GVD- treatment 2

Yesterday I had my second treatment of GVD. The doctor said my bloodwork looked all good and physically I look pretty good. The mucositis that was starting earlier this week is both better and worse. I now have one open area behind my last tooth on the bottom left, but I don't have the feeling that my whole mouth will erupt into one giant mouth sore. The doctor looked at my sore and said "Yea, that will get worse." and gave me some suggestions for treatment/prevention and to ask for a script for pain if I needed one. With past chemos I've been exceptional at keeping mucositis to a minimum and I hope this round will be the same. I use a homemade saline solution a couple times a day (I prefer a slightly hypertonic solution as opposed to isotonic solution. It seems like the extra salt helps with inflamation in the short term) I do a quick brush after each meal, not a full-on brush but just to decrease the bacterial load in my mouth and I use a low alcohol mouthwash twice a day. It may seem like a lot of work but you have to remember that this is the protocol I used during my Auto transplant and I never developed mucositis then (A hospital record, I do believe).

This afternoon I'm supposed to go into the clinic and get a shot of Aranest and neupogen. These shots boost both my red blood cells and white blood cells. The chemo is famous for dramatically lowering my blood counts and the shots will support my levels so I don't need a blood transfusion or antibiotics. The worst part about these shot is that a couple of days after the injection I feel literally like iv'e been beat with a baseball bat. Iv'e had both these shots before individually and this will be the first time I get them in tandem so I expect to really be hurting in a couple of days. I suppose this is the price of avoiding another blood transfusion, which to me is the worst thing I've been asked to do during this whole cancer thing.

On a nonhealth related note, last night the whole family plus Auntie Em went to see Sasame Street Live. It was really fun, josh was jumping up and down and clapping and yelling at Elmo and the rest of the gang. The evening almost didn't happen because I accidently ordered the tickets thru ticketmaster and bought tickets for the wrong date. When I called to see if I could exchange for that nights show I got the standard "Its not our policy to exchange B.S." I'm not entirely clear on the circumstances but someone that had been following my treatment progress in the internet made a couple of phonecalls and arranged for tickets to be waiting for us at the ticketbooth free of charge to us. How Awesome!!

A Touch of mucositis

I woke up this morning and I could feel the beginning of mouth sores starting in my mouth. As of yet, I don't have any open spots or any areas that particularly hurt but I can feel that my mouth is getting "hot" in places. The mouth sores are the number one most commonly reported side effect of the chemo I'm on, and combined with my eternal steroid use, it's no suprise that I'm starting to get sores. I have some pretty good meds around the house that are left over from the SCT that I can (and will) use.

With this chemo I have changed my philosophy on pain management. On all the previous regimines I've accepted a certain level of pain and not used pain killers unless really needed (translation: never). The reason I accepted the pain was so that I could have an eyes wide open view of any changes within my body that might manifest as pain. With this GVD, if I even think I MIGHT have pain later, I go straight to the Lortab. I'm not messing around this time. The pain I'm experiencing is reasonably light, intermitant and easily treated. Mainly it is concentrated in my left lower lung and right lower lung. The significance of this is that this is obviously where my most threatening tumors are and the pain has really only taken hold since I've been on the chemo. I take that to mean that there is alot of inflammatory process going on in these battleground areas, and what that means to me is that there's some serious cancer killing going on there to. I have this irrational fear that I will become addicted to the Lortab and once chemo is over I'll have trouble kicking my habit. I know thats ridiculious but I've been pretty hardcore about not using pain killers and a total shift in doctrine towards a near habitual use is akward for me.

Anyway, in total GVD chemo remains the easiest chemo to date. Energy is still high, motivation still good. I'm having a little trouble sleeping (trouble falling asleep and staying asleep) but I still think it could be steroid effect. I fell off the decadron a couple days ago (the main suspect in my sleep trouble) and I taper off the prednisone before too long so I hope everything will resolve itself in a few days.

GND is pretty easy

The side effects from the GND chemo are still pretty light. The only thing really to report is the steroid effect I get. The steroids I get along with the chemo make me kinda anxious and give me a touch of obsessive-compulsive behavior. I get phrases and ideas stuck in my head and I can't stop thinking about them it's really more annoying than anything else. Otherwise, energy is good, appetite is very good, spirits are up, plan is to keep doing what I'm doing until something changes.

How do I restart this stupid thing?

