great gobs.  Otherwise there is not much medically going on.  I am just trying to close things out before going into the hospital on Friday for the stem cell transplant.  This weekend both boys were here, and they got lots of things done that I normally would have taken care of.  It feels good that the gutters clear, a project to remove 50 year old yew trees that were choking the house is complete, and tree limbs that came down in the Halloween snow storm last year that were blocking out pastures have been cleared away.  Barbie organized a family “last supper” for me Saturday night, and it really felt good to have their support.  Plus it was a treat to have Tyler, the ultimate tractor fan, sitting on my lap as I drove the tractor in support of the boys’ efforts.

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.  

Getting Ready to Collect

I am now into the 2-a-day Neupogen shots part of the lead up to stem cell collection.  I never did have many bad side effects from the Cytoxan they gave me last Wednesday night / Thursday morning.  I did go in this past Friday for a check of my blood numbers.  The general blood counts were better than they expected.  My white blood count was 700, whereas the normal range is 2,000 – 8,000.  Any count less than 1,000 is considered neutropenic [a condition of an abnormally low number of neutrophils (white blood cells)].  So I am supposed to stick to a neutropenic diet, which means no raw vegetables (salads), any cheeses with molds, or anything that has been in the refrigerator for more than 24 hours.  The last condition has the greatest effect, as much of our diet consists of long-in-the-tooth leftovers.

The double Neupogen shots do result in some bone pain.  Since Neupogen increases white blood cell generation in the bone marrow, doubling up causes so many white blood cells to be created that they are forced out into the blood stream.  So the bones with blood-generating bone marrow end up causing some pain.  The back, hips, big leg bones, breast bone, and ribs.  So far it has mostly been the back, ribs, & sternum.  The good news is that the pain pills they gave me worked fine last night, and today it has not been very bad.

Tonight I get to take a special shower with hibiclens, a special antimicrobial skin cleanser.  I get to take a second shower with hibiclens tomorrow morning to minimize the chance of an infection when they put in the line for the stem cell collection process.

So things are going well.  In fact, better than we could ever have expected.  More to come after actual collection.

Feast Time at BIDMC

Note the exquisite cutlery for the Thai food.  Quite a fine support group.

Start of Stem Cell Collection

Wednesday, 10/3, we went into Beth Israel for the start of the Stem Cell Collection phase of my treatment.  Things have gone well so far, but the side effects are just beginning to hit me (Thursday night).  So the odds are great that this blog post will be a several –session effort.

First there was the issue of whether something had to be done to my teeth before I underwent the SCT (stem cell transplant).  I had a cleaning on 9/24, and they took a full set of x-rays.  There was some concern about shadows in my left jaw under a 1986 root canal.  The shadows indicate something might be brewing there.  The latest prior x-ray of that part of my mouth is 2005, and it looks very much the same.  The solution would be to pull the tooth and graft some bone there.  But I feel nothing amiss there, and there is no observable change from the 2005 x-ray.  The question is whether an infection would be unleashed when my immune system is completely down.  So the x-rays and questions were sent to a dental unit at Brigham & Women’s Hospital.  The response was that nothing needed to be done before my SCT.  Thank heaven, as that would have delayed everything by quite a bit.

So we set off on Wednesday at 8:30AM.  As we were leaving, painters were arriving to redo our bedroom.  Our bedroom has not been redone since the owners prior to the ones from whom we bought the house, so it is at least 35 years old.  And there was water damage from a leaking gutter that we  fixed the first year we were in the house, 1982.  Since mold is the enemy of anybody with no immune system, that bedroom was a fortress full of enemies.  Barbie is still deciding on new window treatments, so it will be a while before the upheaval is completed.

Meanwhile, the traffic proved why I will need to be much closer to the hospital when I am released after my confinement.  Near gridlock prevailed on several intersections west of 128.  Overall it took 1:45 for us to get into the hospital.  They took blood, and I went for a full body x-ray scan.  The blood indicated that everything was still fine for the SCT, and the bone scan was to establish a baseline to compare against later.

The doctors listened to my vitals and declared everything was ready to go.  I did ask about the planned treatment, as I had spoken to someone who had taken Neupogen as part of her treatment for lymphoma.  In her case it had enabled her blood counts to recover.  And the Wikipedia entry for Neupogen says “Filgrastim (another name for Neupogen) is in a class of medications called colony-stimulating factors. It works by helping the body make more neutrophils.”  Neutrophils are white blood cells.  That says nothing about causing stem cells to go into the blood stream so they can be collected.  The doctor explained that the Neupogen causes so many white blood cells and stem cells to be created that there is no more room for them in the bone marrow.  Therefore, they are forced out into the blood stream.  That is why one common side effect is bone pain, as the cells are forced out.  He promised me that I will soon learn what bone pain feels like.

