Snow Day

The Weather Channel meteorologists predicted serious snow for last night into this morning. We didn’t get any snow but sleet and freezing rain fell for hours. I want a job where I can be wrong all the time! Freezing rain can be treacherous. Instead of 4 inches of easily removed snow we got 1 ½ inches of compact sleet and frozen rain. All of the schools in the area naturally closed for the day. A Snow Day. “So what …?” You are no doubt asking yourself. “Jeff doesn’t go anywhere anyway, certainly not to school, what does a Snow Day mean?”

Today would have been my first virtual help session with the handful of AP physics students at my school. These AP students take their class over the internet with Virtual High School (VHS); I am not their regular teacher. The school and I have set-up webcams at each end, one in a computer lab at school and one attached to my laptop at home. We’d previously checked out the quality of the connection and the video is clear enough at each end that we can make drawings and write equations that are visible to the other end. We were all set to go. So today is a true Snow Day for me. Tomorrow the physics students and I will try again; our experiment in remote tutoring will begin.

A snow day traditionally means two things. Firstly, I don’t go to school: done. Secondly, I shovel snow: also done. The snow in this case is the 1 ½ inches of nasty, heavy, sticky, wet sleety mess on the driveway. Our driveway will not be ignored. Some can simply drive their cars onto the thin icy layer and wait for Mother Nature to warm up and melt off the slush. Our driveway is steep. If it is not well cleared it is a bobsled run. I spent my afternoon shoveling a section and then spreading a sand/salt mixture. After completing 4 sections I was done.

Right in the middle of section 3 I had an epiphany. When I was a young father I could shovel snow all day; relentless vigorous shoveling. Our sons would, of course, join me (they have a Snow Day too) and when they were small their enthusiasm outstripped their productivity. Now, our boys are tall, strong, rational and tireless. They are both elsewhere too. I, on the other hand, pause frequently to rest and assess my slow progress. I wonder if there are some corners I can cut. It is ironic that our culture encourages our children to move out, on their own, just as they become really useful. I miss them for many more reasons than just their strong backs.

Many have asked about our sons, Robert and David, and their adventures in travel and education. Expect an accounting of their recent experiences in my next entry to this blog.

Moo too!

A month ago I posted an entry to this blog about the dairy allergy I’d acquired after the bone marrow transplant. In late August I figured out that the problem with my guts was due to dairy and thus began my vegan diet.

My sister-in-law, Debbie, has done extensive research on the issues of dairy sensitivities. There are three components of dairy that cause trouble. Potentially I was allergic to the milk proteins, casein and whey. Another possibility is that I’m not able to digest lactose. My doctor expected that the dairy problem would be temporary and I recently thought it was now time to see if dairy would still make me suffer gastrointestinal indignities. The milk protein casein is in all forms of dairy. Lactose and whey can be reduced or eliminated from some dairy products.

In a pessimistic mood, I figured that I would probably still be allergic to dairy so I started my self-testing with casein; if I reacted to casein then no dairy would be ok yet. I picked a time when I could be at home (i.e. near a bathroom) for at least 2 days to start my experiments. I’d learned from my original trial with dairy-free diet that it takes at least 2 days for the dairy to clear my system and my guts to settle down. I found a good source of casein that had no lactose or whey: soy cheese. Odd huh? The casein is used in some soy cheeses to bind the soy ingredients. Surprise, surprise I didn’t react to the casein. That’s a good start.

Now in an optimistic mood, I tried various forms of whole milk: yogurt, milk and cheese. I know that casein is not the problem, is lactose or whey going to torpedo me? Wasn’t I amazed that once again I didn’t react to the foods? So ends my forced march through the rigors of vegan eating.

Pizza, cheese on pasta, grilled cheese sandwiches, and actual yogurt (anyone want the leftover soy yogurts?) have all found their way across my tongue. Yum. I’m still a bit nervous about recklessly relaxing into a diet rich in dairy, but I’m much more relaxed being able to eat some good normal favorites.