Well, it’s been several months since my last update and I’ve have a lot of things that have happened in that time frame. The quick run-up to now is that my Auto SCT went in practice better than it could have been written about in the textbooks. However, the treatment was ineffective against the cancer and I relapsed after about three month’s post-SCT. The next step was to enter a clinical trial of the new chemotherapy called MGCD0103. The purpose of this chemo is disease stabilization. Instead of eradicating the cancer, the plan is to slow or stop the tumor growth while I recover from the Auto-SCT. I was on MGCD for about 5 months with good results until this week when a routine CAT scan showed that the tumors had begun to grow again. The main site of interest is the tumor in my lower left lung that had doubled in size and is now about the size of a small baseball. Since my cancer obviously isn’t responding to the MGCD anymore my oncologists have switched me to a more conventional chemotherapy called GVD (also known as GND) it stands for Gemcitabine, Vinorelbine, and pegylated liposomal Doxorubicin. I had my first infusion of the new GVD chemo a couple of days ago and so far have been pretty lucky to have little to no side effects. A few people I have talked to that have been thru this chemo say that it is pretty easy to tolerate and one person put it as “my favorite chemo so far.” We’ll see… I’ll update in a couple days to let everyone know how it’s going.

Day +14 Home

Yesterday (day +13) I was discharged from outpatient service and today (Day +14) I actually returned home. I've been in Omaha for exactly one month from start to finish. I could have returned home yesterday but had some unfinished business at the local clothing stores in Omaha so I delayed my return by one day.

Day +12 Trip to the Mall

Today I'm officially an outpatient. The first thing I did was go and check out the malls in the metropolitan Omaha area. Total time spent walking around: 4 hours. Total money spent: $0.00. The only reason I mention this is the demonstrate how quickly my strength has returned.

Day +11 Discharge

Today my WBCs jumped to 3.6 and the doctors confirmed that I'm being discharged today. All my symptoms have resolved themselves and I feel like practically a new man. I'm still a little sluggish and fatigued but that will change in time. The nurses expect me to be discharged by noon so I have some packing to do this morning.

Day +10 - WE HAVE CELLS

Today my WBCs were 1.0!!!! That means my bone marrow is starting to regrow itself and I won't need blood trasnfusions or antibiotics anymore. The doctors say that since I'm feeling much better I will probably be dismissed from inpatient service tomorrow and probably dismissed from outpatient on Wednesday. That means going home on Wednesday. Just as quickly as my cells came, my appetite returned, not at full strength but at least it's not a chore to eat. The loose stools have stopped also. The only kinda bad thing that happened today is that I needed to get some IV potassium because I lost so much during the loose stools.

Day +6 thru +9: Buying time

The past couple of days I have been lying low waiting for my WBCs to kick back in. I wish I had the energy or motivation to write more about these days but there really wasn't anything special about them. Loose stools and nausea persist but are getting easier.

Day +5 - Holy Crap this SUCKS

Well, the preliminary blood tests came back and were of course negative for everything (They always are) and the stool cultures came back negative for C-diff, which means that I'm off isolation (I forgot to mention that they assume you are positive for C-diff until you prove them wrong). Other than that I'm in survival mode, eating 5% of my meals drinking as much water as I can tolerate and trying to walk around, which is beginning to be increasingly a chore. After about 300 yards I need to take a 10 minute break before I can do the 300 yard trek back to my room. The fevers are intermittent and last for only an hour or so. My bowels are still a disaster and I spend about 25% of my waking hours in the bathroom. The doctors say that I’m doing exactly as expected and that by this weekend I should be feeling better. He said that I should not be disheartened by this hard time. I told him I was a Soldier and could take a lot more and have been thru worse things than this.

Day +4 Neutropenic fevers

I woke up early this morning with full body chills and a new unexplained pain in my left jaw, right behind the angle of the jaw. I lied in bed fro about 20 minutes contemplating whether I could call the nurse or just go back to sleep. I eventually woke up Carrie and told her to call the nurse. After the nurse did a quick assessment, I found myself down in the treatment room getting prepped for IV antibiotics. My temperature was 100.5. The PA on call prescribed the antibiotic, Cefepime, IV three times a day until my counts return. The PA also ordered a blood culture to determine what microorganism was causing my fevers. He also ordered stool cultures to rule out C-Diff infection, which is a nasty little bug that preys on immuno-compromised people. The pain in my jaw is suspected to be an infection of the parotid gland, which is exactly what I thought it was when the pain started. It seemed like the antibiotics started working immediately because ass soon as the dose was over I felt a little better. I finally got back to my room at about 0445 of day +4. I spent the majority of the waking hours in bed trying to keep warm or on the toilet trying to … well, you get the picture. My appetite practically zero and I eat only because I need to keep myself healthy. I feel like I’ve had it pretty easy so far but I think things are about to get pretty deep.

