Happy Birthday, Rick!

I have a second birthday now. On November 8th we infused Ann's stem cells into my blood. Hopefully, it has already found my chemo-dead bone marrow and has started growing. We'll know in a few weeks.

This whole process was started with two rounds of rather caustic chemo in Seton Hospital. That part turned out to be the hardest. Being tethered to the wall via the IV tree (Charlie) was a little too confining for me.

Then we moved to San Antonio on November 1st. We have the largest 2 bedroom apartment I could get just across the street from the La Cantera shopping mall. Oh, and right next to the La Cantera Resort Golf Course. I'll practice there when I feel better.

On November 2nd I started 5 days of outpatient chemo. That was designed to kill as many cancer cells that were left as possible and to wipe out my bone marrow while not quite killing me. That is the doctors' balancing act. I don't think they give enough chemo that it kills directly, but they are constantly worried that it will damage some other organ or initiate some other illness that kills. Consequently, they are constantly measuring and testing through the process.

They needed to wipe out my bone marrow (or very nearly so) to create a blank slate where my donor's (Ann's) cells could take up residence. I understand her DNA will actually replace mine. I also assume her allergies and a few other things. If I start cross-dressing, just shoot me! It takes about two weeks to know it is working and about a month to know to what final extent.

To give me her stem cells Ann had to endure a lot. She started with five days of growth hormone shots that caused her bone marrow to over-produce stem cells and force them out into the periphery blood system where they can be more easily harvested (no bone marrow tap). This process causes headaches, bone-aches, and other uncomfortable side-effects before and after collection; but the hard part was collection.

On collection day they put a large straight needle (a transfusion needle) in each arm and hook them to a centrifuge machine. The blood comes out of one arm, the stem cells are spun out, and the processed blood (less stem cells) is put back in the other arm. Ann had to lay in a hospital bed, moving very little, while they collected as many stem cells as possible. The first day was about 8 hours.

Usually one day is enough, but I think Ann's cells knew where they were headed and they were reluctant. We wanted 5 million + cells and only got about 3.5 million volunteers. Consequently, it took a second day. Her two days were far worse than my five days of chemo. I sincerely appreciate that she was willing to do that for me.

The first batch had to be frozen because it was collected more than 24 hours prior to use. The second batch was kept thawed and was infused into me first. They used several large turkey basting syringes to "push" this fluid that looks like thickened blood into the tubes in my chest. I had no reaction at all to that batch. I guess my bone marrow really was dead because it never saw Ann's cells coming!

The frozen cells were different, but the reaction was to the preservative they add when they freeze it, DMSO. Yes, that is the horse liniment we used to rub on sore joints! I immediately got a dry cough, a tightness in my chest, and became very flushed. Is that what menopause feel like?? Are you that old, Ann?? As soon as they were done (about 10 minutes) the reaction stopped. I ate a late lunch and took a drug-induced nap.

I've felt a little better every day since, though Dr. LeMaistre says I will probably get more fatigued for a week or so before I really start improving.

From here a whole lot of measurin' will be goin' on. I'll go to the hospital every day, give blood and see the doctor. If anything is out of kilter, they'll adjust medicines, give me a transfusion or put me in the hospital. By Thanksgiving, those visits may be down to every other day and by early December, twice a week (I hope).

During this and for the next year or so, we'll have to watch for signs of Graft vs. Host Disease (GVHD) or rejection. It can be treated, but must be dealt with quickly. And, since the greatest risk is closer to transplant we will have to live in San Antonio, close to Texas Transplant, through December. For most of 2008 I'll make frequent trips to San Antonio to see LeMaistre. I'll take advantage of that to see my clients here.

Well, it's time to go to the hospital for my daily visit. More later...

RICK