Here I am, a couple of weeks out from a tandem bone marrow transplant, and I'm out a-farming. Scraping the horse turnouts, actually, which I grant isn't the hardest work in the world, but I'm still pretty pleased with myself. I'm also pretty pleased with my Ford tractor, which sat patiently in the rain and cold and sun waiting for me to come back. It started on the first crank and went right to work without the slightest complaint. Those old-time engineers with narrow ties and slide rules really knew what they were doing when they designed that tractor, let me tell you.

Last Time?

Today I have to go to the hospital for various blood tests. Routine stuff, and if my blood looks all right, it'll probably be my last set of lab tests at the hospital. If my platelet count exceeds 50,000 (and it by all means should) they'll schedule me to have my central venous line removed, and then they'll hand me back to my regular oncologist for routine monitoring. But for all practical purposes, today marks the official end of the bone marrow transplant procedure.

It went really well. Not "really well considering all the things that could have gone wrong" but just plain old really well. I had no complications at all, and I can't even say that the five days of chemo leading up to the transplant were that bad. Oh, I was sick as a dog, but I've been sick as a dog because of chemo before and I can't say this time was any worse - it just lasted longer.

My stem cells implanted quickly, I grew white blood cells quickly, and all went well. The only real excitement was after one or another of the chemo treatments. My blood pressure went down to something like 90/50 (expected with that sort of chemo). I stood up to use the urinal and my blood pressure went down even more, and I passed out cold on my feet. I don't remember it at all, but I'm told I started to fall forward, caught myself on the IV stand, then fell sideways and hit my head on the wall on the way down. All I know is that suddenly I awakened lying backwards on the bed surrounded by an awful lot of people, most of them asking "Do you know where you are?"

But that was it for excitement. The rest of time was spent either getting chemo, getting over chemo, or waiting for my stem cells to implant. I don't mean to disparage the hospital - they really try to make the experience palatable - but being stuck in a hospital room for a couple of weeks really sucks. The hospital bed was probably the worst of the whole deal. The mattress had an impervious rubber cover, presumably for easy cleaning, and it seemed that no matter what I did, I was always covered with a cold clammy sweat because the mattress didn't breathe. Even at night with the blankets pulled up I was clammy and sweaty.

And that's bad because - and there's no really delicate way of putting this - chemo makes you smell. Your urine, sweat and presumably everything else take on a characteristic scent, presumably because of some chemical or another appearing in the sweat and urine. Spend a night on a rubber bed while exuding chemo smell and the first thing you want to do in the morning is change your shirt to try to get rid of that weird chemical chemo smell. Blech. The smell goes away after a few days, but for a while it's pretty unpleasant.

I suppose the $64,000 question is whether or not it worked. There's no way of knowing without a PET scan, but for now I'm confident that it did indeed work. Put another way, I have no reason to believe that it didn't work, which maybe isn't quite the same thing. But either way, I'm going to proceed with the expectation that it did work, and that includes going back to work Monday morning for the first time in months.

Cookies

I tried on several occasions to update my blog from the hospital. They had newly installed WiFi capability and I was its first user. It worked in a technical sense, but about every five minutes it abruptly quit and you had to re-log in.

Anyway, the hospital guest WiFi was unsecured, and every time I tried to update my blog, I sustained a thunderous barrage of "negatory, good buddy" messages from Blogger (and probably rightfully so) because there was something wrong with my cookies and certificates and heaven knows what all else.

The point is that I tried to get updates to my blog, but my failure is not exactly my fault.

I Survived

I'm finally back, having survived the second half of the tandem bone marrow transplant. Lest we forget what that involved, it amounted to five days of high-dose chemotherapy to kill my lymphoma (and my bone marrow, and my hair follicles) followed by infusion of two bags of my own stem cells harvested earlier, followed by about a week of tedium as we waited for A) my blood counts to collapse, and B) my stem cells to take over and start making new blood cells.

My counts went really low, much lower than the first transplant. My platelet count dropped to 11,000, which is scary low, and I broke out in masses of dull red subcutaneous bleeds all over my arms, shins and thighs. In the end I needed three transfusions of platelets and two units of packed red cells to keep me alive while we waited for my stem cells to "take".

They finally started to show signs of taking off a couple of days ago, but it wasn't really until yesterday and today that one could look at my lab results and see definite signs of progress. My white count will probably reach normal tomorrow, though it'll take longer for my hemoglobin and platelet count to return to normal as they take longer to mature.

The chemo was... unpleasant. No mistake of that. But I didn't think it was much worse than anything I'd already had, except for one bizarre side effect of Cytoxan, a side effect so strange you almost wouldn't think it possible: it caused an intense burning to set in in my mouth and throat, identical to the burning of super-hot peppers. Only there was no flavor to speak of, just the burn, and since I hadn't actually eaten anything, I couldn't flush caustic chemicals out of my taste buds with a glass of milk or anything. The only thing they can do for that burning (and it was by far the hottest burn I've ever experienced in my life, exceeding every hot pepper I've ever tried) was lots and lots of morphine.