Day +3 - King on his Throne

The most exciting thing about today was the loose watery stools that I had all day. In total I had 4 stools and the nurse gets concerned after 5-6 so I'm good for now.

Annoying? -Yes.
Getting my down? -No

My WBC's dropped to 0.2 today. They didn't bother doing a differential because the white cells were so rare. I'm sure my ANC is below 300.

This evening my temp has crept up to 99.0 and my appetite has fallen to about 10%. I keep hydrated and active but I'm just not hungry. The nurse said this is completely natural and expected, I'll probably take this opportunity to loose a few of those post chemo pounds (Dont tell my nurse) Anyway, the nurse said a neutropenic fever in not uncommon and well treated if I develop one. For now the game plan is to hydrate like mad and eat what I can. Sounds like the Army...

Day +2, Blood transfusion

So my HGB dropped below the 8.0 limit for acceptable amounts in my blood. This morning it was 7.7, Guess today I get my transfusion. I have a childhood phobia of being infected with some bloodborne pathogen so I was pretty anxious about this whole thing. One good thing is that the blood supply in a "volunteer supply" which means that the donors are not paid for their blood, they give because they know its the nice thing to do. Non payment means that the junkies who sell blood to buy drugs are not in the circulation because they have no motivation to give blood.

The evening before the transfusion, the nurse came in and drew a type and cross on my blood so they would be all prepared in the morning for the trasnfusion.

The entire infusion took about 5 hours because I got 2 units and each unit runs over 2 hours. Once it got started, my anxiety about the process went away. The nurses took vitals about every half an hour to monitor my progress. The transfusion raised my hemoglobin to 10.4.

Day +1

Another very uninteresting day in Omaha. My labs came back and my hemoglobin was 8.0 and the dcotor said I'd be getting a blood transfusion tomorrow, oh fun. I feel pretty good but am starting to get loose stools from the DMSO that I got from the trasnplant. Oh, I should mention that I give off the oh so pleasant odor of creamed corn, also compliments of DMSO

Transplant day

The day before the transplant I couldn't sleep a wink I was so nervous about the procedure I ended up taking a Xanax, which is something I never do. Thankfully the atmosphere in the treatment room where I’d get my transplant was very light and not uptight at all.

Once I was settled into the room, my vitals were taken and I was connected to a heart monitor. In my civilian job I read EKGs for a living so I asked to see a printout of my heart rhythm, which the nurses gladly obliged. The next thing I know, the transplant coordinator is wheeling in this cart with a warm water bath for thawing my stem cells.

After a quick confirmation that the cells in the bag belong to me, the bags were hung on the IV pole and spiked. Slowly at first then increasing in speed, the stem cells flowed down the IV tubing into my hickman catheter. This was it. I was getting the transplant.

My transplant included three bags of stem cells that took about 15 mins each bag to infuse. Before I knew it, the transplant was over. The transplant team came in and sang me a re-birthday song and gave me my birthday cake

(The pic was taken later back in my room) and that was it. I was done. NOW, I just need to survive the next 10-15 days.

Melphalan, What a let down

In my last post I talked about getting the B-E-A of the BEAM protocol. In this short little post I'll talk about melphalan. Melphalan is supposed to be the meanest, baddest chemo given during the transplant. In my experience it was kinda lame.

The rules to melphalan are:

1. Chew ice chips for 10 mins before infusion
2. Chew ice chips during infusion
3. Chew ice chips for 20 mins after infusion
4. And of course, hydrate

The ice chips are supposed to protect your mucosa from the melphalan and avert mouthsores. hydration is a standing order for all chemos, enough said on that.

The infusion lasts about 30 mins and in very unremarkable, I had no nausea or any adverse reaction. As of this posting, I'm glad to report that there are no signs of mouth sores.

Chemo

This post is a little late.

The BCNU dose of chemo was given over three hours and is reconstituted with alcohol, so I ended up getting a pretty good buzz off of it.

Now, I'm getting my dose of ARA-C followed by Etoposide. Both are one hour infusions with a flush in between. The nausea started shortly after my second dose of Etoposide.

