Transplant Journey

Day 115: What a long, strange year it's been

2006-12-10T19:41:00.000-08:00

Weight: 151
IgG: 1470 [9171 at diagnosis in January 2006]
M-spike: .9 [7.3 at diagnosis]
B2 Microglobulins: 2.53 [6.7 at diagnosis]

You know it's been too long since your last post when it takes five minutes to figure out what "Day" it is. I think it's been 115 days since Richard's August 17 transplant.

Richard is doing pretty well, overall. Here he is after stringing the Christmas tree lights. The popeye biceps are unintentional. Seriously.

Other indications that he's feeling and looking better:

-- He has hair. And, yes, sometimes it's little things like hair that make us feel normal.
-- His weight is pretty decent. He now weighs about 151. Not bad. It's up from a low of 138 in the hospital.
-- He's getting fiestier (fiesta-ier?). This is good and bad news. The good news is it means he's feeling better; the bad news is I'm not getting my way as often. But fiesty is good.
-- His blood counts continue to look good, i.e. his red and white counts are just a smidgen below normal.

Some recent news, however, was a bit discouraging. We had hoped the stem cell transplant would have produced a complete remission (no myeloma cells). However, we learned last week that Richard is in partial remission. His IgG level is on the upper end of normal but myeloma cells remain, evidenced by monoclonal protein levels (myeloma cells produce monoclonal protein). Richard's "M-spike" (measurement of the monoclonal protein) is now .5; full remission would be .0. His Lambda light chain level (don't they sound innocent?) is high (430), but lower than at diagnosis (2030).

So now we have several options: have a second stem cell transplant in early January; take a wait and see approach by monitoring his IgG and M-spike levels over the next month or two to see if the levels drop more or start to rise; start a new round of chemo with different drugs (since the ones he used before were either moderately unsuccessful or produced an allergic reaction); or some combination of the three. After a phone consultation with Dr. Durie of the IMF, we've opted to have tests over the next month or two to monitor any change.

So while we wait and see, life keeps us twirling round and round: we anxiously anticipate the birth of our first grandson in April; Richard participates in a writing class through Sutter Cancer Center; and I mourn the loss of my mother.

I think we're definitely ready to give 2007 a try.

Day 44: Guitars, cowbells and bulbs

2006-10-01T21:35:00.000-07:00

Richard update: sternum pain from possible fracture and all-over, maddening itchiness are still issues. But many good things spill into our days...

Richard's sister gave him one of her guitars last week. Thanks, Liz! So now Richard can learn how to play (um...thanks Liz..). Doesn't he already look like a folk singer? Well, without the black boxes around his ears.

Daughter Alissa, friend Lisa, neighbors Bill and Andrea, and their friends (and yours truly) participated in the Cowtown Marathon/Half-Marathon/5K walk-run today, along with 2800 other participants. The day started with a ringing alarm clock at 6:30 a.m. Richard and I looked at each other bleary-eyed and said, "Whose idea WAS this anyway?"

Alissa, Lisa and I walked the 5K. It was my first "race" (yes, racing the leaves down the street at my pace...). Richard walked to coffee and waited for our return. By the time he walked to the park with us, walked to coffee and back, he probably logged as many miles as we did.

We survived the day, and enjoyed Richard's parents' company later in the afternoon. They came bearing gifts of planted bulbs.

Ah, fall. My favorite time of year.

Day 42: Pruning pines and plasma

2006-09-29T22:52:00.001-07:00

IgG: 1591 WBC: 4.6 Platelets: 404 Hemoglobin: 12.3 Red BC: 3.8

Richard's IgG level is just barely in the normal range for the first time. The goal of the stem cell transplant was to achieve normal plasma cell counts. The normal range is 700-1600, and Richard's count is 1591. We were hoping for a level of about 1000, but we'll take this.

The doctors will check the level again in about a month, with a more complete battery of tests including another bone marrow biopsy (which is painful, contrary to what the oncologist led us to believe the first time it was done in January). This time drugs will be Richard's friend during the in-office procedure.

Pruning plasma cells is not all that Richard has been up to. He also has been slowly pruning overgrown branches in the back yard. To make up for yesterday's sleeping picture, here is Yard Guy! Ever careful to guard eyes and lungs! Dragging cut limbs to the curb in single trips! Sorta.

We saw The Illusionist this week. Decent movie. We also saw The Benchwarmers on DVD tonight. Sophomoric movie with a message (a Sandler-produced film...enough said).

Day 41: Dem Bones...

2006-09-28T23:58:00.001-07:00

Richard continues to get a little stronger each day. Today he had blood drawn, a visit with the doctor, and a 3-hour arredia infusion (to ensure continued normal bone functioning). He deserves the sleep he's getting in the picture here. [The flash went off and he *still* didn't wake up.]

Richard's bones continue to be a theme in our life. Because he has severe osteoporosis due to the multiple myeloma, his bones are easily fractured and broken. Collapsed and fractured vertabrae are what first alerted us to a problem in May of 2005; over the next several months he fractured his pelvis and ribs. Last Sunday, ten minutes after I left for a work retreat, Richard was pressing down on something and he felt a pain in his chest, and heard a crack. We think his sternum is fractured. He had an x-ray today, and we will get the results soon. However, there's really nothing to do except to let it heal on its own.

Richard is also still suffering from an intense rash. The doctor gave him a pill to take, and that seems to help a little, but the constant itching is nerve-wracking. I rub lotion onto his back to relieve the itch. Maybe this is just a sneaky way to get a backrub?

Thanks for all your comments and encouragement. Cards and calls are always welcome.

Special hugs to good friends Kathy, Lisa and M'Liss, and a too-far-away hug to Gaylenintexas. Thanks for being there.

Day 27: Positive but rashy update

2006-09-14T22:02:00.000-07:00

WBC: 4.67 (normal!)

Things are progressing nicely in Richardland.

Richard has been spending a little time in the garden. Here's a recent not-the-best-lighting picture. Can you tell we need to prune that bush behind him? Fall is a great time, but it also signals all sorts of fun activities like pruning!

Richard had a check-up yesterday. He's gained two pounds over the last week (cue angels singing Hallelujah), and his blood pressure, pulse, heart rate and blood oxygen levels are all good. Also, his white blood count is finally in the normal range for the first time since June. Red blood counts remain a little low (3.84), but not terribly so.

The doc informed us that less than 5% of patients develop a particular strain of pneumonia after transplants. He wants Richard to avoid this nasty predicament, so he prescribed sulfameth/trimethoprim (800mg) two days a week for two months. As soon as Richard's nausea subsides, he'll start taking it.