News

So… what’s new this week?

Good news from Dana Farber this week, today my visit there was my 5^th in a row that didn’t need a transfusion of red blood cells. All of my blood counts were up, at least a bit. That’s good and a little unusual, at least for me.

Good news that I’ve been feeling well and more energetic lately. I got permission to return to riding my bicycle on Tuesday last week so Barbara and I went out for rides on Wednesday and Thursday. We would have gone out for more rides but schedules and weather argued the point and won. I’ve been enjoying indoor exercise as well. My friend, David, loaned me his spiffy indoor rowing machine. Well… you’ve seen what great shape those members of the crew team are in. David helped me set up the machine next to my exercise bike and gave me basic instructions for using it. There is a proper and powerful motion for the rowing stroke; David showed me that too. I tried using the machine a bit and he suggested that I start with about a 5 minute rowing workout at least in the beginning. The rowing motion and forces are smooth and gentle. 5 minutes is so little, so wimpy. The next day I rowed, pulling hard and getting a good workout for my 6 minutes of rowing. I might have rowed longer but I pulled a muscle in my back. How did he know that exactly 5.000 minutes is my limit? 4 days later I was able to slowly start using the rowing machine in a humbler sort of way. I think that maybe I simply don’t have any muscles anymore.

Good news from our sons, Robert and David. We heard from both recently and they report that they are happy where they are. Rob is back in the Peace Corps teaching math in a Guinean village. He’s in a nicer school with a reasonable number of students and living in an upscale house that has indoor toilets (but no running water, go figure.) David is studying in Budapest; he spent last weekend in Prague. He seems to be having way too much fun and benefiting from the experience.

I hope you are enjoying some good news too!

The Red Sox

No news is good news… yes or no? In my case I’ll go with a qualified maybe. For the last month or so I’ve held steady, in a medical sense, and it is a better steady than the one I was going through previously. Before, my “counts” slumped in a regular predictable way… steady. Now, steady means that my counts are not changing, not rising, not falling. That is an improvement. It is an improvement that I haven’t needed transfusions; it is an improvement that my Hickman line (a venous catheter) was removed. With the Hickman line gone I am freer to exercise, that is good.

What sort of patient am I?

(I’m going to indulge in some sports metaphors.) There must be patients whose treatment and progress is like the record of our N.E. Patriots. Sunday night they won their eighth game in a row to achieve a perfect season so far. The Patriots played the Red Skins who have a pretty good record and I had high expectations of a good, maybe close game. The Pats blew them out, 52 to 7, the challenge I foresaw didn’t materialize. There must be medical patients that go through their treatments in the way that the Patriots go through their schedule. One of my nurses told me of a woman who returned to work 2 weeks after her bone marrow transplant. The Pats move forward with confidence born of experience. Of course, they are going to succeed.

Then there are the Red Sox. Think back to the ALCS against the Indians. There we were in Cleveland down 3 games to 1. Either we win 3 games in a row or go home defeated. What are the responses that this situation elicits? The pessimists say that it’s hopeless; we have to show up but, put in a weak effort and expect to lose. Manny Ramirez said its ok, if we lose there is always next year. The optimist says that we aren’t out yet, we won’t be done till the last out of the last inning, why should we lose? The Red Sox are clearly optimists. As we well know, they went on to win the ALCS and what is equally remarkable is that the majority of runs scored by the Sox were made while they had 2 outs against them.

Most patients face circumstances analogous to the challenges and progress of the Red Sox. Very few fall into the “Patriots category.” What is clear watching sports and what is even more obvious as we go through medical procedures is that we don’t get to specify what challenges we face; at best we can control our participation in our challenges. Does our attitude and participation in our medical treatment make a difference? Does the Red Sox attitude matter to their success?

What sort of patient am I?

I ask myself often and try to do what little I can.