My Meds:

• Zofran 8mg every 8 hours for nausea.
• Allopurinol 300mg in the AM to protect my kidneys from chemo
• Bactrim DS twice a day to prevent pneumonia
• Remeron 30mg for sleep
• Lorazepam 1-2 mg every 4 hours as needed for anxiety and nausea.
• Ambien 5-10mg for sleep
• Compazine 10mg every 6 hours for nausea

A-freakin-pheresis

The past three mornings I have been getting apheresis down in the treatment center. Each session takes about 4 hours and is more or less painless. Each day I started my morning at about 6:30, drag my self down to the geriatric clinic (I know, right?) and get a, or should I say two, neupogen shots. I get out of the clinic at about 7:25 or so then grab a bite of breakfast before I head to the apheresis room.

A more detailed look at what apheresis is can be found at this link : http://en.wikipedia.org/wiki/Apheresis

Particular attention should be paid to the section on leukopheresis

Heres a look at the basic setup of the apheresis machine.

Before every session the nurses would draw a CBC from my hickman and enter the information into the apheresis machine. My WBCs were pretty high, 50 the first day, 41 the second, and 38 the last. The nurse said that a level of around 20 is average for this procedure. My RBCs and HCT were low but generally stable during the treatments. My platelets declined down to 111 by the third day, and the nurse said that was totally expected. In summary, don't be suprised if all your levels drop during apheresis.



On the first day of collection I collected 1.9 million. On the second day 1.8million and 1.4 million the last day. I had an above average yield and finished in three days, but on can expect to spend 4-5 days getting apheresis. Collection times running into a week to 12 days is not unheard of.



Some advice on apheresis is to load up on calcium before you go in. They treat your blood with sodium citrate to prevent it from clotting in the machine and some of the citrate ion is inadvertantly trasfused along with your treated blood. Sparing you a lecture on inorganic chemisty I'll just say that the citrate ion pulls calcium out of your blood and you may experience symptoms of hypocalcemia.


Early symptoms of hypocalcemia include: Tingling in lips and extremities.

Later signs and symptoms of hypocalcemia: Cramps, EKG disturbances, death.

I had trouble with calcium levels the first day but after injesting a few TUMS tabs the symptoms disapeared. The nurses recommended over the counter calcium supplements during apheresis: 1000mg the evening before and 1000mg in the morning before apheresis.


The stem cells (along with RBCs, platlets and some plasma) collect in a bag while the rest of your blood is returned to your body.

Heres what one days collection looks like

Another thing to remember about apheresis is the your blood is removed from your body at normal body temperature but returns to your body at room temperature. I recommend wearing a sweatsuit and a hat during apheresis to prevent getting cold, because you will. The nurses should offer a warm blanket; I dont care how hardcore you are (because I'm the most hardcore) but when they offer the blanket, take it.

So now that I'm done collecting I start the next phase of treatment: Conditioning... The chemo part. That begins tomorrow afternoon about 2:30

Hickman and Mobilization

Yesterday I had my Hickman Double Lumen Catheter installed...






Essentially it is a tube inserted (in my case) in the left chest that is tunneled under the skin and enters the circulatory system at the left subclavian vein and is strung into the superior vena cava and stops just inside the right atrium of the heart.








The difference between what I have and the illustration is that my catheter stops when it just enters the heart and the catheter in the illustration continues into the pulmonary artery.

The catheter is split into two sides (one red and one blue) this is so, during apharesis they can pull blood out of my body thru one tube and reinstill the blood thru the other side. This keeps them from having to start another IV.



Care for the Hickman Catheter:



Flush each side with 10cc saline daily

Cleanse entire external catheter with alcohol weekly

Cleanse body area under bandage with alcohol weekly

Change dressing weekly.

If the dressing gets wet or looses integrety then change as needed.



More Detailed Care Instructions Here: http://www.cc.nih.gov/ccc/patient_education/pepubs/hickman.pdf



I also started the Mobilization process. Basically everyday I go down to the clinic and get a dose of neupogen. I'm no stranger to neupogen since I've been getting it all thru chemo. however I get a double dose for mobilization. Instead of getting the 400mcg that most people get, I get 950mcg everyday for about 5-6 days before they start collecting the stem cells. The most common side effect of neupogen is bone pain. It would be fair to say that I'm having moderate bone pain but the pain is reasonably relieved by Tylenol.

