Flowering Crab Photo Update

Sounds like you might make it back to see the tree, yourself, Dad! :-) 

Day 10 and GREAT news!

Dad's blood work today showed that his white blood cells went from a .2 yesterday to a .9 today so they are definitely starting to kick in. His red blood cells and hemoglobin increased and that was without a transfusion. His platelets increased from 7 to 24 which is excellent! The only thing is his potassium is still low. So the doctor has put him on potassium pills and we'll see how that goes. They said to eat potassium rich foods...like bananas, potatoes, avocados, and Gatorade. I looked it up and avocados have more potassium than a banana or a potato. Dad immediately thought of Laura's guacamole...the best guacamole ever! So I called Laura and she was happy to make some...I'm sure she's making it right now as I'm writing this. She will call when she has it made and then she and John will pop over to deliver it and to have a visit. We're looking forward to both aspects of this!!

Now here's the great news. When the doctor came in today he told Dad he didn't need any more of the daily medications that he's had to take...an anti-viral and anti-fungal medicines. He's just continuing the antibiotic til the end of today. He put him on the potassium pills. AND....he said that Dad is doing so good, that he may be discharged tomorrow or Monday!! He said that if his bloodwork looks good tomorrow that will help decide the day. At that point, Dad will be an out-patient for a week and a half...going in 2 to 3 times a week. We'll know more tomorrow morning when we see the doctor. For now, we're extremely happy!

Day 9 PM

The platelets today had to be concentrated (they removed the plasma from the bag) so it took longer. Dad finished getting the platelets around 3:30 and he didn't have any reaction to it. He also got potassium and that is still dripping in (slowly). It should be finished around 7:00 tonight. He's been sleeping most of the afternoon, possibly from getting benadryl early this afternoon as a pre-med to the platelets. Hopefully he will be hungry for some dinner. He wasn't hungry for lunch, but then he ate a good breakfast.

Day 9

Yesterday's blood transfusion went without a hitch. It took about 5 hours and Dad slept pretty much through the whole thing. He walked another 1/4 mile in the evening, hanging on to some wheel chair handles for support and me, dragging the iv pole along behind. He ate a small amount of turkey and mashed potatoes for dinner.

Yesterday, this sign was posted outside our room door. It means that you are at added risk of falling. They should have put it up about 3 days ago, but didn't. When I asked the nurse about it, she told me that nothing else was off today...just that it should have been up before...and then she said, actually, it should be because he's a star patient. We'll take that approach!

Today's blood work showed that Dad needed platelets and potassium. So we're waiting for the platelets to arrive. They are "concentrating" them to try to avoid any reaction (along with Dad taking the obligatory tylenol and benadryl before hand, too). The potassium drip takes 4 hours...so there goes the day again.

Good news, Dad woke up this morning and the first thing he said was that he was feeling better. He felt like the "white army" was at work. Sure enough, when we went down to the treatment center and got his blood work, his white blood cells showed the first signs of increasing. They went from a .1 to a .2. It's a step in the right direction!

Dad ate a good breakfast, eggs, oven browned potatoes, OJ, grapefruit juice, coffee. Again, the doctors were impressed with that, as that is apparently uncommon for most at this stage. Dad got the approval to get his saline iv removed...so at this point, his dancing partner is gone. And he got the go ahead to go outside for some fresh air. Unfortunately, when we did get outside, it was a bit too windy and chilly, so we're waiting for a bit of sunshine. At least the "umbilical cord" to the iv pole has been cut. I'll post later to let you know how the platelets went...hopefully it will be good.

Day 8

First I'll fill in on the rest of yesterday...day 7. The platelet transfusion did not go well. Dad had a reaction and they had to stop that transfusion and give him steroids to counter the welts and itching. They decided that they would not give him the red blood transfusion either...it would have been early evening when he finished, so he just came upstairs instead. We walked a half mile before settling down in the room. Since he was really low in all counts, he just slept solid all afternoon. I had to wake him at 7:30 to see if he wanted anything for dinner (he didn't have anything for lunch but a few bites of banana). Dinner didn't go over too well...he ate a few bites of soup and some peaches...but at least he ate something. He had no problem getting to sleep for the night around 10:00.

Now on to today. Expectedly, his red blood count was way down, so he is currently getting the transfusion. He will have 2 bags and it takes about 2 1/2 hours per bag. Before going down to the treatment center, he said he would try some breakfast and ate some scrambled eggs, OJ, and pineapple...so that was really good! His speech is a bit less slurred (from the lining in his mouth being swollen) so I think that is improving. He looks a bit better today, even though his blood count is down.