Bottom third

Three weeks in a row without a transfusion, this is a breakthrough of sorts. I’ve been getting transfusions on a regular weekly basis since the bone marrow transplant 3 ½ months ago. The transfusions have been red blood cells; I’ve been consistently on the anemic side. The pattern has been that I get a transfusion on Monday and on Thursday I’m okay, I don’t need a transfusion, but on the following Monday my counts are back down to the point that I need another transfusion. And so it goes, week after week.

Most patients that are recovering from a bone marrow transplant, of the sort I had, recover their counts faster than I have been doing. Dr. Alyea graciously puts me in the bottom third of the class. I say 'graciously' because the bottom third includes the bottom tenth as well, doesn’t it? I don’t mind being one of the slower cases as long as I’m still moving forward and taking the long view I see that the trends are all up.

Le Pain

Thirty years ago I was introduced to Julia Child’s two volume, 1,239 page, treatise on French cooking, Mastering the Art of French Cooking. It is impressive; there are detailed instructions for every step of each recipe. Makes you think that French cuisine is tricky; it must be… there are so many details to illustrate. My wife, Barbara, who was then my fiancé, challenged me to master French bread. She yearned for the baguettes she loved in Paris. She lived there for a year after college. The recipe for French bread required only 29 of the 1,239 pages. My previous experience baking bread was while I was in college and I had made it up as I went which explains why I made bricks. My bricks, I mean loaves, came out in various shades of brown but they had a consistent feel: dense and brick-like.

I rolled up my sleeves, studied the text and illustrations in the book, visited the lumber yard and the tile store. I measured and stirred and kneaded and slashed and spritzed and splashed and baked. I baked and practiced and learned and amended. With time and attention paid to the task I found success. With her arms flung around my neck, Barbara showered me with praise, this bread was better than what she had in Paris. We married the following spring. Everybody loves this bread; it is fragrant with a crisp crust and light chewy crumb. Never has a loaf gone stale.

In 1989 I bought Julia Child’s The Way to Cook. This cookbook includes instructions for French bread too. The recipe is only 11 pages long and incorporates new technology invented since the writing of Mastering the Art of French Cooking. The preparation of the dough is simplified by the use of food processors, a new fangled kitchen appliance. Other aspects of the original recipe were streamlined and simplified. The final product is just as good and the preparation time is less. The level of skill required is also less, letting machines do some of the work. Even with the greater ease of the “new” method I didn’t bake French bread very often. I really saved the extravagance for special occasions.

In the fall of 2006 Mark Bittman a writer for the NY Times revealed to his readers a method for making excellent bread, with the same qualities as Julia Child’s French bread, that had been invented by Jim Leahy of the Sullivan St. Bakery in NYC. The result of Leahy’s recipe is a loaf with a robust crust and an aromatic, chewy and moist crumb. It is delicious. The big deal with Leahy’s recipe is that the skill level needed is minimal and the time invested in making the bread is quite small. A little planning is needed since the dough is made the day before the bread is baked. It takes me 7 minutes, total, to make the dough and clean up after myself. At the other end, I need to be around the house for 3 hours to form the loaf and bake it. I’m not working with the dough for 3 hours but I do need to be there to do the few final steps. I make this bread often. The link below takes you to a web page where you can scroll down a bit to a video showing the process and to the recipe. Want to try it?

http://boards.epicurious.com/message.jspa?messageID=567096&tstart=0

By the way, I was at Dana-Farber today and it was the second visit in a row that I did not need a transfusion.

Moo!

I was told that after the transplant that I would have the immune system of an infant. This new me would have a different immune system than I had previously or that my brother, Michael my stem cell donor, had. My new immune system will not remember fighting off germs and the protection that gives me. I had chicken pox when I was a kid, I should never get them again, right? I can get chicken pox now, new immune system, baby immune system. I get that. It is why I have to be so careful around sources of germs especially viruses.

