In the Hospital: Days -3, -2 and -1

Day -3 passed uneventfully – I was administered Ara-C and Etoposide (the A and E in the BEAM High Dose Chemotherapy regimen that I am receiving). This was the fourth day I’d received these drugs and I had no ill effects and still feel reasonably well considering I am cooped up in a hospital all day long, every day long.

Day -2, I was administered Melphalon (the M in BEAM) and this is considered the worst of the chemo drugs in this regimen. It very likely will cause lovely side effects such as mouth sores, nausea, vomiting and diarrhea.

With the Melphalon I experienced slight nausea through much of the day but nothing too terrible or disabling. At night, in addition to the pill I am given for sleeping -- Trazodone  (after looking it up on the web I discovered it is actually an anti-depressant with sedative effect) -- I also took 1 mg of Atavin (aka Lorezapam) which works well for nausea in chemotherapy patients. Atavin is also an anti-anxiety drug and between it and the Trazadone I had a restful night in spite of the hospital environment.

Day -2 also provided a thrill. The weather in Denver went up from the single digits to the mid-50’s on Day -2. And I found out from the Day Nurse (to my surprise) that I was permitted to leave the 3rd floor Oncology/Transplant unit and go outside. So Linda, me and my IV pole sat outside and basked in the warm Denver sun chatting for about 20 minutes on Day -2 afternoon. When you’ve been deprived of outdoor life for five days, 20 minutes in the sunshine is a wonderful thing.

Today, (Day -1), the Winter Solstice, Dec 21, 2005, I am being administered Zofran (the anti–nausea drug) by infusion and at approximately 11 am Denver time I will be finished with my hydration and will be freed from the IV pole for a day or more. Let me repeat that: freed from the IV pole – a very liberating experience.

Day -1 is considered a rest day – a day with no chemo – a day with no IV pole for the most part – the day before the Stem Cell Transplant.

Later on Day -1, I was provided another outdoor thrill – without the IV pole, Linda and I were able to leave the hospital and wander the immediate neighborhood during this 50 degree partially sunny Denver afternoon.

On Day 0, Thursday, Dec 22, my stem cells will be transplanted back into me, an anticlimactic event I am told. My stem cells were collected on Friday, November 25th, the day after Thanksgiving. After processing, they are frozen in liquid nitrogen at around -165 degrees Centigrade in bags inside of small metal caskets which live inside of liquid nitrogen tanks.

See the following links for some explanation of bone marrow and stem cell transplants and on the stem cell collection process:

http://www.lymphomainfo.net/therapy/transplants/bmt.html
http://www.lymphomainfo.net/therapy/transplants/stemcell.html

Shortly after being admitted to the hospital on December 15, I went into the Cyropreservation Cell Processing room and said hello to my stem cells and told them to “Behave Themselves”. The technician in the room thought I was crazy and said, “Don’t worry about it, at -165 C they ain’t goin’ nowhere.”

The Stem Cells will be thawed tomorrow. The plastic bags go into a warm water bath and into something that I am told looks like a hot dog cooker (a chafing dish of sorts, I presume). A nurse practitioner will bring the temperature down to 37 degrees C and will administer the stem cells to me as an infusion via a syringe into an access port of my Central Venous Catheter.

The stem cells are preserved in a substance called DMSO which emits a strong odor/aroma for about 36 to 48 hours after the transplant. I have heard different things from different people and the odor/aroma has been variously described as like garlic coming through your pores, like cream corn, like fish, not at all objectionable, just a strong food like aroma, and also as highly repulsive – a truly horrible odor.

There will be another transplant taking place on my floor tomorrow so the PS/L BMT South Wing should be an interesting olfactory experience for anybody who chooses to visit.

I received a question from a friend asking if Chemotherapy attacks only malignant cells and not healthy cells. My understanding is that for my type of Lymphoma, the chemotherapy I’ve been receiving wipes out both healthy cells and malignant cells. The healthy cells can be regenerated from the bone marrow and hopefully the chemo wipes out all malignant cells and they will never be seen again.

In my case, I need the more extreme measure of a stem cell transplant in order to accomplish this task.

I’ve also heard via email from a few people admiring my knowledge of Lymphoma and its treatments. As much as I love praise, I must say that I went into this occurrence of Lymphoma remarkably ignorant considering I’d had this disease back in 1990. And today, while I feel I have learned a helluva lot, my knowledge is truly nothing more than skin deep.

This disease and its treatment are so complex and Diffuse Large B-Cell Lymphoma is only one of about 30 Lymphomas (many of which have different treatments) and it’s only one of God knows how many other types of cancers (virtually all of which have different treatments, I think). All I can do is try to learn enough so that I can be a good advocate for my own treatment – asking appropriate questions and demanding (having spent most of my life in New York City has made me proficient at demanding) appropriate necessities and remedies.

Now to change the tone and topic here are a couple more Computer Programs that I really like that I forgot to include in the last posting:

Lookout – fabulous Outlook Search Tool: www.lookoutsoft.com/Lookout/lookoutinfo.html

Google Earth (a 3D interface to the planet) I love using this to zoom from an outer space view of earth to the building we lived in in New York City to the townhouse we’re renting in Denver. I haven’t done anything else with it but the potential seems great. And for 20 bucks a year you can upgrade to Google Earth Plus in beta and import GPS data.

There was an article on the front page of the NY Times on Tuesday, December 20, 2005 talking about how Google Earth is threatening to other countries for security reasons – Russia and India have protested. It is amazing the power Google has amassed. And we all thought Microsoft was going to take over the world – Google is literally over the world.
http://earth.google.com

And now for some quick Movie Reviews. Disclaimer: Watching a DVD of a movie while in a hospital room with endless interruptions may not be the best way to evaluate how much one enjoyed a movie. Nevertheless here goes:

War of the Worlds (Spielberg/Tom Cruise) – Two Thumbs Down – neither Linda nor I liked it; she hated it more than I did.

Hotel Rwanda (Don Cheadle): I thought it was a terrific movie with a great performance. Unfathomable that this massacre could have occurred 11 years ago without international outrage and intervention. Linda feels more or less the same.

Next posting will likely concentrate on Blood Counts and what they will mean for me and how I feel. Stay tuned – it might be more interesting than it sounds.