This morning, the physician assistant came in first and said she was amazed at how good he was doing. She thought the walking was helping immensely. And she called him her "star" patient. Dad told her if he was her A+ student, he hated to see what the C- student was like. When the doctor came in he was amazed that Dad had the breakfast that he did today...he said that he was doing really great and we should start seeing the counts go up in a few days. The nutritionist also was amazed at how Dad was today. So those were all good things to hear.

Day 7

We're still basking in the warmth of a signed message from Jeff Bridges yesterday! Sara, you are amazing to attempt such a request!!

I didn't get back to posting after yesterday morning. Yesterday's blood results yielded no necessary transfusions. Dad's temperature throughout the day dropped .2 of a degree each time I checked it...so by 10:00 last night, his temp was down to 100.2 so it's definitely going in the right direction. Yesterday was not a great day for him though...other than the fact that it was one day closer to feeling better. Nausea was a problem and the lining of his mouth is showing the effect of the chemo. Everything in his mouth is just sort of swollen and thickening. His speech was slurred a bit because of this. It affected his appetite...which wasn't much except the breakfast...just some yogurt and some apricot nectar for the rest of the day. We did manage to walk 2 times ...1/3 mile in the morning and 1/4 mile in the afternoon. By evening, he was too tired to do another....but that was a good walk for day 6.

He's still on the antibiotic and a saline drip so his dancing partner is here to stay for awhile. He had a fairly good night last night.

Today, when he woke up, he had bitten his tongue during the night (because it was swollen like everything in his mouth) and since his platelets are low, has a blood blister and also on the other side of his mouth is a mouth sore. This is common, too. So he needs to "swish" (use a particular saline mouth wash) more often to help. Until those white cells start producing, it will just be a situation of keeping a watch on it.

He wasn't very hungry for breakfast, but managed to eat some canned peaches and some decaf coffee. We then went down to the treatment center for the usual doctor visit and found out that today he needs a platelet transfusion and a red blood transfusion. The doctor said they were going to fill him up...and Dad asked if they were going to change his tires, too. The doctor keeps saying that Dad is doing very good. He said that day 5-8 are usuallly the worst, but that Dad was doing really good with his walking...and he was totally impressed that Dad ate an omelet yesterday along with grapefruit, OJ, hash browns. The doctor said for day 6 that was amazing...so I don't think he has seen that much.

So right now we are waiting for the blood to arrive. It will take about 4 hours for the red blood and about 1/2 hour for the platelets...so that will pretty much take us up to dinner. This is an example of how fast our days can go. So the plan is, while Dad is getting the transfusions, I'm going to physical therapy for my shoulder for 1/2 hour and then I'll escape and go to a grocery store up the street to get him some different toothpaste, since the one he has now isn't sitting well with him. Since Dad will be getting a treatment and monitored by nurses, I can be relieved of duties for a short time.

The nutritionist came in today and I asked her about alternative ways for Dad to get protein (yes, Sara, I'm onto the "p" word) and she said the kitchen had a protein drink that is not thick like a milk drink, but rather a fruit juice drink. So we'll give that a try. I also asked if there was anything to drink to help lessen the thickening or coating in his mouth and she said she has heard from several patients that hot tea and honey helps...so we'll be trying that late today. She also said that given all that's going on...that Dad looks way better than most patients on day 7...so that was good to hear. The doctor has said it, too, but it's nice to hear it from someone else!

Also, this morning, since it's day 7, Dad got a neupogen shot which will start to boost those white blood cells. It probably won't show up in his blood work for 2-3 days. He will get another shot tomorrow, too, and I'm not sure if it's every day after that...or not. One day at a time.

And now for something completely different...

Hey Everyone....this is Sara here and I am commandeering this blog for a post.

A lot of you know this already, but for those of you who don't, I've started up a side blog for a project I call "The Dude Abides Project."

Back in my first century bike ride in Maryland in 2009, I had some temporary tattoos created that featured dad with his freshly shaved head and sunglasses with the words "The Dude Abides" above it. This phrase, in case you don't know, comes from one of my family's favorite movies, "The Big Lebowski" starring Jeff Bridges. It's shocking if we get through a holiday without at least 100 references to this movie.

Anyway, I'm basically getting people to print out the logo and take pictures with it around where they live. So if you want to participate email me at saratzki@gmail.com and I will send you what you need!

Today, I received an extra special edition of a Dude Abides submission. From the original Dude himself, Jeff Bridges. You can read about it here:

http://thedudeabidesproject.blogspot.com/

And you can see it below. He. Is. AWESOME.