What I didn’t get is that the immune system is responsible for allergies. I have developed a new allergy. The hints were undeniable, something was wrong. I was running to the bathroom a dozen times a day. I will spare you the details, even I don’t want to know (or remember) the details. Let’s just say that the Imodium was woefully ineffective. I experimented by excluding foods from my diet, reaching the inescapable conclusion that I had become allergic to dairy products: milk, butter, cream, cheese (wonderful cheese…)

I am already a vegetarian, have been for 3 decades. Now I’ve just become a reluctant vegan. This means a significant change in what I cook, isn’t everything better with melted cheese on top? (OK, not Asian food.) We’ve had to explore the wacky world of soy yogurts and margarine and non-dairy sour cream/cream cheese. (Oddly one brand, Tofutti, is surprisingly good.) This adjustment to my diet has meant some serious compromise. Pizza without cheese is not the same dish, though a pizza can be tasty with a thoughtful assortment of veg. I’ve acquired a taste (by persistence) for coffee and tea plain, no milk or creamer.

What it really boils down to is that I don’t mind sacrificing the dairy component of my diet to have a calm and functional tummy. I still get really excellent food; Barbara, my wife, made a vegan cake yesterday that is one of the best cakes I’ve ever tasted.

The doctor reckons that this allergy to dairy is likely to be temporary; I’m hoping he’s right. I am still visiting Dana-Farber once a week and during these visits I usually need a transfusion of red blood cells. I’ve been feeling well and continue to enjoy the nice weather out in the back yard.

Missing out...

It’s been a while since I last wrote an entry in this blog. Perhaps it’s been too long because I’ve gotten a few emails lately asking if everything is ok. Yes, things are going well, I feel well. In fact, I’m writing this while in the lobby at Dana-Farber. My check-up is ok and my lab results show that my white blood cells and red blood cells are a bit on the low side. I can fix the white blood cell count with simple injections that I can give myself at home. The low count of red blood cells means that I need to stay to get a transfusion of red blood cells. This is something that I can do right here in the Dana-Farber clinic. Getting transfusions has been a regular part of my visits here. This is not unusual for me as I’ve been getting transfusions on a weekly basis for about 3 months now. It is not painful, it is not uncomfortable, it is just deadly boring. First there is the waiting for my blood to arrive (usually 2-3 hours) and then there is the time I spend while the blood drips in (2 hours.) I have to say though, that sitting through a boring day at Dana-Farber is a small price to pay for the kind and quality of care that I receive here.

In an effort to protect myself from sources of infection I live with a long list of rules. The rules tell me what I can eat, where I can go, what I can (or must) do. I am essentially under house arrest. If I wear a mask and gloves, I can go to see the doctor. But as for getting out of the house, that is about it. One of the things that I miss most due to the confinement is school and teaching. I really miss being at school. School started up about a month ago and it is the beginning of the school year that I especially enjoy. Each new year brings a fresh batch of eager students. Their enthusiasm and willingness to work doesn’t always last but it is always present at the start of the year. It is great fun. I have new ideas to try out, I have a stack of freshly printed papers to pass out to the students, I have my room all nice and tidy and welcoming. I really miss being at school. Touching base with colleagues and sharing stories is a nice way to pass a free period. There is always some interesting news floating along the grapevine. I really miss being at school.

Lately I’ve been sitting outside my house in the backyard enjoying the cool weather and the few remaining birds in the woods. It has been a good summer for sitting outside, and it is one of the few places that I can go… very pleasant. It is not much freedom, but it helps.

Chimera

I am not feeling at all myself lately. Not many people can say that and really mean it. It turns out that I am a chimera.

A chimera is a mythological creature that breathes fire. It has the head of a lion, the body of a goat and the tail of a serpent.

A chimera is a fanciful plan, an unlikely scenario.

A chimera is an organism with two or more distinct genetic aspects. 8% of fraternal twins are chimeras.

