May 29

I wanted to share some pictures with you that I took during Doug's stem cell infusion. I took more pictures than my blog allows for one posting. I hope pictures speak louder than my words to describe this awesome event in our family's life.

The medical technologist came to the clinic with the cells in a caldren of refrigerated nitrogen. The cells collected were spun in the blood bank's lab and 25 cc's of stem cells were put into each of two bags. Each bag also contained 25 cc of DMSO, a preservative, which does not harm the patient but leaches out of their bodies producing an oder which to me smelled like cream corn that you get in a can.

Since the day of collection Doug's cells have been kept frozen at -196 degrees celcius. The med tech, Natalie. who brought the cells works for the Carter Blood Bank. They will store 1/2 of the cells collected from Doug should Doug ever have need for them in the future.

Natalie's undergraduate degree is in clinical lab science. She is certified by the American Society of Clinical Pathology to do this specialized work. What we found interesting is that she is a cancer survivor who has been cancer-free for 14 years. I'd guess her to be in her early 30's.

The two chemo nurses and Natalie trippled checked the label on the packaging to be sure the stem cells were Doug's and going back into the correct patient. Natalie read to Debbie then Debbie to Fatima.

In the picture above you can see that each bag of cells is contained in a protective metal case. They come frozen flat. Then the bag of cells is placed in a machine that Natlie brings with her called (in laypeople terms) " the warming bath". When the stem cells come up to body temperature the bag of cells is ready for infusion. The team works together rapidly at that point.













The "blessing" of the cells took place (see the other May 29 posting). The first bag was hung on the pole with the other hydrading fluids that Doug received prior to the arrival of the cells and were connected to Doug's central line. I called it his new life link. Meanwhile Natalie is warming the second bag of cells.

One of the chemo nurses monitored Doug's vitals the entire time while the other nurse monitored the rate of flow of the cells into Doug's central line. Because Doug's collection was so successful with so many stem sells per micro lieter he only had two bags of stem cells whereas others frequently have more than two even as many as eight bags.

Each bag took 20 minutes to drain so that in 40 minutes Doug's happy cells were using their God-given instinct to find their way back into Doug's bone marrow. Natalie explained that the cells have receptors on the outside and when returned know right where to go. They set up shop in the bone marrow and within a couple of days they start dividing. Meanwhile Doug will feel weak and fatigured.

Doug was comfortable during the entire process and said he felt nothing. I can't help but tell you I have a picture of him talking on his cell phone to a pastor who called him just before the action started. When I heard Doug say "How can I be of help to you?" I wondered if the pastor had any idea what Doug looked like from where I was sitting.

When the infusion was complete and Doug was unhooked he stood up and walked with me to the car and rode with me to the pharmacy to pick up a perscription. I can't find words to describe what that felt like to both of us.

We go to the clinic every day now. We have to be real careful of infection/fever until his immune system kicks back in. Friday and Saturday he will have blood transfusions. Sunday the injections of neupogen will begin again to assist in the growth of new cells. This time, however, the dosage will be less. We are grateful that during this entire process he was able to be a clinic outpatient.

~Carole

PS Of interest to us (and no one else) is that May 29 is Dr. Collins' birthday so Dr. "V" covered for him. She is a brilliant physician whose last name is longer than most can pernounce so goes by Dr. V. She has covered for Dr. Collins and seen Doug before.

May 29 Blessing

Today was the day Doug's stem cells were infused back into his body. In a ceremony as emotional for us as our wedding day, the following blessing of Doug's stem cells was prepared by Rev. Gina L. Biddle, BS, MA, BCC from the Chaplain Services Department
UTSouthwestern Medical Center. Dale, our social worker, chemo nurses Debbie and Fatima, medical technologist Natalie from the blood bank and Pastor Gina shared this special moment with us. As the first of two stem cell bags was hung for infusion back into Doug's body we each had a copy and responded in kind to the following:

Blessing of the Gift of Cells

for

Rev. Doug Kilcher

CHAPLAIN: We come today to celebrate a new beginning.

Any new beginning stirs up many feelings within us.

ALL: We feel afraid and anxious about the unknown, but at the same time we feel excited and hopeful as we look forward to new possibilities.

CHAPLAIN: The cells we bless today, Doug, offer new possibilities for your healing. We give thanks to Carole, for her gift of love and companionship to Doug as he takes this journey of life. These cells from your own body are an amazing gift from the Creator of all life.

ALL: Thank you, Great Creator, for this gift of life and for this transplant as a means of using this gift of healing.