Day 6

Leaving off from yesterday's post....I finally had to wake Dad about 3:30 so I could order him some food. I took his vitals first and his temperature was at 102.6...yikes! So I called the nurse and she came up right away and got him on an iv bag of sodium chloride (saline). He wasn't the least bit hungry but managed to eat a few bites of soup, cottage cheese, and a few bites of pears. They keep saying how important it is to at least get some food down the gullet. The chemo has stripped out the lining of the stomach and that's why he has diarrhea (everybody gets that at this point). It's important to keep food flowing through the system so it starts to return to its normal state when the cells begin to start forming again.

The nurses change shift at 7:00 so the evening nurse came up right away to touch base about Dad. His fever around 10:00 was 102 so it was heading in the right direction. By then the drip of saline had finished. They hesitate to give tylenol to lower the temp because it can disguise the problem...it can take the fever down with the cause still in effect. They do have an upper limit ...and then they would use tylenol...but Dad's temp wasn't to that level.

The night nurse, Pat, is very nice and helpful. She said to give her a call anytime. It wasn't that much later and I had to call her again. I took Dad's blood pressure and it was 98 over 55 and when that upper systolic number is lower than 100...you call the nurse right away. So Pat came up and took Dad's blood pressure sitting, laying, standing...and determined that the lower pressure was most likely from dehydration (since he is losing fluids with diarrhea, and with his fever...the body uses fluids with a fever to try to cool off the different organs. The body is so amazing!) so she got a bag of saline to drip throughout the night and into the morning.

All Dad really wanted to do was sleep all the time (which Pat said was normal since his white blood cells are gone and everything else is low and the fever causes that, too), but it's very important for him to walk if he can for his lungs. A person is very prone to pneumonia when sedentary. So Nurse Ratchet went into second gear and got him out of bed to walk. We borrowed a wheel chair and Dad held on to the handles and pushed the wheelchair ...for a bit of extra support and in case we got down to the end of the hall and he felt light headed. So we walked the hall here on our floor. Amazingly, Dad walked 4 or 5 passes and just gutted it out, even though he would have loved to be lying in bed. That was at 6:00. At 8:00 we got another walk in with only 3 or 4 lengths of the hall...but not bad considering he had a 102 temp. When he's not walking, every 2 hours he has to use the spirometer....it helps your lungs. I can't remember if I've shown a picture of it on the blog or not. Here's it is:

To exercise your lungs, you exhale away from the machine, then put the mouthpiece in your mouth and inhale slowly, making the center white platform rise to the top. It's a good lung workout. Dad had an advantage...I think left-over days of swimming was the key.

I took Dad's temp during the middle of the night and at 2:30 it was down to 99.9. The nurse came in at 5:30 for the usual blood draw and to administer the antibiotic. At 6:30 Dad's temp was 100.6...still way better than yesterday. He was actually hungry this morning and he ate a really good breakfast...Denver omelet, hash browns, OJ, grapefruit, coffee. So that is really doing good for him, since he hasn't been very hungry for several days.

So we're off to see the doctor this morning and then we'll be walking the halls for awhile. He's still pretty sleepy when he's not sitting up and eating...so it's anybody's guess what his blood counts will be. I'll let you know later ...after our doctor visit.

Day 5 - out of the boring bracket

Dad was running a bit of a fever before going to bed last night and by 6:30 this morning it was at 38.3 C (100.9 F) so I reported that. Also, last night Dad was having some diarrhea so the nurse wanted me to get a sample this morning to send to the lab to test for c diff - a particular strain of bacteria found in the intestines. So a sample was secured (I won't go into details...but that was my least favorite nurse duty) and it is being analyzed.

In the mean time we have a sign on our door that tells all who enter to suit up and put on a gown and gloves. The sign stays up until either the test comes back negative, or until he gets over the infection. It also tells the housekeeper to use a clorox wash on everything in the room. In other words...the sign means..."possible cooties here".

We went to the treatment center this morning for results of the daily blood work and to see the doctor. Dad's blood work was as I expected...he needed a platelet transfusion today. White blood cells were still .1, but the red blood cells and hemoglobin were up (still below normal...but up). This morning he also required a shot of magnesium (administered thru iv). Because of his temp and low white blood cell count, they started him on antibiotics...through a drip. Hence, the no longer boring status.

He's still really tired and dozing off most of the time. When the doctor came in, he said that Dad looked good...he realized he didn't feel so great with everything ...but he said he looked way better than lots of people going through this. He also said that all of Dad's symptoms are very common and pretty much to be expected for going through the stem cell transplant. He told Dad to keep up the good work and keep walking. I thought it was very encouraging to hear the doctor say that he looked good.

Well, the c diff test came back negative and we just got the formal ok so the cootie sign is now off our door. That's good news. Because of Dad's fever, they are also checking for possible causes so they drew blood from both lumens of his catheter, from his port, checked his stool, checked his urine, drew blood from his arm. Dad asked if they'd like any of his ear wax to check (that was about all that was left to check).