Richard has developed a rash, and it's especially visible on his forehead. It makes me itch just looking at him. The doc says the rash is not uncommon, and that it will go away in time--go away with all the other lingering symptoms, such as nausea, low food tolerance, fatigue, light sore throat, a slight cough, and always feeling cold. While these symptoms are annoying, the rash makes him miserable. If he can't stand it longer than another day or two, the doc will put him on a steroid treatment. However, they're trying to avoid steroids if possible because of Richard's diabetes; steroids really elevate glucose levels.

Richard starts back soon on monthly infusions of arredia (the drug that makes his bones function properly). In two weeks he will have the arridea treatment and a check of his IgG level.

The IgG level, which indicates the number of plasma cells in the bone marrow, will tell us if the stem cell transplant worked. His IgG level going into the transplant was about 2500, after months of treatment (it was 9700 at diagnosis). Normal IgG levels are between 700 and 1600.

Let's see. What other updates are there. Well, Richard remains bald. The good news is that I no longer wonder who the stranger is in my house.

Well, that's just a whole lot of in-depth tidbits about Richard's body that you didn't bargain for. We share most of the details for other multiple myeloma folks who keep track of those types of details. Thanks to the rest of you for hanging in there with us!

Day 23: Cowtown Marathon

2006-09-10T09:13:00.000-07:00

No real news to report. Richard is still very tired, sleeping about 11 hours a night and resting a lot during the day. Yesterday he walked two blocks, and did some exercises the physical therapist had shown him.

The main reason for posting today is to invite people to join us in the Cowtown Marathon on Sunday, October 1, in Land Park. (Click on "Cowtown Marathon" for details.) It's a marathon, half-marathon, team relay or 5K (3.1 mile) walk. They anticipate about 2,000 participants.

Proceeds benefit the Leukemia and Lymphoma Society.

Alissa and I have signed up, and plan to do the 5K run/walk (trust me, we will be *walking*). We think it will take us about an hour to walk. Please join us if you can!

Day 20: Buhbye borg corsage, hello lattes and muffins

2006-09-07T22:14:00.000-07:00

WBC: 2.3

Yesterday the doctor gave Richard the green light to be in public. Well, to be in relatively open spaces while avoiding sick people. His white count is still low, but higher than it's been in about a month (ignoring the artificial numbers created by neupogen shots). The doctor's exact words were, "You can take off that face mask now." Sweet.

We celebrated by going to our favorite neighborhood coffee place, where Richard had his first iced latte and bran muffin in three weeks (he wasn't supposed to eat anything that wasn't cooked, or that was unwrapped). That's a latte grin in the picture.

We then took a short drive around our neighborhood before going home for a nap. Richard is still pretty tired and weak.

Today Richard had his catheter port taken out...another step toward normalcy. The borg-like corsage has finally been removed. It was a short hospital procedure, with just a local anesthetic. The surgeon had a little trouble pulling it out because there was scar tissue that had attached itself to the line--a common issue. And now we don't have to go to the hospital or to see a doctor for 7 days! Yippee.

Day 16: Keeping that 101.0 at bay...

2006-09-03T22:47:00.000-07:00

WBC: 1.7

Richard has been home for three days, and things are going fine. Our daughter from NY is visiting, so that's been fun and a good distraction.

Richard has been feeling fluish, and has been running a very slight temperature. His temp hit 100.0 yesterday, which was a bit anxiety-producing. A temp of 101.0 means an immediate re-admit to the hospital. That's something we both want to avoid. Today he's fluctuated between 99.1 and 99.7. He continues to drink lots of water, and remains semi-reclined. Sanitizing wipes for counters and bathroom fixtures remain our friend. Our house has become like a small clinic, with one patient.

Here's a picture from Friday of Richard and our transplant doctor, whom we really like. I think I might have been laughing, so the picture's fuzzy. At least that's my excuse, and I'm sticking by it. Note the mask hanging around Richard's neck. It's the stem cell transplant version of a cowboy's scarf. Hoohaa.

Richard has "catheter care" every other day, and then Friday he has his port removed at Sutter Memorial Hospital. From what we can tell, it entails just a local anesthesia and maybe an anti-anxiety medicine. It's easier taking ports out than putting them in.

Things we appreciated this week: Our neighborhood and kind neighbors, our children, and our caring family and friends, who continue to reach out to us. Thank you.

Day 13: Free at last, free at last

2006-08-30T21:08:00.000-07:00

Day 13: Free at last, free at last

WBC: 26
Platelets: 48

Richard came home today.

After I picked him up at the hospital, we had a quiet ride to our house. Richard was savoring just being outside for the first time in two weeks. He's so happy to be home.

When we got to our house, he went from room to room taking it all in. He checked on the plants in the backyard, too. They're still alive, which is a miracle. I've always confessed that the only things I can grow are children.

He spent the day on the barcolounger (thanks again Jeff), remote and phones in hand. He watched the US Open, then went to bed at 9. His appetite is a little better, due mostly to having non-hospital food. I asked him what he wanted for dinner, and he said "steak!" Steak it was. Even though I had to cook it forever (he's still on a low microbial diet), it was tender enough to have good flavor. He had about two ounces of steak and a few bites of well-scrubbed, steamed squash. The squash was the first vegetable he's had since he left home I think! He couldn't stand the smell of anything cooked in the hospital.

We're on fever patrol right now, taking his temp twice a day. I'm also extremely careful about cleaning door handles, and anything he touches. When his counts are higher in a couple of weeks, we can be less diligent. Right now I have lysol bleach wipes in the kitchen and bathroom, though, and use them throughout the day.

Richard has doctor appointments over the next few days and weeks, but having him home is very sweet.

Day 11: The hopeful uptick.

2006-08-29T23:12:00.000-07:00

Updated Wed 11 a.m.

WBC: 0.4
Platelets: 20
Lbs. Lost 10.4

We're hoping Richard has turned a corner in his recovery. His white blood cell and platelet counts went up ever so slightly. This is the first uptick since he was admitted, and we and the doctor are hopeful that this marks the beginning of a restoration of his blood counts. In addition, he gained a fraction of a pound. The odd thing is that today was also the first day that he had a slight fever (99.3). (Shrug.) When I left this evening, I checked his temperature and it was 98.8 (just call me nurse Robin), so hopefully it will stay down. He still doesn't feel all that well, but we're hopeful that we see that glimmer of light that heralds the end of the tunnel.

I just fell asleep typing this. I looked up and saw a long line of llllllllllll's. Time to sign off. In the morning I'll post a couple of pictures from today.