CHAPLAIN: Loving Creator, our understanding Friend, we come bringing all our fears and hopes to you as we bless these cells for Doug's healing.

DOUG: Today I receive these cells with profound gratitude and hope.

CAREGIVERS: Doug, may you feel our hope and love supporting you, bringing you renewed energy and hope.

CHAPLAIN: May Divine Love and Wisom "be healing to your flesh and marrow to your bones" (Proverbs 3:8). God of all love and grace and healing, bless these cells for Doug's healing according to his deepest needs of body, mind, and spirit. May Doug feel your power flowing through every cell, bringing a new day of health and joy and creative energy.

ALL: Loving Creator and Friend, come with us now on our journey into the new. Lead us forward with your vision of abundant life, and help us to continue to become all you created us to be in your divine image, now and forever. In the Name of Jesus Christ.

Amen.

May 22-26 &27

May 22-26 & 27

I didn’t post anything from the 22nd through the 26th because there was nothing unusual to share. It was a time of rest for Doug as the team waited for his white count to drop. On Memorial Day we did drive to a farmers market. Whoopee!

Today, May 27, is a day we’ve been both excited about and dreading. We've been excited because today is the beginning of the end of this particular chapter in our lives; dreading because the words heavy dose of chemotherapy (as compared to a standard dose) made our imaginations go back over all the after math of every other IV chemo Doug has endured previously. Neither of us slept well last night.

The chemo nurse caring for Doug today is one of our favorites. We were in a private room with a window looking out on what turned out to be a stormy day. A large bag of general fluids and anti-nausea meds were started at 9 a.m. At 11:30 the nurse brought in the chemo bag, hooked the small bag onto the pole, and connected it into Doug’s line. That bag’s drip was done in 30 minutes. He felt nothing different while it was going in. Two hours later he threw up once, he received an additional injection of anti-nausea medicine in his line and we waited until the large bag’s last drip finished. He walked out of the clinic with me at 3:00 p.m.

I was surprised that after he rested for about an hour he said he was hungry. We are doing small, frequent snacks. With little strength and vitality he is spending his time in bed but so far no complications.

We have been warned that today would be an AOK day. As his blood counts drop during the next 7-10 days he will feel less well. As his counts recover he'll build back up. We go to the clinic every day now so it is their plan to treat Doug as an outpatient. I am his private duty night nurse!

There is a chance he’ll have to spend a few days in the hospital when his counts are the lowest. After the clinic is closed I have a phone number to call anytime I have a concern. The doctor on call will tell me what I need to do. If it is best that he be admitted to the hospital, this time I will be able to take him directly to the hospital without going through the emergency room. That is huge for both of us!

Tomorrow we check into the clinic for labs and fluids. Thursday is the day Doug's stem cells will be returned.

Doug said today that he can see the checkered flag of remission in the distance. Thanks to all of you who have stayed in the bleachers to cheer for him throughout this race.

~Carole

May 19-21

I promised to get back with you about the unit of measure which followed Doug’s 412 as computed by the blood bank’s C34 test. The answer is micro liters. As I understand it, that is a lot of stem cells ready for collection. It was a surprise to the technicians who were with us and they were pretty sure they could get the 20 liters Dr. Collin’s group requires in one day. Ok it was a 6 hour day but better than what we had anticipated. Our transplant coordinator had warned us that they scheduled 5 days for collection but usually harvested enough by the 3rd day. Prayer changed that for Doug!

He was in a hospital bed and I sat beside him in a broken “chemo chair”. There were two techs from the blood bank. The one who watched the machine had worked for the company that built and manufactured it, went through the clinical trial period using it and trained end users at all the cancer centers in the United States. He said that 6 months ago a computer version came out but he doesn’t trust his own home computer to work right all the time so is biased towards one that is monitored by a human (solid state cell separator rather than a computer controlled cell separator). He retired from the company and now works part time for the blood bank.

As he was attaching Doug’s lines to the machine (or the machine to Doug’s central line) he told Doug that Doug was about to receive one of the only medical procedures that is painless. One just has to tolerate resting in bed (which Doug is tired of doing!).

The male tech was concentrating on the machine most of the time and the female did paper work as well as other duties in and out of the small room where we were located at the clinic. The operator of the machine determines what cells are coming up the “collect” line. He watches the color and manually controls and fine tunes the flow as needed.