He got through the yellow bag of platelets without any reaction (they gave him some benedryl and tylenol before giving him the transfusion). He got through the antibiotics without a reaction...so the nurse will be up to our room to give him the next dose of antibiotics (iv) at 4:00. He got his magnesium. Now, he just needs to wake up so I can order some food for him. He's been sawing logs since we got back to the room.

The nursing staff and doctors are very attentive here. The cooperative care nurse was just in, checking up on things. They are always available when you call...they have a cell phone and answer immediately. That's all for now. I'll try to post later today.

Day 4 afternoon

Dad didn't get back to his room til 3:00. The blood transfusions took quite a while. They took it slow to try to avoid any reactions...so he did just fine with the 2 bags of blood. Sara came to visit and brought Dad some deviled eggs for Easter...in fact, that was the only thing that even resembled Easter today. It was great to see Sara! and Dad, even though not much for conversation today, really appreciated the visit. He's pretty much been sleeping or just lying around all day...just doesn't have the energy for anything else..and I'm sure that's just what his body needs...some rest to repair itself. He missed lunch altogether because he was getting the transfusion, but he ate a decent dinner, even though he wasn't thrilled with it. He had tomato soup, macaroni & cheese, cottage cheese, and pears....not bad.

So this is just one of those days that you just get through and go on to the next day. I will post tomorrow to let you know how Dad is doing then.

Day 4

Dad had a fairly good night and a good breakfast. His nurse came in about 8:00 and said his hemoglobin was low and that he needed some blood today. So we're currently in the treatment center waiting for the usual doctor visit and waiting for the blood transfusion to arrive. He will require 2 bags of blood...standard procedure. It will take about 3-4 hours ...it's a slow drip, I guess. Dad's currently sleeping in the recliner here...he's really tired, but that's understandable due to his white blood cells being just about zeroed out (.1) and his hemoglobin low, and the platelets are still going down. He has a little way to go before needing a platelet transfusion, but my guess is that will be tomorrow. This is all normal for all of this to be going on. The nurses are on top of everything and are very good about checking up on him and asking him all sorts of questions to try to catch things before they become a problem. Dad just needs to rest today and sleep when he feels like it. He's not feeling bad, other than being tired. I'll post a bit later today.

Day +3

Dad is doing fine this morning. Last night he had a bit of nausea, nothing much, but Sarah, our favorite nurse here, was on duty last night so we had a visit and came up with a plan for Dad to take some anti-nausea medication as a preventive for the next day or 2. It worked out well last night and is working good today. Dad met with the doctor and his blood work is fine. His white blood cell count went down by half...so he's at .3. The RBC (red blood cells) & hemoglobin stayed the same. His platelets dropped...but no transfusion necessary today. Dad walked 1/2 mile this morning...so that's really good. He's still somewhat tired, but functioning well. Lunch has been ordered and is on the way. He ate a good breakfast this morning. We both took a short morning nap. That's all to report today. This is one of those boring days...but as the doctors and nurses say here, "Boring is good!). I may try to post later today...if not, tomorow.

Day: transplant + 2

Dad is doing fine today. His blood counts continue to drop, as expected. For the first time, he's feeling like he has less energy, again, to be expected. His white blood cells today dropped to .6 (normal is 4-11)..so his immune system is pretty well gone. His red blood cells are at 2.6 (normal is 4.3-5.9)... common symptoms are fatigue and possible light headedness. The purpose of the red blood cells is to deliver oxygen from the lungs to other parts of the body. His hemoglobin today is 8.6 (normal is 13.3-17.3 ...for men) Low hemoglobin = anemia and the signs are fatigue, dizziness, lack of concentration. Hemoglobin is the functional unit of the red blood cells...it's a protein structure inside red blood cells and it helps bind the oxygen. Dad's platelets today are 40 (normal is 150-400). Low platelets means less or no blood clotting.

Given all this, Dad is doing fine, eating well, and he is wanting to go for a walk...probably a bit shorter than the 1 1/2 - 2 miles that we've been doing...but he does want to get some sort of a walk in today to maintain strength.

One thing the nurses here are fanatical about is possible falling...they do not want that to happen, especially due to the low platelets. They harp on this constantly (and it's a good thing). They have said if Dad is ever out walking or even in the room and feels a bit dizzy...to sit down...it's better than falling down. Then all you do is call a nurse on your cell phone and they will be there. So at this point I'm monitoring Dad when he's up and walking at all times...that even means when he goes to the bathroom in the middle of the night...or day...and also when he's in the shower in the morning...I'm right there. Poor guy can't even take a whiz in private!...but there's a reason for that and it's all in his best interest...and he isn't complaining a bit.