But though I had some side effects from the chemo, and required supportive treatment in the form of platelet and red blood cell transfusions, I didn't have any complications. No fevers or infections, no shingles, no gastrointestinal bleeding, nothing. Most of the time I felt so good it was hard to remember why I was in the hospital in the first place, though when my counts collapsed last week, I suddenly remembered in a hurry.

Anyway, I'm back, the cancer is presumed dead, and I'm on the recovery road. I already feel better today than I did yesterday, though the effort of getting all my junk home did sort of wear me out a bit.

The Countdown Has Begun

It's time to start making preparations for going into the hospital. Specifically for today, I have to start collecting a full day's output of urine in a festive orange jug - again. I'm not sure what diagnostic purpose this fulfills - maybe they resell it to a chemical plan who extracts uric acid from it. Mine is not to wonder why; mine is merely to aim accurately into the orange jug.

I think I have the official fidgets.

I'm Just Not That Into That Movie

I watched He's Just Not That Into You a few days ago. Boy. All I can really say about it is that I'm clearly not the target demographic for that sort of thing. It was tedious, talky, predictable, contrived, boring and fundamentally irrelevant to my life - a worse waste of two or three hours of my time would be hard to imagine. It took about as long to watch as it took for the surgeons to install a central venous line in my chest - and at least after the procedure, I had a functional central line. All I had after watching the movie was a vague desire to take a shower to wash the oily dialogue off my skin.

I'm not saying it's a bad movie. Maybe if you're a rich and incredibly self-absorbed thirtysomething who spends most of your time getting pedicures, hanging around in upscale bars and vaporing about relationships, it might resonate with you (though I'd hope not). But for me, someone who is most definitely not in that target demographic, it was as tedious as reading a book on the uses and properties of hydraulic fluid - and not even that useful.

And funny? Oh yeah, about as funny as having a severely stoned friend waste 45 minutes of your time describing this weird dream he had about the Grateful Dead trying to order chicken sandwiches at Del Taco.

Last Post

This is likely to be my last post before I go into the hospital. Not definitely my last post, but probably my last post.

I just want to thank my family and friends for all their support and help during what has been a difficult year. Support takes many different forms. People driving me to and from appointments because I can't drive myself. People giving me money to help pay for my treatments. Phone calls and emails that distract me and pull me out of the reality of cancer. Talking to my nephews about death metal music or the Croca-Cun or Kill Bill and all its maldiction. And most of all to my wife, who brings me surprises from the store and never is too tired or sore herself to take care of me.

It's possible that I could die in this upcoming procedure. Not likely, by any means, but there is a small chance. And if that does come to pass and I expire, it won't be because I gave up or because anyone failed me.

My best wishes to everyone, and I'll see you all on the far side of this. I may see if I can get a guest blogger to post occasional updates, but we'll see how that goes.

I wish everyone a peaceful, prosperous and happy new year.

Next Week's Schedule

Next Tuesday I go into the hospital and start high-dose chemo. It will run for seven days and I think will consist of three days of Etoposide, three days of Carmustine, and one day of cyclophosphamide.

Etoposide is a drug that inhibits the action of the enzyme topoisomerase, which itself is involved in the making and breaking of bonds in the "skeleton" of the DNA molecule. Whis this enzyme inhibited, the process of unzipping and duplicating DNA goes awry - it is thought that etoposide in particular inhibits the creation of new bonds in the DNA skeleton - and the target cell is either induced to commit cellular suicide or it just sits there, unable to complete the process of reproduction, until it eventually croaks.

Carmustine and cyclophosphamine, on the other hand, are alkylating agents, distantly derived from the mustard gas that was used to horrific effect in World War One. Here, the drugs bond alkyl groups to specific (but different) parts of the DNA molecule. Relatively specialized cells, such as muscle cells and liver cells, have some ability to correct this sort of DNA damage, but cancer cells are relatively undifferentiated and have poor DNA error correction capability - as the DNA unwinds to begin reproduction, the enzyme responsible hits the alkyl group, which effectively staples the DNA chain together at that point. The enzyme can't break the alkyl group, the cell can't back up and give up on the idea of reproducing, so there it sits, irretrievably broken, until it dies.

I've had Etoposide before - it was part of the ESHAP business - but my body had never seen Carmustine or cyclophosphamide before and presumably none of my cells have developed any immunity or resistance to them. The idea is that at high doses, these three drugs should go through my cancer like the prototypical white tornado - and honestly, there isn't much left of my cancer for a white tornado to go through.

They cause widespread damage to other parts of the body, especially those cells that tend to reproduce quickly or are undifferentiated. That means the hair follicles, the lining of the gastrointestinal tract, and sperm cells (really, the last of my worries right now). If I had any hair to lose, I'd lose it (but I'm as bald right now as Imhotep in The Mummy). I'm likely to develop sores in my mouth and throat. I'll become infertile, but who cares?

So it's seven days of high-dose chemo. On the eighth day I get my stem cells back, and then we simply wait to see how long it takes for my white blood cell count to recover before I can go back home. Two or three weeks total, though I'm hoping for two - last time, my stem cells implanted quickly and got back to work with vim; I'm hoping the same thing happens again.