Once in awhile the male tech would sit down. That is when he and Doug talked about cars. He told Doug what he had owned in his lifetime and Doug mentioned his ’67 Chevelle Malibu Super Sport with a 396 engine. Then the tech said he was car poor now. He most recently sold one of his 3 Vipers (a red ’92 with black striping and a silver ’99 with blue striping!) After that Doug didn’t admit to driving a hand-me-down Buick and changed the subject. (Men are funny that way). Doug just reminded me that over the years the guy also owned several Shelby Ford Cobras along with a number of Covets.

I found it interesting that the techs told us that the smaller the individual the longer the process takes. During random conversations he noted that at anyone time only 300 CC of Doug’s blood is in the centrifuge and lines. The plasma and leucocytes (where the stem cells hang out) go into separate bags and the platelets and red cells go back into Doug. Some red cells do get into the collection bag but they are heavier and he watches as the bag layers—the red cells being heavier thus dropping to the bottom of the bag.

He also noted that we all have tumor cells inside us. The difference between someone who gets cancers, although not just this simple, is that the immune system cannot control the multiplication of the cancer cells. If there would be any cancer cells in the collection bag, the intent is that the next chemo Doug is to receive will knock out all cancer in his blood. When the bag of happy cells are put back into Doug 48 hours after the chemo he will again receive injections to build up his immune system until the happy cells graft back into the bone’s marrow and cancer cells can be combated. Stem cells travel through the bloodstream to the bone marrow where they lodge and differentiate into all types of blood cells to help prevent infection and repair the body.

This quote regarding stem cells from Dr. Paul Simmons helped my understanding:
“No other cell in the body has that combination of self-renewal, extensive proliferation and differentiation capacity,” states Paul Simmons, Ph.D., director of Stem Cell Research at the Brown Foundation Institute of Molecular Medicine for the Prevention of Human Diseases at The University of Texas Health Science Center at Houston (IMM). “Understanding how to control the differentiation of stem cells is still a major endeavor that is underway in many labs around the world.”

Six hours after Doug's treatment began the machine had separated 20 liters of what the blood bank will cool than freeze until they are returned to Doug 48 hours after his last chemo treatment next week. A warming process of the blood products takes place first but that is part of “the rest of the story”.

Doug was disappointed yesterday (20th) when he learned that his chemo cannot be given until next week. His white cells are too high—a good thing at some times and not good for the impact Dr. Collins wants to have on the cancer cells in Doug’s body. Doug is still very weak and wishes for more energy which I cannot go out an buy or graft to him.

Memorial Day is celebrated early this year so Tuesday is the first day they could schedule the “sledge hammer” chemo that we are not looking forward to yet signal the beginning of the end of our battle to fight back. We know you will be praying with and for us and that support will get us through.

~Carole
P.S. To our friends in the medical field more familiar with blood than I am, if I have misrepresented anything known to you, I’d be glad to make corrections in my blog.

May 15-18

The 15th and 16th of this month blend together in my mind as hospitalization routine for Doug (and me).

Doug has had engaging conversations with the medical team that has cared for him during his stay in the hospital. On the 17th when he was discharged to my care at home the discharge nurse said, “All of us want to know where you found such a kind man?” I smiled and told him it had taken me 40 years to train him and I wasn’t interested in training in another one!

Seriously it makes me proud to hear his care-givers in the hospital refer to him as kind considering the type of pain he had to cope with and how cruddy he felt over all. Just this week a relative (young adult) wrote that she felt Doug was the kindest man she knew and wished him full recovery. His kind way with me was one of the reasons I was attracted to him 40 years ago!

Doug slept most of the afternoon Saturday. Kristi was with us for the last time this trip and when she kissed us goodbye told us that she’d try to save up enough money to come back every three months or so. She loves Seattle and brought us a table top book of the city so she could point out to us the areas visually she talks about: where she lives, the area overlooking Lake Washington where she works, the dog park that she loves to hang out at with friends and their pooches. Of special interest is a view of the city that includes the hospital where Doug was born.

Saturday evening Doug’s temperature began its journey upward. Because he was feeling so weak and sweating abnormally he called the on-call doctor. His fever was 1/10 of a point from where he’d have to call the on-call team anyway. The on-call physician who had treated Doug in the hospital frequently gave us a new medication regimen to try and we were able to avert a trip back to the ER and the hospital.

As I write it is Sunday, the 18th. I checked on Doug throughout the night last night and administered his pain meds as scheduled, gave him a Popsicle and filled an ice bag for his head.