Well, I need to wrap this up. Dad is ready to go for an afternoon walk and then we'll watch a movie in our room.

Day +1

First of all, thank you to all of you for being part of this blog and for following Dad's/Leo's progress. Your support is a great source of strength for him. He especially enjoys your comments...so keep them coming!

He had a good night last night. As always, the nurse came in to draw blood at 5:30 or 6:00 and then we went down to the treatment center at 9:00 to get the results. His blood is doing what is expected....all counts are going down. They look at many different parts of the blood, but the main things are white blood cell counts (these are the fighter cells...the ones that fight bacteria, and infections and diseases), red blood cells (they carry oxygen and they contain hemoglobin...these things are necessary for survival and give you energy and strength), platelets (these help the blood clot, so a person doesn't bleed to death when cut). They also check absolute neutrophil count (ANC)...I need to figure out what that is...that's for a later date of discussion.

So each day Dad goes for his daily doctor visit and sees the transplant doctor, the physician's assistant, the treatment center nurse (if he needs any catheter caps changed, or lines flushed, or dressings changed), the cooperative care nurse, the nutritionist. This morning the nutritionist asked Dad what percentage his appetitie was...10%?? 25% ?? and Dad said 100%. She just sort of stared and then said that was great, that's all she needed to know. When the transplant doctor came in he asked Dad how he was feeling and if he was having any problems. Dad said he felt great, was eating good, taking walks. And the doctor just stared for a minute and then said, "Well then I'm going to go visit some SICK patients", and smiled, got up, and left the room!

The verdict today is that Dad is doing fine and at this point doesn't need any transfusions. He actually did some work this afternoon...participating in a conference call. (Luckily, it wasn't yesterday when he was a bit loopy from the drugs).

Here's some information on what to expect with Dad's blood: the white blood cells will be the first to bottom out. The red blood cells will follow and then the platelets. To give you an idea of where Dad is at with the blood counts....his white blood cell count is 1.6 (normal is 4-11). There's no transfusion of white blood cells...they just have to recover, although in 1 week Dad will start receiving more of those neupogen shots which encourage white blood cell production. Dad's red blood cell count is 2.77 (normal is 4.3 - 5.9). His hemoglobin today is 8.8. If they reach 8, he will require a transfusion. His platelets are at 47. If they reach 10, he will need a platelet transfusion. So they will be keeping a careful watch on all of the above, but for now, he's feeling good. We went for a 3/4 mile walk this morning and will aim for the same this evening, but that will be dictated by Dad and how he is feeling at that moment.

THE BIG DAY - TRANSPLANT DAY !!

The transplant is complete! Dad got along just fine and didn't have any of the possible symptoms like nausea. The only thing he had was the smell that emanated from him....it happens all the time during a stem cell transplant. I don't understand the theory, but right after the stem cells were going in, he started to smell like creamed corn...or something like that. Every nurse that came in during the transplant said, "yep, you're getting a stem cell transplant". The strange odor goes away in a day usually. Thankfully, I have a bad sense of smell so I barely smelled anything.

I took lots of pictures so you all could see the process, so here they are:

Dad was hooked up to IV fluids at 5:30 this morning to hydrate him. It's important to be very hydrated because as the stem cells enter the body, there are also various red blood cells that are broken and it puts the kidneys under stress to process all those cells. So all day today I have to keep track of input and output...carefully measuring both. The nurses in the transplant room kept track of input and output while he was there, then I continued on when we came back up to our room.

Dad is ready for the transplant in this picture and just waiting for all the premeds and the stem cells to arrive.

Here's Dad all hooked up...looking like the apheresis machine (see the post on April 11). Let's see, where do I begin with all these cords and tubes?? On the right is his Hickman catheter with 2 lumens (tubes) dangling down. This was for the stem cell harvesting and one lumen today accepted the stem cell transplant while the other lumen carried a saline solution at the same time to keep him well hydrated. Dad calls these things "tassles" and has threatened to do a tassle dance (mercifully, he hasn't!). The white circles with attachments are for monitoring the heart during the procedure...like a continual EKG. The bump on his upper right chest (on the left side as you look at the picture) is his port, which has been taking a rest as of late. The catheter has been the workhorse while we've been here.