Wednesday a.m. after a good night's sleep:

The Wall (you can see just the top of the huge yellow, two-panel get-well card from the anniversary party...thanks, Liz and everyone!)

Richard's general reaction to eating when the food nazi brings him chicken noodle soup. Note the matching blue jammies and cup, always the sign of a good patient.

Day 10: Holding, holding...

2006-08-28T22:59:00.001-07:00

WBC: less than 0.4
Platelets: 16
Lbs lost: 11

Things were a little better today. Richard seemed to feel better most of the day until late afternoon. He was able to eat a little, but had lower GI troubles in the afternoon.

As can be expected, Richard has made friends of all the nurses. The nurse assistants have taken to sitting down and talking about family and travelling with him. As for me, I've become a food nazi, asking for special orders of peanut butter and jelly sandwiches and popsicles for Richard so he'll eat. Last night I asked a nurse to please use the foam antibiotic when she comes into the room. It's sort of like a good cop/bad cop thing. Guess who the bad cop is.

The doc thinks we're ready to see the numbers start to come up, and they can't tick upward soon enough for us. I cannot wait to get Richard home, even though it means I have to do some major housecleaning before he walks in the door (bleaching/scrubbing to get rid of those pesky microbes). I've half forgotten how to do deep cleaning, but I do have those stinky plastic yellow gloves! Now if I can just find a sponge...

Another pre-SCT photo because I still can't find my new camera. I really hope it just fell under a car seat...

Things we're thankful for: The Fam.

Day 9: Tomorrow is another day...

2006-08-27T21:07:00.000-07:00

WBC: less than 0.4
Platelets: 23
Lbs lost since SCT: 11

Yes, I know. Vivian Leigh's character was annoying in Gone With the Wind, given to stating the obvious, such as "tomorrow is another day." (Wha? It is?) But the statement seemed fitting.

Today was not the best day on the SCT roller coaster: mouth discomfort, throat pain, nausea, lower GI problems, throwing up. The mephalen he took last week is doing its job. No time for boredom today.

Richard's counts should start swinging up in a few days. He's receiving Nupogen again, to stimulate stem cell production. We expect him to have a blood transfusion if his platelets go much below 20. We'll see where he is in the morning. I looked back in my notes from January, and the doctor said approximately 50% get mouth sores, 99% get diarrhea, and the majority have fevers and blood transfusions. We seem to be on target. Yay for normal sickness.

We did manage to watch a nice little international film titled "Turtles Can Fly." It's a powerful film about a group of orphaned children (Kurdish refugees) on the Turkey/Iraq border trying to eke out a living finding and selling land mines prior to US forces' arrival in 2003. [This was the first movie filmed in Iraq after the fall of Hussein's regime.] It was not light or funny, but very moving. We've watched our share of Friends and Seinfeld over the last week, so this was a nice balance.

Unfortunately, I forgot my camera today, so all I have to offer in the way of pictures is this one from two days ago. No, he's not praying. It's a "this cellblock is too small" moment. We are listening to Mozart's flute concerto #1 and #2, and Richard is imagining himself conducting. Note the pencil "baton."

The orchestra did quite well under new leadership.

Day 8: Kumbaya

2006-08-26T21:59:00.000-07:00

WBC: less than 0.4
(I guess readings below this level are not reliable since they're so small.)
Platelets: 43
Lbs lost: 10

We understand that the anniversary luncheon on Saturday was grand, that a good time was had by all, and that people trekked over to L&N's home for an after-party. One thing about Richard's family--their parties last for days!

As promised, today the music therapist dropped off a guitar for Richard. Basic instruction is happening in the photo: "This is a string. This is your finger. This is your finger on string."

Richard continues to eat very small meals, but he has to force down anything other than ice cream and saltines. Everything tastes really odd to him. He's been craving chocolate, and specifically an Almond Joy (which is weird, because I've never seen him eat one before). I bought one today, and even the candy bar tasted odd to him. Those taste buds are falling down on the job.

I also brought in some playing cards, and after a good wipe-down with the handy-dandy green antibacterial spray (wiping down the front and back of 52 plastic-coated cardboard rectangles is fun!), we played the two-player card game Casino. We only got through a practice game, but the competition should heat up in the days to come.

Thanks for all the calls, gifts (thanks Cyndi!) and cards. Richard's closet door is getting cozily cluttered!

Day 7: Happy 60th Anniversary!

2006-08-25T22:05:00.001-07:00

WBC: 0.5
Platelets: 63
Lbs lost: 8

Richard and I send out a huge Happy 60th Anniversary to Richard's parents. We're sorry we can't be with you and all your friends and family to celebrate your anniversary! The nurses have asked if you wouldn't mind sharing your secrets!

We love you. Have loads of fun and a drink or two for us!

(Now back to regular programming.)
Yesterday and today were pretty good days. Boredom and occasional nausea were the only spoilsports. For dinner today, Richard ate two servings of ice cream and an entire half of a turkey sandwich! There was dancing in the halls over that one.

Alissa sent Richard a bag-o-goodies, sans Scoobysnax...

and Daniel brought him an electric shaver. Richard can't use a razor on those remaining stubborn facial hairs, but the shaver gnaws away at them without nicking the skin.

Nurses' attention has shifted from Richard's food intake to mouth sores. His mouth is now the center of attention. At each shift change, the new nurse will come into the room, reach for the blood pressure cuff, and ask, "How is your mouth?" They peer inside and nod their heads knowingly. They keep expecting fever and mouth sores, but nothing so far. Morphine is ordered and ready to be administered when the sores pop up. I hope they never arrive and that Richard stays healthy during the rest of his hospital stay (1 to 1-1/2 weeks)! Five mouth rinses a day and hypervigilant bacteria patrol may be helping, but we'll see.

Final note: Richard continues to make progress on exercising, and we're up to six hall laps, three times a day. Next stop: Mr. Universe pageant.

Day 5: Lyre, lyre

2006-08-23T23:47:00.000-07:00

WBC: 1.2
Platelets: 143
Lbs lost: 6

Sometimes boredom is a welcome change. Richard felt only moderately nauseated today, which is a big improvement over the last six days. Boredom is better than nausea. Today he spent proportionately more time sitting in the chair, doing exercises, and cruising the hall than on previous days. Who would have thought that boredom could be so great?

During one of our hall cruises, we picked up a hitchhiker: the BMT ward's musical therapist. She brought in her lyre and strummed a few haunting melodies. Richard loved it. She promised to lend him her guitar over the weekend, since he is interested in learning how to play. I hope the other patients and nurses don't mind. At least it's not the drums.