We went to the clinic this morning. Doug had the usual vital signs taken, his daily Neupogen injection, and blood draw. The nurse practitioner listened to his lungs and spent a lot of time talking with us alleviating my concerns about the “new normal”.

The chemo nurse drew a vial of Doug’s blood specifically for the “C34” test which she sent to the Carter Blood Care group today. They will evaluate the number of stem cells therein. We will receive word in the morning whether or not Doug will begin the stem cell harvest tomorrow or just go in for another injection. The team is optimistic and feels that Doug’s cells will be ready to begin the harvesting process tomorrow. If so, Carter Blood Care will bring the machine to the clinic. We are told collection is a boring process with little to no side effects.

The stem cells will be protected in dry ice from the “sledge hammer” chemo he’ll receive potentially late this week. When they are returned back into Doug’s system they will be “happy” and absorbed more readily to the bone marrow because they have not been damaged by the chemo. This will make Doug’s final recovery easier.

NEWS FLASH

At 1:30 p.m. I received a call on my cell phone from the weekend transplant coordinator for Dr. Collin’s team. She had just received the results back from the Carter Blood Care group re: the
C-34 test taken at 10 a.m. this morning. Doug is defiantly ready for collection tomorrow. We need to be at the clinic at 8 a.m. and plan to be there for 6 hours.

The most amazing thing is that when I asked about the C-34 she told me they begin collection anytime after the number 10 (which I have no idea if its 10 parts/?? –I’ll have to get back to you on that). Doug’s number is 412! I went into where Doug is and gave him the "high five". We are both excited to get to this next level of treatment.

It will be interesting how many days of collection it will take before they have enough for 2 infusions, one for now and one stored for future use should that be needed before Jesus comes and makes Doug’s body new.

~Carole

May 13 and 14

The last two days have been a roller coaster ride as far as Doug’s fever, pain and nausea is concerned. Each time we ask the medical staff about this turn of events that keep him in the hospital they say “It’s normal."

Doug’s doctor did put off the stem cell harvest originally scheduled for the 13th. He shows no concern at all and tells Doug the dates are flexible and he's still on schedule.

To assist Doug they gave him 1 unit of platelets and two more units of blood yesterday (13th) and another bag of platelets today (14th). His fever spikes to 101 frequently. Fever and pain is most often blamed on the high dose of Neupogen (780 cc) that he gets each day. Even though he is still in the hospital, we are both sure he is where he needs to be. I would hate to be taking him to the ER each time his fever spiked.

I think I've referenced this before but today a nurse explained to Doug that the pain happens when the “baby white cells” are being asked to multiple rapidly and come out from the bone marrow into the blood stream. For Doug this causes sharp pain in his sternum.

Today (14th) we had a neat experience with Doug’s day nurse. She is a fun, vivacious individual who is easy to talk to. We also learned she is a contract nurse with a traveling nurse agency.

Doug said, “Tell me I’m not going to have pain after they harvest.
The nurse replied, “Well my pain lasted for about 3 days afterwards but I went back to work the next day.”

Doug: You mean you’ve been through this?
Nurse: Not as a patient but as a donor for people who are not well enough like you to use their own stem cells. If I am healthy, why not? I’ve been matched 4 times and donated 2 times. The first time was for a 15 year old boy who had acute leukemia. He is now 17 and in remission. The second time was for a 40 year old woman. I’ve heard she is in remission too but I haven’t met her yet.
Doug: You mean you can meet the one you donated to?
Nurse: Yes, you can meet after their first full year in remission.
Doug: Why would you donate two times?
Nurse: I’ve been giving blood since I could and put my name on the National Bone Marrow Donor Registry < http://www.marrow.org/>. I figure since I am healthy and can give someone hope and a better life I should. If I got sick or one of my loved ones did, I’d want someone to do that for me. As far as I know I am the only woman who has donated twice. There have been a couple of men who have donated twice.
Doug: How do they figure out you are a match?
Nurse: They start with blood type but then much of it is based on DNA testing. I don’t know all the details. One time I had an IV in both arms and had to sit without moving my arms for 8 hours straight. I had my DVD player in front of me and someone else put a new one in when it ran out. The hardest part is that they want you to have had lots of milk to drink before the harvest because the transplant depletes your calcium but I couldn’t go to the bathroom while I was hooked up to the machine. Well, they would hold a curtain around me but you have to be on a bedpan and that didn't appeal to me. The second time the harvest was from my hip bone.
Doug: What made the difference in the way they do the harvest?
Nurse: It is up to the doctor to decide what is best for the patient. The donor is not the patient. It is the way the physician feels the stem cells will graft the best to the patient.
Doug: May I ask if you are motivated to do this for others because of a Christian faith?
Nurse: Yes, I’m a Christian. God gave me the health I have and if I take it for granted He can take it away, too. My mother has always appreciated that I loved serving others before this but I’m her baby and when I did it the second time she wasn’t so sure because of the risks involved for me. I don’t even think of the risks. I think of giving hope to someone in need that I match and can help.

