Prime Time in Rochester

Today I completed four rounds of priming, which chemically encourages my bone marrow to release stem cells into the bloodstream. Tomorrow the harvesting begins. Each morning—for as many as are needed to gather six million stem cells—I'll start my day with five hours of apheresis, where my blood (through intravenous ports) will be circulated through a machine that is clever enough to extract stem cells from everything else.

It's a pretty straight forward operation. After getting set up, I just relax and let the machine do its job. As I went through several rounds of this in Duluth in order to shed my excess plasma cells, I know the drill. I'll be sure to bring a book.

The staff estimates that it will take 2-4 rounds of apheresis to get enough stem cells, after which I should be all set to begin chemotherapy—which starts with the injection of a poison to kill off everything in my bone marrow.

Meanwhile, Susan and I have been settling into a routine during our first week at Transplant House, located just four blocks from the Mayo Clinic. At least at the outset of my visit here I am strong enough to walk to and fro between the two. It's a bit over half a mile one way on fairly level terrain and terrific exercise for my legs and lungs. As a bonus, I've noticed that my peripheral neuropathy (numbness and tingling in my hands and feet) has diminished since my walking has increased. Yay! Because I'm expecting my overall energy to nosedive after I receive the chemo, it's important to keep building strength now to help sustain it as long as I possibly can (I figure it's easier to retain than to recover).

One of the conundrums that Susan and I face is anticipating my food interests after I take the chemo. We've been warned that my sense of taste will be wonky after chemo and that I'm likely to suffer loss of appetite. That's unfortunate because I need to keep eating to maintain strength. My weight is down to 154 as of this morning (from a high of 206 back in October 2014, when I first experienced lower back pain) and the transplant nurses have told us that it's common for stem cell recipients to lose 10-15 lbs over the course of the protocol—an additional droppage that I am loath to shed.

Yesterday we went to a local farmer's market and bought fresh veggies, enough to make a large pot of soup, in anticipation that I'll like soup during recovery. I sure hope I do. Today we went to a grocery store and picked up more ingredients for the what-will-Laird-eat-after-chemotherapy-has-wiped-out-his-taste-buds-and-appetite sweepstakes, which we expect to begin playing sometime next week.

It was great being able to take advantage of the season (mid-July, with lots of stuff available fresh and local), the weather (lower 70s), and my burgeoning stamina to add a two-mile detour onto our walk home after my daily dose of neupogen. Susan and I then had fun cutting up in the kitchen, adding peas, corn, potatoes, carrots, onions, green beans, Great Northerns, and a couple of diced chicken breasts to a base jump-started with some garlic salt, a can of crushed tomatoes, and a box of chicken stock. Yum.

I'm anticipating that the trickiest part of the post-chemo period will be adjusting to the hygiene protocols while I'm immune compromised. Lots of hand washing, teeth cleaning 4x daily (using a sponge-like thing called a "toothette" because a regular toothbrush may cause bleeding), wearing a mask when out in public, and generally being what Elmer Fudd would describe as "wery, wery cautious."

While I'll probably be plenty tired of it by the time I'm past the danger zone (typically 2-3 weeks), there is no way around it; I simply have to go through it.

Reservations in Rochester

This week I got the call I wanted from the Mayo Clinic. They will begin my stem cell transplant procedure July 12. Yeehah! Here we go.

By implication this means the doctors are satisfied that my cancer is responsive to the chemotherapy, something I had to establish before they'd proceed, and that the protocol for the next two-and-a-half months is expected to be a continuation of the chemotherapy I'm already taking (and which I know I can tolerate well enough), aimed at gradually increasing my strength and recovery from the mess they found me in Jan 31 when I finally stumbled into the ER at St Luke's Hospital in Duluth.

Looking ahead, here's the front end of what will happen in Rochester. The first week is highly scripted. After that the schedule is more flexible, depending mainly on how I respond.

July 12-14                      Final testing begins.

Afternoon July 14          Meet with Dr Buadi (who oversees all stem cell transplants at Mayo). I need a green light from him after he digests all the test results. While we're expecting no surprises here, who am I to rule out surprises after all that's befallen me the past year?

Evening July 14             They'll start giving me injections to induce my bone marrow to make my stem cells available for collection.

July 18                           Begin harvesting my stem cells. This will proceed until they have more than twice what they think they need.

July 22 (?)                     Once they have the stem cells in hand, they'll give me an injection to kill off everything in my bone marrow.

July 24 (?)                     Two days later they'll reintroduce my healthy stem cells to start repopulating my bone marrow. The rest of my time in Rochester (perhaps six weeks in all) will be devoted to healing under close medical supervision, hoping that a robust response from my stem cells will dominate, placing the cancer in remission.

Mayo's has enough experience with transplants for people with my cancer and the volume is large enough that I'll be able to stay at Transplant House, a private facility in town (about a mile from the clinic) that is wholly geared to support people going through what I'll be going through. They have two large buildings conveniently located in Rochester (with daily shuttle service to the clinic) each of which houses abut 30 people. Each room has two beds (one for the patient and another for the primary caregiver) and a private bathroom. Kitchen facilities are open to all in the house with private storage space in the refrigerator and cupboards for each patient. Amazingly, this is available for $30/night.

I figure it will be a piece of cake adjusting to the housing after all my years in an income-sharing community. In fact, for me, being bivouacked temporarily at Transplant House will mostly represent an upgrade in living space. It will seem spacious. What do I need, after all, beyond a caring companion, a bed, a bathroom, a comfortable chair, a table, and an electrical outlet with a wifi connection?

Among other things, that means I won't miss spring in Duluth, which can be a tricky sighting.
No only am I a patient these days, but I'm discovering that being a Duluthian entails patience. Every day I look at the Minneapolis Tribune and peruse the weather maps. For most of April northern MN has stood out as the font of blue from which all other cold weather emanates in the continental US. It's impressive. And another week goes by without daffodils or lilacs.

I was driving to a rummage sale this morning when a person in the car casually reported that her husband was going to miss the sale because he needed to help out with the family maple syrup harvest. It's the second half of April for Chrissakes! Talk about a time warp. Sandhill would have wrapped up sugaring two months ago.

That said, the delay does not mean I've missed anything. Since I won't be going to Mayo's until July, I'm confident that I won't miss any spring flowers. Of course the upside of the delay is that the mosquitoes have not yet appeared either, which, up to a point, is a trade I'm willing to make. I give enough blood at the hospital; there's no need to give in the backyard as well.