This lyre is made of ash wood, and it is absolutely beautiful. We briefly talked about Larry's skill at taking all types of wood and making wonderful crafts and pieces of furniture. Richard loved having the break in his day, and looks forward to having her stop by a couple of times a week.

No movies tonight. We spent time reading and trying to solve today's gosh-darned crossword puzzle. We're determined to finish one by the time he leaves the hospital.

Richard is eating more, but he still can't tolerate the smell of warm food. Crackers, bread, muffins, ice cream and popsicles are his friends. And don't even mention cooked foods. The words "turkey and gravy" or "mashed potatoes" cause his face to grimace and contort uncontrollably. If I weren't so kind, I could use that against him, I suppose. [What? You disagree with me? MASHED POTATOES. That's right. Don't mess with me, bub.]

Best moment of the day:
Richard: (Looking out the window.) Do you ever wish you could fly?
Robin: (Reading a book.) I really don't like flying. I hate landings.
Richard: No, I mean flying flying. I wish I could just open this window and take off...Where would you go if you could?
Robin: Probably Italy. I would offer myself frequent flyer miles, too. Where would you go?
Richard: With you.

Day 4: A Room With a View

2006-08-22T22:41:00.002-07:00

WBC: 1.4
Platelets: 179
Lbs lost: 6

Today was a pretty good day, overall. Richard felt well enough to sit in a chair for a while. The freeway is in clear view from his window. We really don't need a clock in his room. The traffic patterns are definite indicators of what time of day it is.

I knew Richard was feeling better today when I returned to his room at 2 pm and he was on his knees in bed leaning over the bed rails to change the CD player that sits on a ledge by the wall. I was so afraid he might fall that I just stopped in my tracks like a deer in headlights. (Fair warning here, you do not want me with you in an emergency. I freeze. Or scream. It's not pretty, and I'm pretty much useless.) By the way, see the blue band on his right wrist? That's an indicator that he is a fall risk. (Fans self.) I'm still worked up over that. But I was also pleased to see he was feeling so well! What's a girl to do.

Other evidence of his feeling better was his cruising of the BMT hall. He took five laps this evening. Another patient was taking laps in the hall, and it felt a bit like a transplant version of Nascar. Each person wore a fashionable green gown, clutched tightly to preserve privacy, and they each pushed an awkward portable drip machine. You could tell we were in the US, though. Richard and the woman stayed on their respective right hand side of the hall, looping around counter-clockwise. At one point Richard whispered, "I think I'm gaining on her." Yep. He's feeling better.

Bicep curls, hospital-style.

Checking for progress. Yep. Feeling better.

Things we were thankful for today: new cards to post on Richard's wall; telephone calls from Richard's work colleagues, friends and family; coffee time for Robin and Alissa (thanks Lisa!); and flowers for Robin waiting on our doorstep (thanks Kristen!).

A big thanks, too, to neighbor Bill who helped me haul a huge mattress to the curb at 10 pm for the semi-annual City of Sacramento Crap-on-the-Curb event.

Day 3: Look out, Ahnold...

2006-08-21T22:58:00.001-07:00

That's right, Ahnold...Richard is buffing up.
Be very, very afraid.

WBC: 1.7
Platelets: 243
Lbs lost in hospital: 5

The physical therapist comes by once a day now, making Richard do exercises to maintain his muscle mass. It's amazing what you can do just lying down: pushing one's knees down, clinching the glutteus maximus, flexing the feet, and doing bicep, tricep and othercep curls. Bed potatoes, all together now...a one, and a two. Slow and steady now. Three and four. Tired? Hah! Five and Six. Rest and begin again. (You can almost hear the whip snapping.)

Richard's nausea is unrelenting, so the doctor ordered a New! Improved! nausea medicine, Emend (not sure of spelling yet). It seemed to help a little. Richard's nausea is now at a 5 (on a scale of 0-10...it's been at 6-7). He had a few bites of cream of wheat, toast, and two saltines. He's lost five pounds, but I'm determined to put those pounds back on after he's home. He's a little tired of me asking him every couple of hours if he feels like having a taste of pudding, or a cracker or ice cream. I think he finally succumbs because I'm such a pest. But, really...what he's doing is rewarding my behavior! (Psych 101) I'm always so pleased when he says, "Okay, i'll try a cracker." Funny how basic things, like eating and drinking, become the most important things in your day at times like this.

And that's all the news fit to report. Thanks to all the callers today. It helps. P.S. I'm printing off the blog and responses each day for Richard.

Keeping the lungs fit, too.
And blow...slow and steady...two, three, four.
Good, now nine more times.

Things we were thankful for today: Great day/pm nursing staff (thanks Lorri and Zoraida); Seinfeld; and our children (which brought some tears and hugs this afternoon).

Day 2: The green bean episode

2006-08-20T22:29:00.001-07:00

Day 2:
WBC 1.9; Platelets 293

Richard had one setback but two successes today. He went past the point of nausea today. I' m not sure why, but three things prefaced the event: the new morning nurse did not give him anti-nausea medicine for 7 hours; the new physical therapist worked him around and made him walk down the hall and back even though he had just done so; and I arrived in his room with a cup of green beans right as he sat down after his walk with the PT. He looked at me and my green beans and. Well... I had been so pleased at managing the nausea up to that point. Sigh. I guess the smell of my green beans sent him over the edge. Oy vey.

But! Richard also had a couple of small successes today. After the G.B. episode, he ate three bites of applesauce, 1/2 of a mini-vanilla wafer, 3/4 of a cherry popsicle and one saltine cracker. I believe those represent the four food groups. He walked back and forth in the unit hall a couple of times, too, which was great. And he felt well enough to sort of watch two movies: Rounders (thanks, Alissa!) and Along Came Polly.

I love my new little digital camera, so I took some pictures of Richard's room today. Archeologists might call this research about a person's lived environment?

The Board

The Other White Board

Evidence of success?

The blur is not due to speed of subject...

Things we appreciated today: Calls from Nathalie, Jeff, and Kristen; a new CD player for soothing music; Alissa and Ryan's DVD collection; and free parking.

P.S. Short phone calls and cards are very welcome. I think the phone was "off" a couple of days ago, but that was unintentional.

Day 1: Sleep on...

2006-08-19T23:06:00.000-07:00

Well, today was uneventful. Thankfully. Richard slept almost all day, due to the continued influx of anti-nausea medicine. He ate two saltine crackers and another 1/2 cup of vanilla ice cream. Nice diet. He also took a shower and managed to catch a few minutes of the Little League World Series. [Now, seriously, how much more excitement can a guy have?]

