After-Action Report: 11/26 - 11/29

Still trying to catch up to the present, before I begin to forget things.

Thursday 11/26: We were at home for Thanksgiving Day, and of course nothing happened, medically speaking. I enjoyed a relaxing evening with a small company of family and friends, and I was able to forget my troubles for a few hours. I drank a bit of wine, since I will soon be chafing under a six-month alcohol ban. After dinner a birthday cake appeared, and I was serenaded by the assemblage in the traditional fashion. I was also given the gift of an Amazon Kindle, which should cut down on the clutter of reading material I would otherwise have to drag along with me, to make the long sessions in the Hopkins IPOP clinic bearable. Thanks to all who contributed to the cost of the purchase.

Because of the next day's procedure at Hopkins, I was subject to a midnight cutoff of any consumption of food or drink. Also, for the same reason, I had been given a set of large antibiotic wipes, which I was expected to use to clean myself from the neck down, both before going to bed, and then again upon rising.

Friday 11/27: We drove back to Baltimore in the morning for the only significant activity of the day, which was to have my catheter installed. Once again I was required to sign a small pile of consents, after which I was conducted into a small operating room. I was given what I believe is called conscious sedation, or twilight anesthesia, meaning that I was not completely unconscious, but experienced no pain. I could hear and comprehend the surgeon's warnings: "...a little stick here... some pressure now... more pressure...". Eventually I found myself in a recovery room with tubes sticking out from under a dressing on my upper right breast, but not much the worse for wear. By early evening we were back in the Tremont Hotel, in exactly the same room as before. The only lingering effect was fatigue, which along with the next day's early IPOP clinic appointment, sent me to bed early.

Saturday 11/28: On my official stem cell transplant calendar, this was Day 0 of my treatment. By 7:45 A.M. I was in a "private" IPOP cubical, measuring perhaps seven feet square, with a curtain providing the "privacy"; and I was attached to an IV machine that was pumping a saline solution into me. The key stem cell mobilization drug, Cytoxan, is in fact a powerful and dangerous chemotherapeutic agent in its own right -- so dangerous, in fact, that the nurse handling it had to wear special protective clothing and gloves, and I had to be given a collection of protective substances both before and after receiving it. I was given the saline solution for a couple of hours before the two-hour Cytoxan IV was itself begun, and for several more hours after it completed. Meanwhile, I was also given mesna, to protect the inner lining of my bladder from being irritated by the Cytoxan once it had been processed by the kidneys; ondansetron, to combat nausea; and, lo and behold, my old friend dexamethasone, for reasons that remain mysterious. At some point some blood tests were run, and I was found to be low on potassium, and sure enough a bag of some potassium compound in solution was added to the array being dripped into me. By the time the entire process was completed, it was well past 6 P.M., and I was quite bloated around the mid-section; I was told to take an extra dose of furosemide for this before bedtime, so as to lose more of the fluid overnight. Back at the Tremont, I began to feel the nausea coming on, and very nearly lost it after taking my evening medications, but managed to keep everything down in the end.

Sunday 11/29: We checked out of the Tremont before noon, and made our 12:30 P.M. IPOP appointment. Blood tests indicated no need for me to be hooked up to any more IVs, so after getting my first subcutaneous shots of Neupogen, we left Baltimore once again. We were given enough Neupogen to last until we return at the end of the week; I must get shots of it daily while at home. It is meant to stimulate the production of white blood cells, and their movement out of the bone marrow. I was still feeling mildly nauseated by the Cytoxan, so I was also given several doses of ondansetron to tide me over for the next couple of days, until it could be completely processed out. Other than that, my only continuing problem was fatigue, for which the only remedy was rest.