BEAM me up

So it's been a while since iv'e been on to update my progress. I apologize for that but there really hasn't been much to say. ICE treatment #3 left me in ALMOST remission. I had a 1cm nodule in my left lung that barely above background on the PET scan. Side effects were unremarkable and fleeting.

Now I'm in the pre-treatmet phase of my SCT. Basically, this week I have classes on basic and catheter care, social work consult, labs, and a trip to the clinic to see the transplant doctor. Beginning this week I will start the mobilization phase of the transplant. During mobilization phase I will be gettting a growth factor called Granulocyte Colony Stimulation Factor, G-CSF also known as neupogen injected subcutaneously every day for about 4 days before the collection partion of the transplant. More on the collection part when I actually get to that point.

The chemo I get during the conditioning phase is called BEAM

B - BCNU (carmustine) - Interfers with the growth of rapidly growing cells and causes them to die. Main side effects- interferes with platlet development,

E - Etoposide (VP-16, VePesid) - Interfers with and stops growth of cells. Main side effects- Mouth sores, disupts platelet and white blood cell production. Had this drug before during ICE chemotherapy. I thought it was the easiest to tolerate.

A - ARA-C (cytarabine, Cytosar-U) - Also interfers with the the growth of fast growing cells Main side effects- Disrupts platelet and red blood cell production, also disrupts white blood cell production. Anemia, neutropenia, bone pain, conjuctivitis and fatigue. kidney problems.

M - Melphalan (Alkeran) - Interfers with cell growth, kills bone marrow. Main side effects- Total destruction of the bodies ability to produce blood components. Mouth sores, kidney damage, black tarry stools, hair loss, infertility. This drug is supposed to be the Darth Vader of chemotherapy drugs. It's so mean that it has its own theme music. Patients are instructed to eat ice chips for an hour prior and an hour after administration to slow the infiltration of Melphalan into the epithelial cells in the mouth. The theory is that this will lessen the mouth sores.



I'll be getting my conditioning chemo therapy on this schedule:

Day -6: BCNU 300mg/m^2 IV once at 1500

Day -5: ARA-C 100mg/m^2 IV BID (twice a day) at 0800 and 1800
Etoposide 100mg/m^2 IV BID at 0900 and 1900

Day -4: repeat day -5

Day -3: repeat day -5

Day -2: repeat day -5

Day -1: Melphalan 140mg/m^2 IV at 0800

Day 0: Transplant day. 24 hours after the dose of Melphalan.

Day -6 starts the day after stem cell collection ends.

ICE is making me a crackhead

It's 3am on a Wednesday morning and I can't fall asleep. I guess I'll use this time to update this blog. I had ICE #3 starting a week ago this morning and it went off without a hitch except for some trouble with overeager nursing staff. My discharge on Friday was delayed by a couple hours simply because my nurse was flustered and made alot of "rookie" mistakes. no harm, no foul but still a little annoying. The treatment and subsequent side effects were the same as expected. moderate nausea that was moderately controlled with medication and fatigue. I got a neulasta shot on monday and expect pretty decent bone pain on, lets see.. Saturday thru monday. not too bad. As for the duration of side effects. I have nausea for about 3-4 days then it just vanished. like one minute to the next. Ive also learned to keep ahead of the symptoms. once they set in they are alot harder to get rid of than if you did pretreat them. I do, obviously have some sleep disturbance that reaches outside of the 3-4 days I previously mentioned. I have very bizarre nightmares on days 4-5 following treatment. I had them with all 3 treatments of ICE and it's part of the side effect arsenal that I have come to accept. Aside from the fleeting nausea, nightmares and periodic insomnia, ICE hasn't been that bad. BUT It's turning me into a crackhead with this no sleep business.

Shampoo? How silly

When I got out of the shower this morning it occured to me that I used shampoo to wash my bald head. What was the point of that? Now my scalp feels ten times more dry than normal. In the past when my hair was shorn down to nothing, like when I was in basic training for example, I just used bar soap to wash my scalp. I dont know why I used shampoo this time.. Habit I guess

In other news I just found out that the KU-MU basketball game will be syndicated on a channel that I don't get. So, what does that mean for me? You guessed it.. roadtrip to the bar! So far it looks like the only people going are my dad, Carrie, and of course me. Were going to try to recruit Casey and perhaps Jenny to come along too. I'd like to get Kevin to come but his work schedule might interfere and the fact that he's not quite 21 really sucks. I wouldn't want him to feel like a designated driver. It will be alot of fun and I've been looking for an excuse to go out, eat some hot wings and get loaded while watching what will no doubt be a fantastic basketball game. The KSU game is at 3pm and the KU game is at 7pm so there is a chance that I could spend the majority of my Saturday afternoon, not only at the bar but reasonably intoxicated. I'll have to see if the rest of the participants are onboard for coming in early to catch the KSU game and have essentially an all day beer and basketball marathon. I bet I won't have much difficulty selling the idea. I'm getting giddy just thinking about it.

