Wednesday, February 9, 2011

Phase Two of this Journey.....

Bob is now in the Pre-SCT workup phase of this "4 Phase" process. Yesterday was a full day, beginning with blood work and ending with a Bone Marrow Aspiration (the one thing he dreaded most, loomed ahead of him for the entire day). In between, there were meetings with a representative from the Carter Blood Center, which will process and freeze his Stem Cells; an Insurance Representative; a Social Worker (required by Medicare) to ensure that both Bob and I have the support we need through this process; Christen, the Transplant Coordinator; and of course,  Dr. Anderson, the Specialist in whom we have put our trust.

The large waiting room in the Bone Marrow Transplant Center, outside the lab where blood is collected, was filled to standing-room only. It's always such a sobering experience to see so many people, in every age group (except children), with varying stages of cancer. One has to wonder why? What has changed, in our society, to cause so many to have cancer. Is it the processed food we eat, our environment, genetics, what?

We met first, with Stephanie from Carter Blood Bank. This facility will process and freeze Bob's cells, for the Stem Cell Transplant procedure. Bob has an Infusion Port, on his upper left shoulder, which is used for his Chemo treatments. A Trifusion Catheter will be implanted, on his upper right shoulder, for the collection of the stem cells (called the Apheresis Process), as well as for the Stem Cell Transplant.

For four days, beginning February 25, prior to the collection of the Stem Cells, Bob will be given injections of Cytokines (Neupogen and Mozibil) which will stimulate cell growth. On the fifth day, the Stem Cell collection process will begin.

The blood, in the human body, is made up of four layers: White Blood Cells, Red Blood Cells, Platelets, and Plasma. The Apheresis Machine will be connected to Bob's Trifusion Catheter in order to initiate a continuous circulation of blood. The machine separates the blood layers by centerfuge (spinning), extracts the Stem Cells, and returns the remaining blood to his body. A blood thinner is added to the apheresis machine to prevent the blood from clotting, which reduces the calcium in the blood. When the blood is returned to the body, some of the blood thinner still remains which lowers the calcium in the body. This can cause tingling in the hands, feet, and around the mouth, as well as pain in the bones (which Bob already has). Calcium replacement is given intravenously during the collection process, to reduce some of the pain and tingling.

20 litres of blood, per day, will be harvested until 10 million Stem Cells have been collected! The cells will then be frozen until it is ready for the Stem Cell Transplant procedure.

The final procedure of the day was the Bone Marrow Aspiration, which Bob has dreaded for weeks! We had asked for sedation in order to reduce some of the pain that he had experienced during his first aspiration, in October. During the October aspiration, I remained in the room - after which, I vowed I would never do that, again! I sat, just outside the clinic room for this procedure, and was so happy when I heard him exclaim "I didn't feel a thing!"

How fitting that the tool used to obtain the Bone Marrow sample and a piece of bone is called a Jamshidi (Jam Sheety) Biopsy Needle!  It is a tubular needle with a cone-shaped tip, with cutting edge, used for obtaining a bone-marrow core.

I think it definitely makes a big difference when someone, who does this procedure 4 or 5 times each day, is the one holding the tool. And, I was also very happy that we requested sedation.  I was thankful that he hadn't gone through the pain of the first aspiration.

The remainder of our time will be spent with Bob undergoing more MRIs, Xrays of the entire body, PET Scans, Heart Tests and Lung Tests. Dr. Anderson has to ensure that he is physically able to withstand the stress of the Stem Cell Transplant.

Since Bob was diagnosed with Multiple Myeloma back in October, 2010 (it seems like forever ago), I've read everything I could find about this incurable form of cancer, treatment options, and treatment locations. Much has been posted on various blogs and MM websites regarding the decision-making process of selecting a treatment facility. It actually boils down to personal preference and how comfortable the patient, and the caregiver, is with the facility and the location.

We are extremely pleased with our choice of UT Southwestern in Dallas. It is both a research and a clinical treatment facility, and has received a designation from the NCI. It does not treat just Multiple Myeloma, but our oncologist is a Multiple Myeloma Specialist. It's about personal preference, and confidence .....and we're confident that we have made the right choice!

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