Here he is just before the transplant, with a bag of sodium bicarbonate dripping along with benadryl and a steroid to ward off any reactions to the transplant. The heart monitor (standard procedure for a transplant) box is weighing down his shirt pocket. (Don't forget to click on these pictures to view them in a larger format)

Since last Monday (the week before 2 days ago), Dad's 600-700 million stem cells have been frozen in liquid nitrogen at a -130 degrees. They arrive in little flat metal boxes...about the size of an I-pad. This picture is the warming bath that each bag of stem cells were submerged into to thaw them out. As you can see, it had to be at a certain temperature and they just barely get them defrosted and then hang them and off they go...back into Dad. By the way...have I said that this type of transplant is called an autologous transplant...meaning it comes from yourself (versus a donor).

An exciting moment...the lady on the right is from the lab that has stored the stem cells and she has just arrived. The red and white cooler holds all 600 million stem cells. The lady on the left is Sandy and she facilitated the process. She thawed them out and hung the bag of cells to drip into Dad. She also verified that they were the proper stem cells.

Here are Sandy and the lady from the lab going through each package of stem cells, doing a double check, matching Dad's name and the batch number and his birthdate...just many ways of checking.

Again, here is one of the metal cases holding a bag of the stem cells. They keep them stored on ice until thawing each one out, one at a time.

This is what each bag looks like frozen. It's a salmon color until it thaws, and then it appears a little darker. Sandy put each bag in another plastic bag and submerged it in lukewarm water and then held it until all the frozen parts were thawed. Each bag was approx. 65 ml in size (that's a little over 1/4 C.) and each bag took about 10 minutes to drip back into Dad. As soon as one bag was hanging to drip, they would take out another bag and double verify the information against Dad's hospital bracelet and then start the thawing process and by then, the other bag had finished draining into Dad and the process was repeated. Dad had 9 bags total. that equaled about 2 1/2 C. of stem cell bags.

Here is a bag after it was thawed. It has turned a darker red and is ready to hang on the IV post.

By this time, the benadryl has been working on Dad and he's a little loopy.

Here are the fluids going into Dad and he is sound asleep. Little does he know that a party is making it's way to his room. A bunch of nurses and coordinators are heading his way. Hopefully he will refrain from drooling! Joanne had come in earlier to decorate with signs.

Here's one of the signs to celebrate the return of the stem cells!

And here's another.

But this one was the favorite of all the nurses and coordinators. It was done by our very talented daughter. Sara, everyone LOVED this sign and it is now going to be added to the cast of signs that goes to every stem cell transplant patient! Way to go! And Dad really loved it!! (Be sure to click on this one so you can read all the words!)

So the party arrived with cymbals and rattles, making a lot of celebratory noise and singing a song about the transplant to the tune of Celebrate. It was a bit corny...but very nice of them to do. As you can see, Dad was fully doped up by this time and tried hard to stay awake with the cymbals and all going on!

Here's a close up of a bag of those miniature miracles known as stem cells, in particular, Dad's.

This picture shows all the machinery that was in action for the transplant. It's all pretty incredible that this process is even possible, considering the main event stem cells aren't even visible except under a very strong microscope.

Here is Sandy and the nurse, once again (as they did with every bag), identifying the tags on the bag to the information on Dad's hospital bracelet.

Sandy and the lab lady, checking out the second batch of stem cell bags.

Yes, Dad's stem cells arrived in an Igloo Playmate cooler...and it was red and white.

Happy to be welcoming back his little stem cells! The P.A. came in during the transplant and has been following Dad's progress. When she found out he was doing great today...blood pressure was very good and very stable, she said, "Boy, Leo, you are just a rock star!".

Dad's request for today was that as he was getting back his life force stem cells, he wanted to watch the digital frame with about 900 photos of family members. Pictures ranging from 1974 when we were married, to very recent pictures. He loves all of these photos of family that tugs on his heart.

Here he just looked up from watching the digital frame for awhile. Notice the smile.

Here's the stack of metal containers that the bags of stem cells came frozen in. I think this was taken just before the final 9th bag was thawed.

The party people also brought Dad a birthday cake (for starting a new life) along with a Live Strong bracelet. Of course they take backstage to the digital frame!

As a final note, I mentioned the importance of Dad being hydrated during this whole event. So after he was disconnected from at least some of the tubes, he said he had to go to the bathroom. The bathroom was attached to his room...it's behind the door with the sign "Go Big T for transplant". So he had to put his "output" in one of those measuring urinal things. He came out and told the nurse and when she went back in there to measure it, she yelled out "holy cow!". He had filled it with 850 ml ...or about 3 2/3 C. of urine! She had never seen that much. So several other nurses and a coordinator had to see it to believe it. I guess there's nothing wrong with his bladder! Anyway, I thought the sign on the door should have read "Go Big P (ee) !