This morning a social worker from Nebraska Medical Center called to ask me a few question about how I'm doing as far as support during and after the transplant and to try to identify and socially relevant issues I may have. The interview went well and of course no issues were identified but it seemed a little odd that I now have a social worker looking out for my best interest. I guess thats what she doing. Its nice that I have her services available if I need them but I really don't think I will. I'm of the opinion that well adjusted law abiding citizens really don't need the services of a social worker. She said that being away from home and staying in the hospital was stressful. I told her that I came from a medical family and wan't afraid of hospitals per se. I didn't have the heart to ask where she was while I was away from home for military service. If there was ever a time when I needed a social worker to help with my issues... that was it.. sheesh. Anyway, I guess thats just part of the process.

Lymphoma forum

For a long time I've been lurking around this web forum for hodgkins lymphoma and not really contributing anything. I guess with my upcoming transplant I've decided that I should open myself up and share not only my experiences but also my insight to the rest of the hodgkins community. For those reading this blog who don't know about the forum its located at http://forums.webmagic.com/ubbthreads/postlist.php?Cat=0&Board=UBB1&page=0
It's been a really useful resource for some of my super specific questions and concerns not to mention that there is a camaraderie among the active posters that I could sure use while I'm interned up in Omaha.

ICE number 2

So I finally broke down and decided to start blogging my experiences. I always thought that blogging was something people that lacked a healthy social life did but now I think it may be a good way to let my interesting (to say the least) life story be known. OK, so I got that out of the way, lets get down to brass tacks...

Last week I had my second round of ICE salvage chemotherapy, basically thats the early preparation for my stem cell transplantation. I tolerated the chemo actually pretty well. I had a couple days where I was nauseated but nothing I couldn't stand. At this point I only feel a little sluggish, the best way to describe it is to imagine the last 2 hours of a hangover where you don't feel 100% but are far from being trashed. That's where I am now.

One of the side effects of the ICE chemotherapy is that it kills alot of white blood cells and weakens my immune system. To combat that I get a shot called Neulasta. You may have seen commercials for it on TV. The thing about Neulasta is that, number one, it hurts like a bitch when I'm getting it injected and, number two, about five days after injection, my bones feel like someone beat me with a baseball bat. Unfortunately, I'm right at the five day point now and can expect to be in considerable pain soon. So I'm pretty excited about that.

The next step in this transplantation process is a PET scan. For those unfimiliar with that, it is basically like a CT scan or MRI that can detect cancer. Around the end of the month I'll have a PET scan to see if I'm in remission or at least very close to it. If I am in remission then I travel to Omaha for the collection phase of the transplantation. Basically I go up to Nebraska Medical Center and they hook me up to a machine like a dialysis machine that takes stem cells out of my blood and returns the rest of my blood to normal circulation. To clarify, a stem cell is like a baby white blood cell that hasn't decided to become a white blood cell yet. I'll need to collect these baby cells because later therapy will kill all the white cells I have in my body and they will need to recolonize my body with the harvested cells. Harvesting stem cells should be pretty quick, I've heard estimates ranging from one day to two weeks. Taking into consideration how well my white cells have heald up during treatment thus far I expect to be closer to one day than two weeks.

Once I've collected a sufficient number of stem cells (approximately 9 million) the real fun part begins. I'll be admitted to the hospital in Omaha for high-dose chemotherapy. From what I've read it will be a five day marathon where I will be infused with a chemotherapy called BEAM. Basically this is the atomic bomb of chemotherapies. It will wipe out all of my white blood cells, bone marrow and make my immunities virtually dissapear. After the five day infusion they doctors will put the collected stem cells back in to my body and hopefully they will regrow the lost white blood cells and bone marrow. I'll be on a modified reverse isolation protocol for about two or three weeks before my white blood cells are back to a point where I can leave isolation. Simple enough.

Right now I'm really motivated to do this thing and get it over with. Pardon my language but I'm really tired of the fucking cancer business. I'm ready to get back to the real world. But you know what they say " All good things to those who wait."