Tuesday, January 24, 2006

day -9

Well, I'm here in a room in the BMT unit at New York-Cornell Presbyterian Hospital waiting for the start of the high-dose chemotherapy regimen. It may be an hour or two away, because the PICC line which was inserted into my left arm this afternoon must be adjusted. After the IV team placed the PICC line in my arm, an X-ray of the area was taken in order to confirm that it was located properly within the vein leading to my heart. The X-ray, unfortunately, showed that it was about 3cm too far in the vein. So, now I'm waiting for the IV team to return, so that they can pull it back to its proper depth.

Today was a busy first day. From the moment I first entered my room, which will be home for at least three weeks, the nurses and doctors began stopping by, checking my vitals, asking questions, and guiding me through the schedule of the treatment. They sure didn't waste anytime. I was told by Scott, the BMT physician assistant, and one of the BMT doctors how the length of my treatment will be organized. Today is considered day -9 of my treatment and the high-dose chemotherapy will continue until to day -3, six days later. Then, there will be a 2 day period of rest: days
-2 and -1. These will be followed by day 0, the transplant day. Thereafter, the days are considered positive: day +1 and onwards. Scott went on to say that days 0 to about day +7 will most likely be the period during which I'll be most susceptible to an infection or fever. Consequently, it's important that I tell him or the doctors about any pain or general discomfort. Don't be stoic he said to me. From about day +7 to day +12 my blood counts will rise steadly and by about day +12 or day +13, which will mark three weeks, hopefully I'll be ready to go home.

The high-dose chemotherapy regimen is composed of three drugs: cytoxsin, carmustine, and etoposide. I received cytoxsin once before immediately prior to my very first stem cell collection. Etoposide I had before as well. It's one of the drugs that constitutes the DICE regimen of chemotherapy. I don't know anything about the last drug, carmustine, but Scott gave me literature about all three drugs. I'm scheduled to begin the etoposide late tonight and it be will be infused continuously over 36 hours. Woah! That's equal to 11 large bags of it! This morning the BMT doctor told me that perhaps the most irritating aspect of the treatment will be the constant urination. I'll need to go to the bathroom morning, noon, and night it seems. Well, if urination is my biggest concern during the treatment than I don't think that's a pretty bad deal.

Generally, I have referred to this treatment as "the transplant" in conversation with people and at times in this blog due to need for brevity. But it's important to remember that the transplant only really means the infusion of my stem cells, which are now frozen in a lab waiting for day 0. The transplant is the process by which my bone marrow and thus, my immune system will begin to recover and heal itself after the high-dose treatment. It's the high-dose chemotherapy, not the transplant, that is the star of this show. It's the chemo that will liquidate any last, resistant cancer cells (and good ones too unfortunately) in the body. Thus, this treatment is known as high-dose chemotherapy and a stem cell transplant.

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