I'll bet you can figure out which kind of chimera I am. One of the tests that are routinely run for people who have had a stem cell transplant is called a chimerism test. This test is initially done about 30 days after the donated stem cells have been transplanted. The test determines what percentage of my bone marrow is from my brother and what percentage is from me. The first chimerism test indicated that my marrow was 92% from my brother Michael. This is a good thing. Eventually Michael's contribution to my bone marrow will be close to (or equal to) 100%.

My blood type has always been A positive. My brother’s blood type is O positive. Even though my blood type is A positive, when I get a transfusion, which has been once a week, I am transfused with O positive red blood cells. Eventually I will be producing O positive blood myself.

It is a strange and almost magical process and through it all I’m feeling fine, so does my brother, I can tell.

The Numbers

The numbers... We are always interested in the numbers. And the doctors are interested in the numbers as well. The numbers come from lab results, largely lab tests of my blood. These numbers give important clues to how I am doing internally. They are valuable. We also give a lot of emotional weight to these numbers, and sometimes they go up, and sometimes they go down. If the numbers improve, we get happy. If the numbers show a decline, we feel sad. The odd thing is that often the numbers do not reflect how I feel. Right now one of the numbers that they look at his my hematocrit. It measures how many red blood cells I have. When the hematocrit goes down, I need a transfusion of red blood cells. In spite of that number going down I often feel just fine. I can't tell that my numbers have gone down until labs come back.

It is astonishing the number of tests that the doctors can request just using blood. It's also a bit alarming the number of tubes of blood that they sometimes draw from me when I go in. On my last visit to Dana-Farber, 11 tubes of blood were drawn to be used in tests. Each one of these test results has a number or describes a condition. At this point in my medical education, I know the meaning of about half of the tests that they do. Which also means that I know whether the number going up is a good thing or a bad thing.

Following the numbers can be a lot like riding a roller coaster. There can be a lot of excitement in the up and down. Let me give you an example. For the last few weeks I have needed a transfusion of red blood cells during my visit on Monday, while on the following Thursday my numbers were fine and I did not need a transfusion. This pattern repeats itself: Monday transfusion, Thursday okay, Monday transfusion, Thursday okay. Keep in mind, as these weeks go on I feel pretty darn good with low counts on Monday and do not feel noticably better on Thursday when my counts are up.

The purpose of all of this medical intervention is to have a successful recovery. My son Robert likened this to watching the stock market. And our nurse practitioner, Melissa, was quick to agree with him. The investor is looking for overall growth in his portfolio. Small day to day fluctuations in the value of a stock are less important than the long-term trend in the value of that same stock. What we hope for, what we look for is a steady trend, a durable trend, that takes me from the point of hospitalization to a full recovery. When I step back and look at the lab results since the beginning of July, I see that there has been a steady, though bumpy, trend of improvement in all of my counts. What I see is that my portfolio, my medical portfolio, is looking pretty good.

One other measure of how I'm doing, is that I had been visiting Dana-Farber twice a week. This week is the first time that I have only one visit. A visit to Dana-Farber is a whole day affair, not having to go for my regular Thursday visit will be a real treat. What will I do with the time?

Doping... or why I didn't compete in the Tour

The Tour de France is over now. Contador won and seems to be untainted by suspicion of doping. I knew that even if I won the Tour, I would be stripped of the title because, and I can confess this now, I am guilty of blood doping. Doping has been the big media angle on the Tour de France this year. It seems that there was more reporting on doping than on riding or riders.

Doping is an illicit performance enhancing procedure used by endurance athletes. It amounts to artificially increasing the quantity of red blood cells. These cells carry oxygen, and a greater number of them means that the body and muscles can do more work with each breath. There are two ways to increase the percentage of red blood cells in the blood (this measure is known as Hematocrit, aka Crit.) The first is a transfusion of red blood cells (RBCs) supplied either by oneself or by a matched donor. The second method is by injection of an artificial hormone, Erythropoietin, EPO, which makes one's own bone marrow produce more RBCs.