Following the transplant, Dad was doing so good, they let him come back upstairs after about an hour, I think. The transplant started at 9:50 AM and took til about 11:20. So we came back upstairs and Dad was hungry for lunch so we ate and he has been taking it easy, but is now talking about taking a little walk. We can't go quite as briskly as we have, because he's still hooked up to the saline bag, but it's almost done. Dad has to give a urine sample here soon to make sure there's no blood in the sample. If it's clear, he can be unhooked from the iv pole. If there is some blood, it's not big deal, he just will have to get another bag to flush things out.

All in all it's been one fantastic day.

More of Stem Cell Transplant 101

Again, regressing to last Monday when Dad was harvesting stem cells. As you know, the first day his collection was .8 (the target goal was between 1.5 - 5) so it wasn't bad, but it wasn't great. They gave him a shot called plerixafor (also known as mozobil) on Monday evening to boost the stem cell count the next day. And boost the cells it did! As stated before, he harvested almost 2.2 stem cells the second day...for a total of almost 3 (that's 600-700 million stem cells).

What I want to talk about is the shot (the plerixafor). We had heard that it was really expensive, but we thought, well, it's worth it - it could have saved 1, 2, or 3 days of 4 hours each day of harvesting & that can't be cheap either. My curiosity got to me so I called the billing department to see what the shot cost. We weren't prepared for the answer. Sit down everybody - this one shot - plerixafor - 24 mg (1.2 ml)....the quantity is 1/4 teaspoon....costs........ $25,ooo.

After getting over the initial shock, Dad had his own take on it. So it's storybook time, ala Dad. Sit back, put on your PJ's, get comfy, and enjoy this special 2 page book:

TITLE: Perspectives



Page 1

Plerixafor (Mozobil) injection

Cost: $25,000

Justification: Speeds up the harvesting of millions of human stem cells for transplants & saves lives.






page 2

A turbine disc from a jet engine

Cost: $75,000

Justification: To put some guy's ass in an airplane so he can fly to Cayman Islands to count his money.


THE END

T minus 1....that means the transplant is tomorrow!!!!!

Dad just got back from his last chemo and he's one happy camper! The chemo he got today was a small bag and had to be mixed up just before administering...it has a short shelf life. It's one that can cause mouth sores and problems with the digestive lining so about a half hour before the chemo started dripping into him, he started sucking on ice chips to chill his mouth and esophagus so that it deters circulation to those areas and hopefully keeps the chemo from going to those places. So he started eating the ice at 8:30 this morning and continued on til a bit after 10:30. He sounds like he's just been to the dentist since his whole mouth is frozen!

He saw the doctor again this morning and all is looking good. The patient coordinator came in to talk to us about what to expect tomorrow for the transplant. Her name is Sandy and she will be helping with the procedure. I'll take pictures tomorrow and will post sometime tomorrow afternoon. They start about 5:30 AM tomorrow giving Dad some hydrating solutions IV and then some pre-meds and then the stem cells. We should be done by early afternoon. Sandy said that Dad will be receiving 8 bags of his stem cells. I'll give more info tomorrow.

T minus 2

All is going well for Dad today. This morning when the doctor was making the rounds, he came into Dad's room and told Dad that he should get an award for his walking. Today is the last day of long chemo days (2 doses). Tomorrow is a short chemo at 9:00 AM. Apparently, it's short, but not necessarily sweet. It's the one that can cause problems with mouth sores and the digestive lining, and that's why it's suggested that you chew on ice chips or popsicles while the chemo is running and a bit longer (thanks, Julie, for that suggestion!). The theory as I understand it is that if you freeze the area of the mouth with ice, it reduces the circulation there...so hopefully the chemo doesn't get that close to the mouth and the throat (while swallowing the ice) and on down.

Dad started wearing a face mask yesterday...for when he leaves the room. It's just a precaution. His white blood cells are way down, but his red blood cells, platelets, and hemoglobin are holding their own for now (still under normal). He wears this mask when we go for walks and when he goes to the treatment center. So the quesion is...WHO IS THAT MASKED MAN?

Why, it's kemosabe.

And Dad's twist on this?? Ok, you all can guess this...right? WWDS (What would Dad say). Come on...you know this.... (scroll down)

It's chemo - sabe!!!!

T minus 3

Dad is doing just fine today. He got through this morning's chemo and this evening's without a hitch. He ate good today at all meals...he's had no trouble with food. We walked (again, at a very brisk pace) for 1 mile this morning just following chemo, and again a little bit ago...another mile. When the doctor heard about that, he seemed fairly impressed. So we're taking it easy right now and will be heading to bed fairly soon. The good part is that when you do this cooperative care plan, you don't have anyone waking you up during the night to take vital signs and such. Now if someone needed to have a nurse check up on them, they would be there. Since Dad is doing fine, he'll just have the usual blood draw at about 5:45 AM tomorrow morning.