I took a picture of him watching Little League, and he asked that I retake the picture of him smiling so I could put it on today's blog.

Richard started a new regimen of "anti" drugs today. Just say NO to infections! Here's the cocktail:
- acyclovir (prevents viral infection and herpes-type things)
- ipofloxcine (prevents bacterial infection)
- diflucan (prevents fungal infection)

He's also cycling through zophran, ativan and compazine every couple of hours to control nausea. His heart rate, blood pressure and temp remain stable. We're tracking some blood counts on a white board next to his bed, and I'll share those with you each day. We can watch his counts bottom out. Fun, fun, fun. Here are counts for day -1 (8/17) and +1 (8/19), respectively:

WBC (white blood cells: fight infection): 3.4 3.1
HGB (carry oxygen): 12.0 10.1
PLT (platelets help clotting): 401 296

For those of you who have persevered through all the medical talk, here are pictures from Tuesday's trip to Bodega Bay:

The rocky cliffs and some of the dozens of otters that can be seen from the hotel restaurant.

Richard on a walk.

Richard and Robin on a walk. This is a bluff off Highway 1. You can't tell, but the ocean is just yards away, behind us.

Ready for breakfast before heading home on Wednesday.
This is my favorite picture. I might have to repost this on Sunday.

Things we appreciated today: my mother's return home after a week in the hospital; a new, easy to use digital camera; and glorious, oblivious sleep.

Day 0: Cold blood, warm heart

2006-08-18T23:21:00.000-07:00

Richard was infused with his stem cells today. Here he is before being majorly drugged with anti-nausea stuff.

Although the actual infusion lasted less than five minutes, there was a bit of formality and protocol in the delivery of his stem cells. Four nurses were involved in the process; another two popped in to "help" but I think they just wanted to be part of the excitement. Eh. I don't blame them.

One nurse hauled in the large tub carrier on a dolly. This tub had stickers on it from all sorts of travels from what I could tell. It reminded me of the old steamer trunks plastered with labels from around the world. After one nurse unlocked the tub (shown in the picture...this is a new digital camera, so this first shot is a bit shaky) , another nurse donned large blue gloves and scanned a doohickey on the top, which unlocked an inner container. She then reached in and removed the frozen bag of cells. Her gloves were coated with ice. It was so cool (no pun intended). Several checks of numbers, name, and birthdate between Richard's arm band and the blood product were done.

The Icy-Gloved nurse handed the small packet of frozen cells to Bath nurse, who kneaded the bag in a warm bath until the cells thawed.

Bath nurse handed the bag to Hangingpole nurse, who verified that Richard's arm band matched the blood product. Again. She then hung the bag up on the pole, and inserted it into Richard's port. The nurses mentioned that in the "old days" (12 years ago), they would have about 10 bags to thaw and administer. This was a piece of cake! It took only a few minutes and they were done. It was a bit anti-climactic after all the Nasa launch-like activity.

Richard pretty much slept through the whole thing. The whole day, really. They had him on all sorts of anti-nausea drugs, including ativan. He woke up around 7 p.m., still groggy and mildly nauseated. Our goal at this point is to prevent him from throwing up. The only food he had today was about 1/2 cup of vanilla ice cream. The good news is that he kept it down. They took off the blood pressure and heart rate monitor around 6 p.m. He continues to use a medicated mouth rinse 4x/day to prevent the very common mouth sores that SCT patients get. Other things that might happen are: garlic odor for a day and red-tinted urine.

He's even cute when sleeping...

Richard's parents, Larry and Nathalie, dropped by in the afternoon. Richard was awake for a few minutes toward the end of their visit, so I was able to take this picture before they left.

Thanks to everyone who has called or emailed or posted something on the blog. It means a lot! Since we're really not supposed to use cell phones in the unit, calls can be made directly to the hospital (916.454.2222). He's in room 4317.

Day -1: Resetting the "block" (the blog clock)

2006-08-17T23:09:00.000-07:00

We're resetting the numbered days on this blog to correspond with stem cell transplant protocol, where Day Zero is cell infusion day. Since that's Friday the 18th, today was....well....-1.

After a relaxing day and night in Bodega Bay (pictures to follow tomorrow), Richard checked into Sutter General this morning. They cleaned his catheter port, drew blood, and put a new dressing on his port site. He received a drip bag of premeds (ativan and another nausea-fighting drug called zophsomething...I left our notebook at the hospital). Then the melphalen was administered through his port at 1:30. It only took 30 minutes. Alissa and Dan visited during the late part of the afternoon, then dinner and the 1960's movie "To Sir With Love." And more ativan. He receives his clean cells at 11:30 on Friday. We hear that the substance used in freezing the cells makes the patient smell like garlic(!).

Note: I lost my cell phone on the trip, so I've temporarily suspended service. However, you can call or send any non-flower/non-organic mail to Richard at Sutter General Hospital.

Things we appreciated today: Good nurses--those who strike that precarious balance between efficiency/professionalism and caring.

Day 26: Bodega Bay Bound

2006-08-14T23:36:00.000-07:00

Since Richard will be confined to a hospital room for 2-3 weeks starting this Thursday, we decided to run away for a day. We're renting a car on Tuesday and driving to the coast. We're headed for Bodega Bay (about 2 hours away), but who knows where we'll end up.

We have sunscreen for newly-exposed skin, a camera, and 24 hours to enjoy.

Let the road trip begin.

A bit of trivia: What actress played the lead in Hitchcock's The Birds, which was filmed in Bodega Bay? [Hint: She is Melanie Griffith's mother.]

Day 24: Babies and Countries

2006-08-12T22:55:00.001-07:00

Wonderfully, and thankfully, life moves on. Illness arrives in some places, while beauty and life arrive in others. Recently, our oldest daughter announced that she is pregnant with our first grandchild. We are so excited! Life is sweet.

On an interesting but less exciting note, we discovered this blog has been visited by readers from nine countries: Australia, Canada, France (Hi, Suzanne!), Indonesia, New Zealand, Philippines, South Africa, United Kingdom, and of course the United States. Some of these have been linked from other cancer survivors' pages, and many have arrived via Gracie's onewheelforlife blog. It's fun to be part of a global social connecting, however brief and anonymous.

Things we appreciated today: An outdoor cafe, the exuberance and potential of youth, good hospital care, and bran muffins.

Day 22: Cleared for Take Off

2006-08-10T18:30:00.000-07:00

We met with the oncologist today and set a date for the stem cell transplant: August 17. Richard will first receive a high dose of the chemotherapy mephalen, followed by a reinfusion of his now-pristine stem cells. He'll be in the hospital 2-3 weeks.