I have used both methods of increasing my Hematocrit. In fact, I have syringes of Erythropoietin (brand name Procrit) in my fridge right now. I knew it would be hopeless trying to hide the evidence of my doping from the International Cycling Union. I didn't even bother going to Europe with my bike.

Since my stem cell transplant I have been transfused with 8 units of RBCs. This is not unusual; till my bone marrow recovers and is capable of producing all the normal blood cells I will need this kind of medical care. I'm eagerly looking forward to the day when I don't need to rely on doping. Who knows? Maybe I will make it to the 2008 Tour de France, free of the shame of doping.

The hospital... a short stay

Dr. Alyea and the transplant team assured me that my stay at Brigham and Women's Hospital would be short (8 or 9 days) and that the most common side effect of this procedure is boredom. Even nausea from the chemo is unusual, only 1 in 10 feel sick. Turned out that it was true. I did get bored and I did not get sick.

In some ways it is harder to be confined and feel well; who even notices the confinement when you feel like hell. I had brought my laptop, DVDs, music CDs, books and magazines. The room has a TV and WiFi for Internet service. I had all the distractions I could possibly enjoy. I even had a double room all to myself. In spite of the diversions, including frequent visitors, I found myself eager to got out and go home.

The treatments that I received were not particularly exciting, drip in chemo (intravenously) over a period of 4 hours. Drip in "normal saline" to keep me nicely hydrated. Drip in electrolytes when the labs indicated a need for them. And finally (on the next to last day) drip in my brother's stem cells (thank you and bless you, Michael.) This last infusion should have been the climax of the week. (For some it must be, the nurse offered me an anti-anxiety drug in case I was getting torqued out about the stem cells; I declined.) For me it was another infusion. Meaningful but not exciting.

Days passed, I got intravenous infusions, and I stayed in my room. Picture me pacing like a caged tiger, no, scratch that. I didn't pace. The room is small and the IV fluids hang on a pole that I had to drag around the room with me if I wanted to walk. What did make the time pass well were the many visits from family and friends.Visitors would bring me tales of the outside world. Astonishing (though some quite hard to believe) accounts of tasty foods from kitchens and restaurants where the food is prepared with salt and spices. My loving family smuggled in little packets of condiments and salt, like the little packets offered by fast food places or Chinese take-out. My official diet allows such additions to the food, the hospital kitchen just isn't aware that they exist. During the last 3 days of my stay at B&W I lost my appetite, probably due to the chemo. I was spared having to feign interest in bland food 3 times a day. There were so many reasons that I was eager to get home.

The morning of July 6, 2007, the nurse confirmed that I would go home that day, most likely late afternoon. I had my stuff packed up and laid out on the bed by noon. All my take-home prescriptions were ready and in a big plastic bag. In the afternoon, the nurse gave me the last infusion of medication, went over the discharge instruction and wheeled me out. Quite a sight, me in the lead, seated in a wheel chair (hospital rules ya know,) the nurse at the helm, family and friends parading along behind. Free at last, free at last!

With the exception of an occasionally queasy stomach, I felt fine and had throughout the hospital stay. Going home was a joyful event.

A new stem cell transplant

Last summer I had an autologous stem cell transplant, meaning that the stem cells were my own; there is no problem with compatibility, no rejection: these are from my own body. This summer's procedure is different. This stem cell transplant, a mini-allogeneic stem cell transplant puts a donor's stem cells (rather than my own) into my system with the expectation of having them settle in and establish a new bone marrow. In my case the stem cells were donated by my brother Michael, who turned out to be a complete match. This compatibility is a very lucky thing for me. That Michael and I "match" means that I'm more likely to have an easy time of recovering. The difficulties with compatibility/rejection are minimized.

