Thursday, March 3, 2011

Phase Three of this Journey ends.....

Written Tuesday night.......

I sit in Bob’s hospital room, looking out the window at the beautiful Dallas skyline, wishing we were here for more pleasant reasons.
The Bank of America building, also known to locals as "The Jolly Green Giant" stands tall above all the other buildings, outlined in green flourescent lights.

We’re very thankful to be in a wonderful facility, with great nurses who are experienced not only with his disease, but with the treatments as well as the side effects.

Monday morning started with outpatient surgery to implant the TriFusion Catheter into his right upper chest. The three lines are used during the Aphresis procedure to collect the stem cells, and circulate his blood back into his body. It will also be used during the Stem Cell Transplant to transfuse his cells, as well as for any blood transfusions or platelets that may be needed.

He didn't feel well before, or after, the surgery .....but that was nothing new. He had begun to have no appetite and just generally felt awful.

Bob had a late appointment on Monday afternoon, at the Bone Marrow Transplant Clinic, for his injection of 960 micrograms of Neupogen and 21.6 mg of Mozobil (a drug used to mobilize the Stem Cells). The appointment was late because the Stem Cell collection must begin within a specified window of time after the Mozobil injection.

Side effects for the Mozobil were listed as:
·      allergic reactions like skin rash, itching or hives, swelling of the face, lips, or       tongue
·      abdominal pain and/or shoulder pain
·      feeling faint or lightheaded, falls
·      irritation or pain at the site where injected
·      unusual bleeding or bruising
·      diarrhea
·      gas
·      nausea
·      vomiting

Between 5:30 and 6:00 p.m., the side effects made their appearance. The abdominal pain he was experiencing was like nothing that he had ever had before. He began vomiting, which he had never done. Both became so violent; the oncologist suggested we get him to the ER at St. Paul Hospital. The Neupogen injections had caused pain in his back and chest, but there had never been stomach pains or vomiting.
After xrays and CT Scans of his abdomen, and chest, to assure that there was nothing else going on, in the early hours of Tuesday morning, he was admitted.  About 8 a.m., I learned that he was not in the “right” hospital.  The Stem Cell collection (Apheresis) is normally done on an out-patient basis, in the Bone Marrow Transplant Clinic, but because of Bob’s situation it would have to take place in the hospital. Stem Cell collections are done at Zale-Lipshy, and he was at St. Paul, and that “window of time” that we had talked about was fast disappearing.

By some miracle, things moved very quickly thanks to the brilliant work of a young lady I’ve come to admire very much. Christen Bennett, the Transplant Coordinator, waved her magic wand and before we knew it, Bob was being transported to the right hospital. By the time I got the car parked and located his room on the transplant floor,  nurses were readying him to be hooked up to the Apheresis Machine.

Betty, the representative from Carter Blood Center, had the machine (shown above) set up and ready to go. Two sets of lines were attached to two of the channels of Bob's new TriFusion Catheter. One set of lines withdrew blood from his body and sent it to the Apheresis Machine, and the other set of lines returned the unused components back to the body.  The sterile tubing and needles are used only once and then discarded.Over the six hour period, all of his blood circulated through the machine four or five times (15 to 20 liters) attempting to collect 10 million Stem Cells! We had been told that, because blood thinner is added to the Apheresis Machine to prevent the blood from clotting, when it was returned to Bob's body, there could be pain. And, because calcium is lost during the process, it is normally replaced intravenously. His calcium was high enough that he didn't need an injection (maybe we have his chocolate ice cream diet to thank for this!) Some other side effects that we had been told to expect, didn't happen. Was this the secret? Expect the worst, and it won't happen!!
Blood work acceptable ranges vary from lab to lab. The range for WBC (White Blood Count) is usually in the 4.5 - 10.00 range. As Bob's Stem Cells were being collected, we learned that the Neupogen and Mozobil really had done their job .....his WBC was 65! We were complaining about pain, and they were working overtime!

If you aren't the patient, lying in the bed, the Apheresis procedure is interesting. The blood components are pulled from the patient and deposited into a container in the bottom of the machine which uses a centrifuge to separate and collect the stem cells. As the separation takes place, the blood is routed to a collection bag (shown left).

The yellow liquid, on top, is plasma which is mainly water. The stem cells are shown at the bottom.

And, this is what 6.18 million cells look like!! Bob's total for the two day period (Tuesday and Wednesday) was 9.38 million cells - not the 10 million that was desired, but enough for a Stem Cell Transplant.

The cells will be stored (frozen) at Carter Blood Center until they are ready for use.

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