The doctor remeasured Richard's height today: 5'7". That's down an inch from about six months ago, but maybe it's just that all that hair is missing! Everything else (lungs, other vital organs) was fine, too, so we are ready to go.

Things we appreciated today: A new cap from our daughter, to protect Richard's bald pate from the sun!

Day 20: Bald is beautiful, baby.

2006-08-08T23:23:00.000-07:00

[Special kudos to those who remember what TV character said that. Lollipop, anyone?]

Nephew Shiloh trekked to Sacramento and buzzed Richard's scalp yesterday. I'm not sure whether Richard looks like a convict or a Hare Krishna guy. I'm still shocked when he walks into the room. Who is that man? Scary yet mildly exciting.

Here are some pictures to chronicle the day.

Shiloh arrives and can't wait to turn on that razor!

Shiloh shaves one of his fingers to show what a level 2 cut looks like. New finger trend.

We briefly try out a mohawk and decide it looks better on Daniel Day Lewis. Richard looked rather punk for about 3 minutes.

Father O'Shea at your service.

"If I concentrate really hard, I won't nick him and open myself up to a lawsuit."

As any good barber would do, Shiloh trimmed up the eyebrows. Lawyer by day, barber by night.

It. Is. Finished. But at least they swept up.

No children were harmed in the shaving of this man.

Things we appreciated today: Our newly pruned tree, our newly pruned guy, and foot rubs. Ahhhhh.

Day 19: Hair Today, Gone Tomorrow

2006-08-07T15:04:00.000-07:00

So the expected has occurred. Richard's hair is falling out. Here a little, there a little. Some in the sink, some in the shower, a lot on the pillow. Finally, I'm not the one clogging up the shower drain.

Richard's scalp looks a bit mottled at the moment, so he's planning to have his head shaved tonight or tomorrow. It's the look du jour: bald and beautiful (smooth and handsome?).

At least there are no small children to alarm with Richard's new look. When the children were very young, Richard sported a big beard (remember the days?). One day he shaved it off, and our daughters wouldn't go near the New Scary Man for at least a day.

Thing we appreciated today: Cool breezes, clean catheters, and calm before the storm.

Day 13. Over the limit

2006-08-01T23:16:00.000-07:00

We got a call from the oncologist last night. They harvested 13 million good stem cells, which is about 4 million more than they need for two transplants. So we didn't have to go in today. Hurray!

Now we wait for a couple of weeks. Around August 22 Richard will go back to the bone marrow transplant ward to get the heavy-duty-chemo melphalen, followed by reinfusion of his "clean" stem cells. More on that later. Right now we are basking in having nothing to do cancer-wise except "catheter care" a few times a week. Think of catheter care as housecleaning for the trifusion port. I doubt they use Mr. Clean or 409, but they flush it well to prevent infection and to keep the line open.

Here's a picture of Gracie and Richard at the infusion center yesterday. It was great to see her after her 3500+ unicycle journey across the US. She rode on behalf of the Leukemia and Lymphoma Society. Amazing.

Things we appreciated today: Family pics. Digital pictures are great, but there's something wonderful about handling 30-year-old photos.

Day 12: It's Harvest Time

2006-07-31T15:56:00.000-07:00

No, it's not time to bring in the sheaves, but it's time to separate blood!

Get this:
Richard's WBC on Friday: 0.49
Richard's WBC today : 29.0

I know, I know. Pretty amazing. All that sternum pain was worth it.

Today we headed to the infusion center at 7:30 a.m. in order to harvest the hopefully millions of new stem cells that Richard's body has been producing over the last few days. I'm not a morning person, so this was challenging. Thank goodness we only live a few minutes away.

This picture looks a little fuzzy, almost surrealistic, because even the camera had a hard time focusing at 8 a.m.

The apheresis machine awaits blood. This could be the name of a horror movie, no? I did not add the blue tint. My camera caught the apheresis eeriness.

Nurse Betsy helps Richard with his green gorgeous gown and blood pressure cuff accessory. He looked stunning.

After weighing, poking and gowning (I can and will make a verb out of any noun), Richard was hooked up to the apheresis machine. This machine looks like it can spin yarn from lambs wool, but it really takes blood from the patient and whirls it around in a centrifuge, thus separating plasma, red blood cells, and "stuff." "Stuff"(c) was the official term (sort of) given to us by one of the nurses yesterday. Stuff(c) contains stem cells and lots of other blood products. Once the machine recognizes the stem cells contained in the middle layer of Stuff(c), it sucks it up into a bag. Each draw process takes about 40 minutes; Richard had six draws.

On the left, Richard "King for the Day" on his apheresis throne. Note the wilted corsage, aka trifusion catheter. More on that later, with a special picture just for Dale...

The courier arrived about 2 pm, and they boxed up the bag of stem cells and the separate bag of plasma (which is whitish-yellowish). The box was taken to Alta Bates Hospital in the Bay Area. We find out tonight how many stem cells were harvested.

We will repeat the process tomorrow. The plan is to harvest enough cells for two transplants--one for now and one for the future.

Highlights from today:

--Dale, Kimberly, Sarah and Gracie The Unicyclist visited.
--I was able to add several more rows to a scarf I'm knitting for a very good friend. This is good news because I started it in May 2005.

Things we appreciated today: Sutter Cancer Center's valet service, foam antibacterial lotion, and caffeine.

P.S. Here's a final picture just for Dale, the man with no beard. Warning: rated "I" for icky.

Day 10: Yep. The neupogen is working.

2006-07-29T23:45:00.001-07:00

Friday night was a wee bit difficult. We were awake at 2 a.m., sitting in a darkened living room, waiting for vicadin to kick in.

Richard began to have severe pain and throbbing in his sternum late on Friday afternoon. Richard wasn't sure if it was heart problems or something else. The doctor mentioned that he might have pain in the chest, hips and long bones as the neupogen began working. Apparently, the drug accelerates the growth of white blood cells, which then push on the mass in the bones. I don't think Richard imagined the pain could be this severe. We had vicadin on hand, but the pain takes about 30 minutes or so to subside. Then after 3-1/2 hours, it all begins again. It reminds me a little of labor contractions. You know the contractions are working to produce something wonderful, but the pain sometimes is unbearable. Saturday morning we told one of the nurses at the infusion center about the pain in his sternum, and she beamed and said, "Great!" I loved her reaction. Yep. The neupogen is doing its job.

Richard is scheduled for stem cell harvest on Monday at 8 a.m. It's an outpatient procedure that takes about four hours.