Doug and I were blessed by her testimony. It made me think about the fact that it would never have occurred to me to donate for a bone marrow transplant. Blood drives are frequent. We hear a lot about being organ donors. I am now much more aware of the essential need not only for whole blood donors, but also for platelets and bone marrow/stem cell donations.

It also made me think of a Donor that shed His blood on a cross to give all of us hope.
~Carole

May 10-12

We've been told to expect the unexpected and that is so true.

May 10 was a quiet day until 10 p.m. when Doug's fever spiked. The on-call doctor told us to go to the ER and from there Doug was transported to another hospital and the floor best suited for cancer patients.

May 11 blended in a bit with May 10 as you can imagine. But the special part of May 11 is that it was Mother's .Day. When I went to the hospital, our daughter Kristi who lives in Seattle, WA was "hiding" beside her father's hospital bed to surprise me. Her Daddy had worked with her to pull off the Mother's Day surprise for me. I also received a large basket of "goodies" from our kids in New York. I love my kids. I'm glad they love me!!!

As I write this posting, May 12 has just begun. Doug is begging the doctors to let him come home from the hospital. He is still receiving bags of medication to fight whatever bacteria caused the fever and I don't believe the cultures taken in ER have been read as yet. I'll check in a few minutes when I go to the hospital. He no longer has a fever.

Today is Kristi's birthday. We'll talk about the first day we saw her. We drove from where we were living in Wenatchee, Washington to Brookings, Oregon to pick her up. We'll also pray a prayer of gratitude for her birthmother's unselfish gift to us.

I'll find a time to take Kristi somewhere we can celebrate her special day. Doug wants to do something special with her also. Ordering up two guest trays of hospital food is not what he has in mind!!

~Carole

May 8 and 9

The most exciting thing that has happened to us in the last two days is that Thursday a fire alarm sounded in the clinic while Doug was getting his injection and central line dressing changed.
It was more than an alarm. In the small room where we were located the pulsating alarm set in motion two strobe lights that flashed repeatedly. A commanding voice announced that something suspicious had been found in the building and that everyone was to evacuate the building immediately.

The nurse said to remain where we were and if they saw flames they would usher us out. The building is a modern glass edifice eight stories high. I wasn’t thinking fire rather that something suspicious could be anything at a medical facility where on floors above us research is carried on in relative secretive, secure areas.

Fortunately for us the clinic is on the second floor. The nurse shut the door to the little room we were in. I watched out the window as people streamed out the main entrance and Doug sat calmly in the designated chair.

In what seemed like quite a long time to me the voice announced that patients being treated were to remain with their medical staff. The alarm was a routine building drill.

Today Doug feels real punk and has stayed in bed most of the day. At clinic we saw that his labs show his blood’s infection fighting cells are at 0.0, numbers they predicted to occur on this day prior to start of treatment. How they know that in advance is beyond me.

Doug will (does!) feel weak and have general bone ache throughout the weekend but nothing like the pain he experienced in his sternum the other day. My job is to help him want to eat something….monitor his temperature, help him to avoid infection and bleeding.

Doug has 9 a.m. injections at the clinic both Saturday and Sunday. We were told it is a quiet time in both the building and the clinic and he’ll be in and out quickly. As in the past I’m grateful for internet church services that allow us to watch on a computer. I hope we can both enjoy services together on Doug’s laptop.

~Carole

May 6 and 7

Tuesday (May 6) started our as another short day. Our clinic appointment for the daily Neupogen injection was at 12 noon. We waited just a few short minutes in the waiting area and Doug was called right in.

This is day 2 of the injections that are being given to “call” (my word) the white blood cells out of the bone marrow in readiness for the stem cell harvest.

We went home. Doug wasn’t hungry. He told me I was free to go do whatever I wanted to do and he went to bed. I decided not to go anywhere and within minutes heard him moaning. I went into see if there was anything I could do. He indicated he had pain in his sternum. It got worse. I had never seen him writhing in such pain even when dealing with the disease initially. He said it felt like someone was sticking a dagger in his chest. With a central line into his heart I was anxious thinking it might be a heart attack.

