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.
Tuesday, July 31, 2007
Thursday, July 26, 2007
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.
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.
Tuesday, July 24, 2007
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.
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.
Monday, July 23, 2007
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...
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...
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