Tomorrow is the last day of his 2 times a day chemo. Then on Tuesday it's a short chemo just in the morning. Wednesday is the big day...transplant day.

Since I don't have anything else to report, I thought I'd show you what our home away from home looks like :

Scenes from our room:

This is in our room...it's Nurse Ratchet's work station.

This is one of the long hallways in the Med Center. It's where Dad and I go for our mile walks. It's a very long hall!

Another part of the mile walk.

Another hallway that we also walk in.

The view down below, as we're walking.

T minus 4

Dad is doing well today. He got through the morning chemo just fine, ate a good breakfast, a good lunch. We took a brisk walk through the med center ...went a bit over a mile. The sun is shining today. Here's the view from the window in our room:

Notice the lovely artwork in the window, compliments of Delia.

If you ever want to view a larger image on this blog, just click on the small pictures and that will enlarge them.

Time has been flying by so fast and I haven't done all the blog posting that I've wanted to, but I have had other priorities. One thing I wanted to get back to was the stem cell harvesting, which was so interesting. The last day of Dad's harvesting, I was able to get pictures of inside the centrifuge, after Dad had finished. The nurses there probably thought I was nuts taking pictures of it all, but I wanted all of you to be able to see it, too!

First of all, as they were harvesting the stem cells, they had this chart of varying colors of blood and plasma. As Dad's blood circulated through the tubes, they pulled a tube to the chart and matched it to the color. The color you see third from the right...a salmon color...that means that most of that consists of stem cells (not all though). If it comes through a dark red like at the right, that would be red blood cells, and the lighter colors to the left indicate plasma. If the nurses need to, they can fine tune the apheresis machine to get the right color flowing through.

Of the 9 million questions I asked, there is one that no one could answer. I asked how many feet of tubing there was in the machine (that Dad's blood was flowing through)..and no one knew. I tried guessing, and to the best of what I saw (without getting out a measuring tape!) I'm guessing there was between 35-50 feet of tubing...that includes going through the centrifuge also. They did say that it took 3-5 minutes for Dad's blood to go out and return to his body. That alone tells me there was a long distance of tubing!

Again...here's a picture of the centrifuge with all tubing intact. The centrifuge is where the blood goes to be separated and in there, the stem cells are spun out into a different tube and go up to the collection bag. In this photo you can see the tubing on the outer edge of the top of the centrifuge. The interesting part is that in the centrifuge, it's not just tubing that the blood goes through...it's more like a belt. It's clear plastic and about 1 1/2 inches wide and the blood goes inside the clear plastic.

Here is the centrifuge belt taken out after the harvesting. You can see the blood that still remains in there.

Here's another picture, more from the side, to show the width of the belt.

This shows the read out on the apheresis machine and what all that means...I don't have a clue and I didn't even ask about that! But proudly hanging is the final bag of stem cells waiting to be counted. This is the day Dad rang the bell and reached the amount needed. A few days ago I did ask the doctor how many stem cells were actually collected....give or take a million. And what he told me stopped me in my tracks. He said around 600 to 700 MILLION stem cells!!!!

Now if that doesn't boggle your mind enough, here's some more technical information about the actual finding of the stem cells..by stem cell markers....how they check them under the microscope...and by the way, they don't count them all (obviously)...just a sample and multiply that out. Anyway...here's the information:

What are stem cell markers? Coating the surface of every cell in the body are specialized proteins, called receptors,that have the capability of selectively binding to other "signaling" molecules. There are many different types of receptors that differ in their structure and affinity for the signaling molecules. Normally, cells use these receptors and the molecules that bind to them as a way of communicating with other cells and to carry out their proper functions in the body. These same cell surface receptors are the stem cell markers.  

Each cell type, for example a liver cell, has a certain combination of receptors on their surface that makes them distinguishable from other kinds of cells. Scientists have taken advantage of the biological uniqueness of stem cell receptors and chemical properties of certain compounds to tag or "mark" cells. Researchers owe much of the past success in finding and characterizing stem cells to the use of markers. 

In recent years, scientists have discovered a wide array of stem cells that have unique capabilities to self-renew, grow indefinitely, and differentiate or develop into multiple types of cells and tissues.

Researchers now know that many different types of stem cells exist but they all are found in very small populations in the human body, in some cases 1 stem cell in 100,000 cells in circulating blood. And, when scientists examine these cells under a microscope, they look just like any other cell in the tissue where they are found. So, how do scientists identify these rare type of cells found in many different cells and tissues—a process that is much akin to finding a needle in a haystack. They identify them by stem cell "markers." In the case of Dad’s stem cells, they were looking for the marker CD34 which is associated with bone marrow.