I called the clinic’s emergency line. They said someone would get back to me. No one did (as soon as I needed them too anyway as the pain was more and more severe) so I called again. In the end the clinic nurse I talked to (and who had given him the injection earlier) told me to bring him back to the clinic. I knew Doug was not feeling well because he went in his robe and got into a wheel chair when we arrived.

After an hour in the clinic they sent us to the hospital ER to rule out any issues with his heart. After an hour at the clinic we checked into the ER at 4:00 p.m. After seeing the triage nurse, we waited 1 hour in that waiting ER room. I had Doug put a mask on. I hate sitting around sick people when you don’t know what bugs they are sharing and wished I had a mask to put on.

Finally we were taken back to a stark room and spent the rest of the evening there waiting and waiting as they ran tests and labs. The ER doc came in at 9:15 to talk to Doug for a few minutes and again at 10:30 to say Doug could go home. He didn’t spend more than 5 minutes total. We did have a very nice male nurse who we saw about ever hour.

They determined the attack must have been a reaction to the Neupogen and the ER doc said he hadn’t found anything that would indicate concern with Doug’s heart. Since we hadn’t been home since noon (nor eaten) we were exhausted by the time we piled into bed.

Today (May 7) we had to be back to the same hospital for a CT scan that Dr. Collins had ordered prior to Doug’s spell. (They wouldn’t do it last night as it wasn't part of the order.)

We waited 2 hours in radiology this time for that scan which took all of 10 minutes. We do not have the results of that test nor do we know for sure what Dr. Collins was looking for. The chest X-ray last night did reveal that Doug still has some pneumonia in one lobe of his lung but they knew that before giving him the chemo last week.

Next we went back to the clinic for another Neupogen injection. Today we waited at the clinic one hour after the injection to see if Doug would have a similar attack. He didn’t.

He still has pain in his sternum but we've been controling it with pain medication. His pain is nothing like yesterday. Hopefully tomorrow will be as uneventful. He'll have injections now until the 13th.

We had to get a prescription filled after the clinic visit and can’t believe how the day flies by doing just one or two things.

One thing we learned from this experience is that bone pain is anticipated but is different in every individual. It generally is not as severe in the sternum so close to the heart. I'm glad they were playing it safe with the ER tests.

No one can predict or prepare you for where reaction will actually materialize. As a result of stimulating the cells in the bone marrow, pain in adult patients occur most often in the flat bones whereas in children getting Neupogen the pain is in the round bones. Pain in children is greater due to the fact they are still growing. As one who witnessed the greatest reaction to pain in my husband in our 40 years together for better or for worse, I can’t imagine what it must be like for parents to have to watch a child experience pain that has an even greater impact on their body.

We saw the devastation in Miramar on the news today and Doug said, “There is always someone worse off than I am.”

It’s all about perspective and a heavy dose of patience while we experience the need to sit and wait.
~Carole

May 5

We had a great day today!

They drew blood. Doug's lab numbers had not dropped (something they expect/want to happen) and predict that they will by Thursday and that he won't feel as chipper as he did today. The chemo nurse we had today asked questions and answered ours. He receivd his first injection of Neupogen, they recorded his vital signs and said they'd see us tomorrow.

As of this sevening he has not felt any side effects from the injection.

We like short visits.

~Carole

May 4

Today we woke to beautiful weather and a perfect temperature to spend part of our day outside. We used Press and Seal to cover Doug's central line so he could take a shower. It seemed odd to tear off a sheet to use on ones body. I wish I had invented something with so many applications. It worked great.

We probably spent a good hour sitting outside during the late morning. Afterwards we ate a small lunch. Then I worked on a writing assignment while Doug took an afternoon nap.

It is evening as I write you. We've just returned from a short drive. I like to change the scenery as often as Doug can tolerate so that being ill doesn't seem too isolating to him. We just have to stay away from people.

Doug told me a few minutes ago that he can feel he is getting weaker. Dr. Collins gave us a manual of what to expect during our journey throughout the bone marrow transplant process.It is a great reference. I read Doug the part that says that 3-5 days after a heavy dose of chemo the reaction he is feeling is normal. That seemed to encourage him. He had his chemo Thursday so, according to the manuel, he is feeling just as they expect patients to feel. The manuel also outlines other signs to watch for which I will do with him.