Things we appreciate: Netflix, family, and Vicadin.

P.S. Gracie finished her coast-to-coast trip on a UNICYCLE! Check out her blog in the sidebar. Congratulations, Gracie! You are an amazing woman.

Day 8. The White Blood Count Ride

2006-07-27T23:14:00.000-07:00

After several uneventful days that involved daily neupogen shots, Richard got blood tests and met with the doctor. This was the first time we had seen the doc since last Sunday. Richard's port site appears puffy, so the doctor put him on two antibiotics. Richard seemed to tolerate them well this evening.

The cytoxin administered last week is effectively suppressing Richard's white blood cells. Richard's WBC was 0.46 today, dropping from 5.3 two weeks ago. Normal range is 4.2 to 10.0. If all goes well, his WBC will start climbing back up in the next day or two. Stem cell collection is next Monday or Tuesday. Richard's red blood count is 3.53, down from 3.9 two weeks ago; normal range is 4.6-6.2.

For you Multiple Myeloma buffs out there, here is Richard's IgG count over the course of the disease/treatment so far:

IgG
1/6/06 - 9171 (Week of diagnosis) Normal range is 700-1600.
2/3 - 9215 [quite active tumor loading; this was pre-inductive treatment]
3/1 - 3806 [achieved a dramatic drop with Thal(200mg)/Dex(40mg 4 days on/off)]
4/24 - 3225 [slowed progress due to treatment ceasation because of drug rash from Thal]
5/18 - [change in treatment to Velcade/Dex(40mg 1x/wk)]
6/12 - 3183 [Velcade only moderately effective at minimizing MM]
7/10 - [stop all treatment in preparation for stem cell harvest]
7/20 - 2808 [admitted to hospital for cytoxin]

Thanks to everyone who has written comments on the blog and sent comments separately by email. We're a little slow in responding, but we'll get there!

More things we appreciate: Friends who make us laugh. For me, it means going out with my girlfriends and discussing topics ranging from religion to Marky Mark. Thanks Monika and Lisa.--Robin

P.S. I took a picture of Richard's port for those not faint of heart. See below.

Richard - Port 7-06

Day 5. Yesterday's Aha Moments

2006-07-25T06:27:00.000-07:00

Aha Moment Number One.
After wondering why no comments had been posted on this blog, we realized our error! We needed to "accept" comments before they were published. Oops. We were so relieved to know people were responding to our posts. The silence had been deafening! Many thanks to everyone who has sent good wishes, comments, and suggestions.

Aha Moment Number Two.
After driving to Davis in 105 degree heat (with no car air conditioner), we realized that we probably should schedule morning appointments. Richard was flushed, lightheaded and a little confused after the ride. We walked into the doctor's office and felt like we had just walked into a meat locker. The cold never felt so good. On the way home, with the windows wide open and the hot air circulating around us, we reveled in the ag scenery from the causeway.

More underrated things: The comfortable and comforting silence between two companions.

Day 4. Nifty Neupogen

2006-07-23T23:55:00.000-07:00

We went to the hospital today for the first of ten days of Neupogen shots. Neupogen is Amgen's registered name for filgrastim, or a type of G-CSF (or Colony Stimulating Factor). I believe these colonies are not populated with real people...

Neupogen increases stem cell production. We hope to harvest a lot of stem cells at the end of the month--enough for two transplants (one now and possibly one down the road). This stem cell acceleration is a little like the Forest Service planting fish in lakes for tourist fishing. In this case, we would be hoping to catch 10 million trout.

They administered 2 ml of neupogen (that's a double dosage) in shot form in the back of the arm, subcutaneously (a fancy word for just under the skin...not in the muscle or anything). Well, Richard has very little subcutaneous fat, so they took a hunk of flesh and pinched it while slowly administering the stuff. The nurse said that if you apply pain somewhere else on your body, it lessens IV or shot pain. I guess your brain can't really deal efficiently with more than one pain site. She said she pinches her leg when having blood drawn. That's our Tip For The Day!

Richard felt pretty good today. He had no fever, but felt a little fluish--a general tiredness and malaise. His blood pressure is still low (99/67). Lots of calls from friends and family made the day go by fast for him.

More things highly underrated: Television. To a sick person, TV provides distraction and healing laughter. God bless Seinfeld and the many cable sports channels.

Day 3. Home again, home again, jiggety jig

2006-07-22T21:34:00.000-07:00

Richard ate breakfast this morning, thus successfully passing Round One of the BMT journey. Reminds me of when I used to play Ms. Pac-Man. I "ate" all the little orbs, which enabled me to move on to a more challenging level.

After many instructions and a still-intact "trifusion" catheter in his chest, Richard and I headed home at 10 a.m. His blood pressure is still low (99/57), but higher than yesterday. We only live about five minutes from the hospital, which is so helpful. Ah....home, sweet home. Even better was "shower, sweet shower."

To keep the port and area around the port dry during Richard's shower, we put saran wrap over part of his chest, stuck in place by waterproof tape. With hundreds of thousands of patients needing these sorts of "cover-ups" after many types of surgery, you'd think Johnson&Johnson or 3M would have created something like this for sale. Shrug.

Richard felt a little fluish today. He didn't have a temp at 2 pm, but a very slight temp at about 5 (99.2). He spent the day talking on the phone, lying pronish on the borrowed barcolounger (thanks Jeff), and eating soup, crackers and cheese, and even a little ice cream (shhhh). I still have to figure out the best way to serve a "low microbial diet." More on that tomorrow.

Please feel free to leave comments. You don't need a Blogger account to do so.

More things underrated: Chicken noodle soup, and a cool shower after a hot day.

Day 2. One more day at The BMT Resort

2006-07-21T22:36:00.000-07:00

After a decent first day, Richard spent most of Thursday night and Friday morning vomiting (sorry, I couldn't think of a better word here..."being sick" just doesn't cut it). The nurses pumped him full of more drugs to take away the nausea, and he slept most of the day. His snoring never sounded so good. They won't release him until he's eating, so we're logging day two at the Bone Marrow Transplant resort.

Richard's also still on a major hydration bag drip (with magnesium and potassium), something that's very important for flushing the kidneys after receiving high doses of chemo. He is still pretty loopy, and forgets that people have called and what the nurses have said (one more good reason to have someone there as much as possible). His blood pressure dropped even further today...it hit 88/52 at about 7 p.m. Our oncology group's on-call doctor was made aware of the drop, and they're watching it tonight.

The good news is that he started getting hungry around 6 pm, s0 he had chicken broth (oh the joy that is chicken broth after not eating!!), vanilla ice cream, and half of a roll. Nice.

