Monday, March 7, 2011

Brought to you by hospital wifi...

Chemo's on for this week. I already knew my counts were up, since I had to make a quick Saturday trip to the ER to get an infection in my surgical wound checked out. Higher counts and a lack of fever or systemic infection saved me from spending the night at the hospital, but I still had to spend four hours letting surgery prod me before they decided I was safe to go home on antibiotics. I suspect surgeons sometimes forget that their conscious patients are going to feel and react to pain.

Anyhow, counts are up and surgery gave the go-ahead, so I will be receiving chemo this weekend with etoposide and cytoxan, five days. Unfortunately, this round can't be received at home, so I'll be enjoying hours in day hospital every day this week. And by enjoying I mean trying not to cry and/or break things. I almost did the former after sitting in the waiting room for over an hour.

Now I'm actually in day hospital. I ordered froot loops for lunch, because I saw a little girl a third my age munching on a bag and it seemed like a great idea. Oooh and there's that lovely wave of crappiness I get during every cytoxan infusion.

The doctor just dropped by and informed me the main tumor has decreased in size by 50%. Turns out the reason she did an ultrasound so early was to document a response so she can move forward with plans for eventual stem cell harvest and transplant. 

Oh look time for more science. What is a stem cell transplant?  A stem cell transplant is a transplant of bone marrow given after either intensive chemotherapy or total body irradiation. The logic of stem cell transplant seems frankly insane outside of the context of oncology. First, the doctors need to harvest bone marrow by using to drugs to amp up the production of the patient's or the donor's white blood cells (which are produced in the marrow) and then collecting those cells from the body. Then, they more or less attempt to destroy the patient's existing bone marrow with high dose chemotherapy, total body irradiation, or both. Obviously, this brings the patient close to a state one might call death. Doctors then "rescue" the patient by transplanting the previously collected marrow stem cells.

Your next question might be, why the hell would they ever do that? Well, some cancers infect the bone marrow, so the goal of a transplant is to replace cancerous with healthy marrow. These patients have to receive donated marrow. In cases like mine, the goal is to give the really aggressive chemo and/or radiation without subsequently killing the patient. My doctor went fishing in the records for other cases like mine and thinks evidence warrants this kind of treatment for me.

So the current and as always subject to change plan is to get a CT in around 2 1/2 weeks and if that checks out move forward with surgery to remove the rest of the tumor and then harvest my stem cells while I'm recovering from surgery. I know, sounds so fun you want to sign up, too!

An aside before I give up writing and succumb to a nap: all these little sick kids need to stop breaking my heart. The little guy next to me was sobbing in terror when they were placing his IV and then when asked about lunch whispers "strawberry jell-o" in his thick accent. Too much. Just too much.

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