The next step was to admit me to the hospital (in a different area, Feldberg 7) for an overnight stay.  The result was mostly waiting.  They stuck in an intravenous line.  The technician said they rejoice when they see veins like mine.  Then they started a saline drip to make sure I had sufficient fluids and to counteract the anticipated effect of the Cytoxan on my bladder.  Apparently Cytoxan can cause bleeding in the bladder, and frequent urination is an antidote.  Then there were other pre-Cytoxan bags of medicine they needed to give me, the names of which I have forgotten or never knew.  Then they had to wait until the Cytoxan doses were “made up”.  Finally around dinner time the Cytoxan arrived.  I got 3 doses, each of which took an hour to infuse.  They were spaced at least 2 hours apart, so the final dose was not finished until 4:30 AM.

Meanwhile, my sister Teena arrived at Logan from Portland, Oregon for a visit.  She is here both to visit me and to visit our new niece, Georgiana Bingham, Margo’s new granddaughter.  Olga and Brewster Bingham live in Acton, which is adjacent to Stow, so Teena is getting 2 birds with one stone.  Teena went by the T to Brian & Bridget’s in Jamaica Plain.

The evening turned into quite a social event.  First Bridget arrived after a 5-mile run.  This is a busy doctor who is 5 months pregnant.  Then Brian and Teena arrived with Thai food for supper.  While we were eating, Elizabeth Beck, a Physican’s Assistant who lives with Brian & Bridget joined us.  Elizabeth works at Children's Hospital, and Bridget knows her from the year she did an internship there.  After enjoying Thai food (while getting a various drips), we all watched the presidential debate.

One of the things they give you along with the Cytoxan is dexamethasone, a steroid.  That is the same as I got over the summer, and once again it kept me awake.  I actually got my second dose of Cytoxan at 11:30, so I took a pill to help me sleep then.  The net result was I probably read an extra 50 pages of my book (Why Nations Fail – which explores why some countries are rich and others are poor even though they have the same external characteristics – a good book).

The net result was a highly interrupted night of sleep.  But I didn’t feel too bad on Thursday.  Barbie & Teena stayed in Jamaica Plain.  Barbie + Brian went to a BSO Open Rehearsal.  The doctors on duty came by and declared I was still alive.  Teena arrived mid-morning, soon after I had a shower and changed to civilian clothes.  But the medical adventures were not over.  They took some blood tests, and I was low in calcium and phosphate.  So before I could be discharged, I needed yet another bag and a half of fluids.  All this was happening as an anticipated deadline of 12:30 was approaching.  12:30 was when we were anticipating the BSO Open Rehearsal would be over and Barbie would arrive, eager to get to Stow for afternoon piano lessons.  But we had a slight reprieve in that the rehearsal lasted until 1:00.  As it was, Barbie got to park and come up to the room before all the drips were finished and I could be discharged.

I was glad I was not driving home, as in spite of both Barbie + Teena as companions, I fell asleep a couple of times during the ride.  As it was, it was a high pressure ride as the first 2 students were cancelled, and it was nip and tuck whether we would get home in time for lesson 3.

Teena & I set off for town, as I had to submit 4 prescriptions to be filled.  We then went onto Acton to visit Georgiana, our new niece.  She is now 3 weeks old, and doing very well.  We both got to hold her after she was fed.  She didn’t fuss at all, and she made all the little cooing noises that delight aunts and uncles.  Eventually I started to get the hiccups, and decided I had better get home to my storehouse of medicines to help control the side effects.

By this morning (Friday) the side effects were starting to kick in.  The most severe was nausea.  I really didn’t know if I was going to keep my cookies down, and I ate my breakfast fruit with a bowl handy.  One of the prescriptions we took to the pharmacy Thursday afternoon was a refill of the anti-nausea pills, so I went up to the pharmacy and picked them up.  It made all the difference, so the bowl became superfluous.  Ultimately I spent most of the afternoon taking a nap, as the fatigue set in.  I am still feeling pretty good, but I wonder how much that is because of the steroid, which you take for 2 days after the Cytoxan.  I have noticed that the steroid has the effect of making me much testier than normal.  I tend to bark back much more when I perceive I am being nagged (sometimes even when the source says she is not nagging).

We plan to retreat to Vermont this Columbus Day weekend.  Two reasons.  First, to see our grandson, Tyler, who is a delightful 2 ½.  Second because there is a WWII reenactment in our neighborhood that will make life unbearable here because of the noise.  The noise is all the more obnoxious because we believe the airport it originates from was created under false pretenses.  It will also have the effect of traffic gridlock, so we are escaping as soon as possible tomorrow morning.

At 5:30 this evening I injected myself with my first shot of Neupogen.  It comes in individual vials?? That you inject subcutaneously.  You either inject them in your belly fat or in a fold of skin on your legs.  I find the belly fat easier.  This probably is because in the absence of running I have developed a bit of flab.  Or because I am now 3” shorter, the stomach is not stretched out as much.  At any rate, that is where I got the Velcade over the summer and that is where the Neupogen is going now.  It has the benefit of not bleeding.

So that is the start of the stem cell collection process.  I am told my blood numbers will plummet over the next week.  That should make me feel pretty crummy.  Then the Neupogen should kick in.  More boring details to follow.