I left the hospital at 10 pm and had to exit through Emergency. I had no idea that the emergency room is THE happening place in Sacramento. It was like a party or something, with people hanging outside, talking and smoking. Children were everywhere. Oh. And it was about 90 degrees outside! How is that possible at 10 pm??

Today's conclusions: Two of life's taken-for-granted niceties are normal body functions and air conditioning.

Day 1: Catheters, cytoxin and calories, oh my!!

2006-07-20T23:18:00.000-07:00

Yay Richard. He successfully made it through today's poking, probing and chest cathetering (yes, I've made "catheter" into a verb). We went for coffee while awaiting "the call" that a hospital bed was available, and checked in about 11:30. Eventually we got settled into the bone marrow transplant ward, which is about a 6-bed unit with a room for family to hang out, cook, and even run on a treadmill. Right.

Richard donned a hospital gown, some really cool grey socks with non-skid soles, and a pair of jammie bottoms. He's been wanting new jammies, so we *scored* this trip.

We had a great view of another building, which actually came in handy later...we were bored at about 6 pm and began discussing whether or not a breeze was moving the tops of the trees across the street. By the way, it was about 105 degrees outside at the time and 62 degrees in our room.

Richard was poked three times for an IV. Ouch. He got a lot of drugs. Legally. Then got carted away to have a couple of incisions in the upper right hand side of his chest, where they inserted a very large catheter down an artery. Three tips hang out, available for doses of toxic chemo and other yummy stuff. (Think here what it would look like to have a corsage with three wilted stems and you have an idea of what it looks like. Great look with those jammies.) I snuck away and walked to Starbucks for lunch. Did I mention it was 105 degrees in Sacramento today? Hot. Seriously.

Richard returned to the room and began talking non-stop. I think he was feeling no pain. A visit by the doctor, dinner, calls to family, a visit by daughter Lisa, and finally a DVD of "Rainman" to fall asleep by. (Geez, Tom Cruise was about 12 in that film. And Dustin Hoffman is most definitely one of the best actors ever.) I noticed at dinner that the hospital had him on 2000 calories a day, and here I am trying to get him to gain weight! He was famished, which I was glad to hear, so he had several snacks of graham crackers and milk. Maybe that was comfort food?

So Richard should be released on Friday afternoon if all goes well. Then daily infusions of neupogen to stimulate stem cell growth. Richard's white cell count should go down for a while, so no public showings for a while. Just as well, with this heat.

Oh! Gracie is almost at the end of her cross-country journey (see link on the sidebar). Amazing!

Love to you all.

Buckle Up...

2006-07-18T21:34:00.001-07:00

Okay, first posting! Buckle up..

This first post is lengthy, but it's *relatively* brief. We knew you probably didn't want all of the marvelous details. Think of this as a Reader's Digest version. And I suppose you have to be of a certain age to appreciate that reference. Feel free to skim! So...as a recap...

In May of 2005 Richard experienced an injury on the job, and we learned (after several tests and much pain and suffering on Richard's part) that he had multiple fractures in his spine. One disinterested Worker's Compensation doctor who evaluated his xrays told us in passing that the injuries to Richard's spine were just a result of "getting old." Richard was 52.

It took several more months to finally receive a diagnosis of osteoporosis. For a white man of his age, his results were 4 standard deviations from the mean. Finally, my statistics course proved helpful! This result meant that he had less than a 1% chance of having osteoporosis to the severe extent that he did. However, this still didn't send up major disease flags for our medical team. It wasn't until December 2005 that Richard's primary care physician put it all together and suspected Multiple Myeloma. Finally. By this time, Richard could barely walk, was disoriented, took 30 minutes to get out of bed...and one morning he couldn't even step down our front step without his legs buckling. He had a fractured pelvis, his bones weren't functioning properly, he had low red and white blood counts and many other things wrong. He had also lost three inches in height due to compressed discs (from the osteoporosis). Instead of 6 feet tall, he's now 5'8" and holding. (I rarely wear heels anymore, so this all works out okay...our height differential is about the same!)

Richard was officially diagnosed with Multiple Myeloma (MM) in January of 2006. MM is a cancer of plasma cells. Plasma cells are made in the bone marrow, and with MM these cells overproduce and impede normal bone functioning. The result is, well, disasterous.

Once diagnosed, Richard was put on a treatment of high dose Thalidomide (200mg/day) and Dex(20mg/4 days on/off), with good results. The International Myeloma Foundation was an amazing source of information and support in those early days. Things would have been so much harder without them and their wonderful staff and directors, including IMF chair Dr. Brian Durie.

Richard developed a drug rash from the Thalidomide after a couple of months, and had to switch to Velcade, along with occasional Dex. He also went in for monthly infusions of Arridea to help the bones function. He has not gotten good results (i.e., fewer plasma cells) from Velcade. So onward to a stem cell transplant. There is no cure yet for MM, but drug therapy and transplants can provide a few additional years of life.

The autologous stem cell transplant (i.e. he's donating his own stem cells) process will involve 1) having a port placed in his chest for chemo delivery; 2) harvesting peripheral stem cells; 3) taking a very high dose of the chemotherapy Melphalan; 4) receiving half of the harvested cells that have been cleaned up. The process takes several weeks. During the Melphalan/transplant phase, he will be in the transplant unit for three weeks at Sutter General Hospital, beginning about August 22.

He should be hospitalized for about 3 weeks, while his white cell count goes down to about zero and then slowly climbs up again. During hospitalization, he will be very susceptible to infection and thus cannot receive any flowers, fruits or vegetables and few (if any) non-family visitors. Cards and phone calls to the hospital room are welcome.

Okay, assuming some people are still reading this (thanks for bearing with us!), the first step in the transplant journey will happen Thursday, July 20, 2006. Richard will be admitted to the hospital overnight for insertion of a catheter in his chest, and a dose of Cytoxin. Friday he will be released, and visit the hospital infusion center each day for about 10 days to check the catheter and have a daily dose of Neupogen (stem cell accelerator). Yummm.

So that's all for now. We'll use this blog as a mini-diary of his progress, and you're welcome to follow along. Thank you all for your good wishes and support.

P.S. Our niece, Gracie Sorbello, is riding a unicycle (yes, that's right...the thingy with one wheel...and no handlebars...and did we mention shoeless??) across the United States this summer (2006) to benefit the Leukemia and Lymphoma Society. Go Gracie! Check out her journey here or click on the link in the sidebar on this page.

Consider donating to the IMF here. They have provided countless hours of phone support, publications, and direction to us and thousands of families like us.