Tomorrow we have a clinic appointment late morning so I'm sure they will make him as comfortable as possible while they build him back up.
~Carole

May 3

Yesterday was my brother’s birthday. I was talking with him on the phone in our family room. Doug shut the bedroom door. (During this time I’m sleeping in the guest room so that both of us get the rest we need.) I never gave it another thought when Doug shut his door. I kept on talking.

I checked on Doug once during the night but I guess it wasn’t the right time. This morning when I heard him stirring I went in to ask what he felt like having for breakfast. He told he had a horrible night. I’ll spare you the details but he probably lost his extra 7 pounds….

He should have had his nausea medication but didn’t call to me to ask for it. He was too sick plus he told me he didn’t want to interfere with my rest. I told him that I am here for him and rest comes to me when needed. I don’t want him to get dehydrated or have to go into the hospital again if we can prevent it.

Because of his condition I called the weekend on-call number to ask which of the three nausea meds I should give him. Doug described his night to the Doctor and we started the nausea pills and other items he recommended. I am recording his fluid intake and gently forcing him to drink. He has been sleeping most of today. He didn’t get much rest last night.

He says he’s learned his lesson and knows he needs to call me. We have a bell he can ring and I’d be by his side in a second. He just has to decide to use it.

So today I’m being quiet. I know he was disappointed he didn’t just sail right through the chemo. I’m sure the clinic team knew he wouldn’t and had us prepared with the proper medication. He just has to decide to do what they tell him to do.

He says he feels much better this afternoon but continues to nap. He hates how weak he is feeling because he has memory of that feeling from before. I remind him that he did get stronger and he will again.

I believe were given two days “off” this weekend because the team at the clinic knows the pattern and knew we would need them. While I don’t agree with Doug that it is wise to care for him self throughout the night at home after a heavy dose of chemo, I realize he did it unselfishly because he wanted me to get my rest. He has always been considerate of me throughout our married life but I told him this is not the time to think of my needs. It's time for him to let me take care of him.
~Carole

May 2

The side effect of Doug’s treatment yesterday has been cramping in his stomach. He tells me he has still not had one tinge of nausea. Other than that (and reduced energy that was expected) he wanted you to know all is good.

We had a very short clinic visit today—basically they weighed Doug. Even though he visited the bathroom every two hours during the night to eliminate fluids, overnight he gained 7 pounds. He said he felt "bloated".

They unhooked him and freed him from his suite case. Nothing else was needed today. We were free to go home. We don’t go back until Monday. According to the schedule it is the only weekend we don’t have to go to check into the clinic.

When Doug told the chemo nurse he hadn't had nausea she said to have the medication on hand—just in case.
~Carole

May 1, 2008

Before I describe much more I want to tell those of you who have cancer, read this blog and may be considering a stem cell transplant that everyones treatment process is unique. As we have talked to others in Dr. Collins clinic in the waiting room we have come to realize that. We talked to a man today that had a different type of blood cancer. Even though Dr. Collins is his physician his treatment has been very different from Doug's.

So don't read this blog through May if reading would give you more concern than comfort. The same Master Physician that is guiding us will guide you but may take you in an entirely different direction. Our intent in sharing our journey is so that our friends and family can keep up with what is going on with us and know how to pray. We are not describing a standard treatment for blood cancers nor for multiple myeloma or a stem cell/bone marrow transplant.
Today we had to be at the clinic by 9:30 for 7 hours of sitting. Doug was in a private area and usheredd into what has become known to us as a chemo chair. His chemo nurse’s name was Debbie. Right away she made us both feel as much at ease as is possible under the circumstance. I had taken lots of reading materials and sat in a chair across the room from Doug.

First he received an infusion of saline solution to hydrate his system. You’ve all seen how the bags hang from a moveable pole with hooks on them. When that bag was empty they brought a smaller bag that contained an anti-nausea medication Zofran combined with 10 mg Dexamethasone, the latter of which he has taken orally since November and doesn’t like how it makes him feel.

When those drips were complete Debbie brought in a large bag that she referred to as a heavy dose chemo, 7600 mg of Cytoxin. (This is not the "sledge hammer" chemo Dr. Collins told us about in his initial consult. Just an extra one he determined Doug needed prior to the stem cell harvest. The hammer comes down May 20th if we stay on schedule.)

I asked Debbie if it were true that the poison goes right through Doug’s heart. She said, “ Yes. Think of the heart as a washing machine. Your heart swishes the blood around inside and when the heart beats, through muscular action with a whoosh ejects the poision out of the heart into the system as waste. It's done its job and needs to leave the body.”