Here is the wild thing about transplanting Michael's stem cells: I get new bone marrow resulting from his stem cells, and a new immune system. It is this new bone marrow that has the potential to fix the three blood disorders, not meds, not chemo. I'm going to oversimplify (because I don't understand the mechanism well enough to really explain.) A new immune system means that I might not destroy my own red blood cells and the anemia goes away. A new immune system hopefully means that the cancer cells are not deemed "normal" or "self", are destroyed and the Myeloma goes away. The marrow being new should mean that normal blood cells will be produced and the myelodisplastic syndrome goes away. This is amazing almost magical. There are no guarantees that I will have success with fixing all that ails me. But the potential is there to do so. And it looks like my best chance to sort out all these problems.

The mini-allo transplant looks like a magic bullet, there must be a down side. Sure. For a long period of time I am at risk for infections of all sorts. The transplant leaves me with a new immune system, new as in that of a new born baby. I do not have resistance to any germs. I must be very careful about exposure to sources of infection, crazy restrictions about what I can eat, where I can go, what I can do. It is hard to imagine all the ways we can pick up germs. We don't even generally consider germs, we are healthy no matter what we do or where we go. For quite a while I am the virtual " bubble boy".

Another concern that comes along with the mini-allo transplant is rejection. Michael and I are as compatible as a donor and recipient can be, yet there is a concern with rejection, in the same way that an organ transplant recipient is likely to reject the new organ. In my case the rejection can also come from the new marrow and new immune system. The new marrow (Graft) looks out and sees my body (Host) and does not recognize it as 'self' and tries to reject it (my body.) Referred to a Graft versus Host disease, GVHD, this can be a tricky part of my recovery. Managing the GVHD is where the skill and experience of my medical team is crucial. I have tremendous confidence in my doctor and team at Dana-Farber. I don't believe there is a better transplant team anywhere to see me through this recovery.

By the way, I was admitted to Brigham and Women's hospital on June 29, 2007. I was discharged from the hospital on July 6, 2007. I'm home now. More about all that in the next installment.

A brief recap

Like all good serial TV shows, a recap of previous events is appreciated by viewers, the same is true here. This summer (and for the next year) I am undergoing treatment for a form of blood cancer called Multiple Myeloma.

As they say... Previously on... (remember that this is a brief recap)

During the summer of 2005 I was diagnosed with Multiple Myeloma and began taking drugs to diminish the cancer with the intention of being treated with an Autologous Hematopoietic Stem Cell Transplant (aka auto transplant) in the summer of 2006. The meds were effective at reducing the cancer and I continued to teach my regular schedule at St. Peter-Marian HS. With the support and cooperation of my school, early during the summer of 2006 I went into Brigham and Women's Hospital for the "Auto" transplant. I was in the hospital for about 3 weeks and things there went well. I went home and continued to improve. I returned to school and a full teaching schedule that fall of 2006.

The point of the Autologous transplant is to kill off the cancer (which is largely in the bone marrow) with strong chemo then rebuild the bone marrow (also damaged by the chemo) by returning my stem cells into my system that will go to the bones and re-establish my marrow. I had collected my own stem cells 2 weeks prior to hospitalization. Since I am returning my own stem cells into my body there is no problem with rejection.

My hair grew back, I got stronger, I had a more or less normal school year. I also got sick much more often than I ever had before. I seemed to catch every germ that wandered by in spite of the great cooperation from my very understanding students. My newly formed bone marrow didn't provide the same immunities that I'd developed over the years, in fact all my childhood vaccinations and immunities were now gone as well.

For most patients that have an autologous stem cell transplant, there is an extended period of remission that can last for months or years. I am one of the unfortunate few that didn't directly benefit from the procedure. My cancer load was roughly the same after the transplant as it was before. In addition to the disappointing results of the Auto transplant, a couple other blood disorders evolved: myelodisplastic syndrome and auto-immune hemolytic anemia.

This summer's procedure has the potential of fixing all three problems. This summer, my big procedure is a Reduced Intensity (nonmyeloablative) Allogeneic Hematopoietic Stem Cell Transplant, (aka mini-allo transplant.) There are many similarities between the auto and mini-allo transplants. But... this summer's procedure is riskier and requires a much longer recovery period.

More about this summer and the current medical fun and games in my next post...