Thursday, November 19, 2009

Stem Cell Transplant Evaluation

On Monday afternoon, Huong and I drove to downtown Baltimore and checked into the Tremont Plaza Hotel for a two-night stay. People travel to Baltimore from all over the world to be treated at Johns Hopkins, and the Tremont has a long history of catering to Hopkins patients, offering them special room rates, and such services as a shuttle bus that will take them to and from anywhere on the Hopkins campus, which is a couple of miles distant. Arrangements can also be made to use the shuttle to reach the shopping, dining, and entertainment opportunities offered by the Inner Harbor area, which is actually close enough for the healthy to reach on foot, but possibly not for someone who is struggling. The upper floors have suites with separate bedrooms that can be closed off from the rest of the suite, which can come in handy in a chemotherapy situation, and presumably in others as well.

Tuesday was a long day, with the first appointment beginning at 7:00 A.M. and the last one ending around 5:30 P.M., and the appointments spread amongst three different buildings. We did a lot of running to and fro, but none of it out of doors, as all of our destinations were either in the main hospital, or in buildings connected to it by an underground concourse, or by an above-ground bridge.

First came the heart tests: a MUGA scan and a plain old EKG. The MUGA scan was a new one for me; it involves extracting a small amount of the patient's blood, adding to it a radioactive tracing substance, injecting it back into the patient, and then putting the patient under the scanning device, which produces a "film" of the heart's beating action.

Following this came a urine test and a spectacular number of blood tests; I became a little concerned when I saw the forest of tubes I was expected to fill. Then I was interviewed by the oncologist's assisting CRNP, who also gave me a very light physical examination. Next came a bone marrow aspirate: bone marrow was extracted from my locally anesthetized hip for biopsy.

The last appointment of the day was for a transplant education class, which both of us attended. We were joined by two other patient-caregiver pairs. As an aside, I have never had much of a problem fighting off temptations to indulge in self-pity, because wherever I go, I am constantly presented with examples of people in worse trouble than myself. Although I was by far the oldest of the three patients in the room, I otherwise had nothing to envy in my two patient classmates. One had endured a much longer and more grueling induction therapy than mine; she had already said farewell to her hair. The other was looking forward to an allogeneic transplant, using stem cells donated by her brother; allogeneic transplants are much more complicated and dangerous than the autologous transplant that I will undergo. One thing I learned in this class is that the catheter I will get is not a Hickman line after all, but a pheresis catheter (also called an apheresis catheter). Another is that one of the mobilization drugs I will get -- Cytoxan -- also has anti-cancer properties, and is used to treat various disorders, both cancers and non-cancers.

I felt barely human when I finally returned to the Tremont on Tuesday evening; I wasn't sure I would be able to remain standing long enough to prepare myself for bed. Wednesday's schedule was substantially more relaxed, beginning at 9:00 A.M. and ending before 3:00 P.M. First came a set of pulmonary function tests, measuring my lung capacity and my ability to efficiently utilize the oxygen drawn in by my breathing apparatus. Following this were, incredibly, more blood tests; had they not actually taken place, I'm not sure I would have believed that there were any remaining to be done. Possibly, they were designed to throw more light on issues hinted at by the results of Tuesday's tests. The day wound up with CT scans of chest and sinuses, and a bunch of X-rays.

Some of the tests were turned around before we left Baltimore; apparently the results of all these were in the expected ranges. We'll have to wait for the remaining results; in particular, for the bone marrow biopsy.

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