The reason she wanted Doug to drink water while receiving the fluids during this process is that the bladder serves as a holding tank for waste. She wants him to get Cytoxin out of his system as quickly as possible so that it won’t irritate his bladder.

Doug was hungry so I went up to the Food Court to get us both something to eat. Soon after we finished eating a lady named Nellie introduced herself as being the representative from Cater Blood Care organization. She will be doing the stem cell harvest, holding of the cells for 24 hours, then returning them to Doug through infusion in his central line. The harvest part of the process is scheduled for May 13th.

Nellie told us that when she was young she wanted to be a nurse but she hated the sight of blood. She got married and had a child. At age 22 job she got a job at the blood bank where she became fascinated with blood science. (I’d guess her to be in her late 40’s now.) She worked some in the mobile clinics with donors and eventually worked up to be the regional supervisor. She admitted to becoming bored after awhile so when the opportunity came to her three years ago to transfer to the stem cell team she did so. She now feels she has the big picture of the entire process.

She had papers for Doug to read, a questionnaire to fill out, and need of his signature. She answered our questions and said she will see us in a few weeks.

When the chemo bag was empty they brought in one more bag of saline solution. During this entire process Doug could walk from the chemo room with his pole to the men’s room!

When the last bag was empty Debbie brought in a suite case that had the largest bag of fluids yet. It contained several gallons of what Debbie told us was just hydration fluid to help flush out the Cytoxyn.

A tube from the one end of the bag went into a computer that is about the size of a paper back book. The tube from the other end went into a tube connected to one of the “straws” running into Doug’s central line. Thus he was connected to his suite case! It was on wheels. When he walked and pulled it behind him he looked like he was heading to the airport.

His dressing was changed before we left and it looks real good. He has three different medications for nausea but has not felt the need for them yet.
~Carole

The Central Line

I haven’t had a chance to sit down at my computer until now to tell you that the placement of Doug’s central line went well.

We first checked into the clinic for a chest X-ray and labs because Doug had been battling a bit of pneumonia and a cough. He’d been on an antibiotic so the team wanted to be sure he had cleared up enough to proceed as planned. Because we had to wait to be seen and wait after for test results we were an hour later than scheduled to be at St. Paul’s hospital for the surgery. Doug did get the OK from Dr. Collins and we are now on the next leg of our journey to fight back.

I’ve asked Doug to dictate to me the happenings of the next few hours as obviously I was not with him in surgery.

Doug: “They gave me one of those all-to-familiar hospital gowns and put me in a bed in a surgery “hold” room. I was asked at least three times who I was even though I had an arm band on with my name on it that they looked at each time. I wasn't sure I wanted people working on me who couldn't read :-)

A real nice hippy-looking type fellow came in and told me he was going to be my nurse. We chatted and he told me he had been a nurse for 20 years in various hospitals in Dallas. Then a Korean female nurse came in who said she’d be checking in on me. She told me what was going to happen and apologized that the surgeon was in a long procedure but that I would be next.

I was wheeled into the OR and prepped. They put a paper drape over my body--including my head—so that I wouldn’t be able to see them working on my chest. That was probably a good idea!

They gave me a local injection in my chest (Lanacane _sp?) and began the procedure. I was awake, talking and joking with the folk which they told me they appreciated. I felt no pain.

I now have a hole in the right side of my chest. (Think don’t hug me there) with a line that goes up into my neck and then makes a 180 degree turn down into my heart. From the internal line three clamped tubes come out and hang down on my chest approximately 4 inches. Carole refers to them as my straws. The good news is that I don’t have to get poked and prodded every time they draw my blood for lab work.

They use these three tubes to draw blood or to infuse liquids and medications including chemo drugs. They will also be used to harvest my stem cells, give the grand slam chemo, and infuse my stem cells back into my blood stream. It is my job to treat my filling station with the greatest respect and care! (Of note is that the three clamps are red, white and blue.)

They put a large dressing on the area then wheeled me back into the holding area bed to watch me for an hour. I had not eaten the day before so they gave me a sandwich and an apple which I enjoyed. After 1 hour I was put into a wheel chair and taken out to our car.

Like other Dallas and Fort Worth worthies, I now have my own personal driver. Her name is Carole!”
~ Doug and Carole
PS During the month of May I'll be using the date as the label of the post to make it easier to follow the day-to-day treatment process.