Monday, March 15, 2004

Collecting Stem Cells

Dave’s Great Adventure, Book Two
Chapter 2, Verse 11
March 15, 2004
The light at the end of the tunnel.

They say that you should beware of the light at the end of the tunnel. Often, it is just the headlight of a train, about to run you down yet again. I have seen that light several times recently. But, I guess, eventually the trains stop running and you actually get to the other end of the tunnel.

The last time I wrote, I had just completed the accidental extraction of a large bore tube that entered my chest and wound down into my heart. When it was placed, it had been sutured into my skin with a couple of non-dissolving sutures. They really bothered me. They hurt, pulled, irritated my skin, and eventually looked like they were getting inflamed. I asked the nurses if we could take them out. They asked my doc. Jeff said we should leave them in, that sometimes if the stitches were taken out, the catheters might accidentally be pulled out. I was thinking at that time, “You’d really have to be some kind of dumb ass to accidentally pull out your catheter.” But, I kept pestering the nurses, and they took them out, one at a time until, three days before I yanked mine out, I had none left.

And you know what happened. “Dumb ass!”

So, I went back to the clinic to see what we would do about my lack of large bore access to my blood. They sent me up to the apheresis room at Presbyterian-St. Luke’s, which is where the stem cells are collected, by a procedure called, what else, “apheresis.” That’s a way to get the stem cells out of circulating blood rather than having to suction them out of one's bone marrow, which was done until recently. There, they were to evaluate my veins as to adequacy for apheresis by large IV needles, rather than by another central line. We met Mary Kay, one of the techs. She inspected my veins and pronounced them adequate “for multiple days of collection.” That’s what I wanted to hear, no need for another central line. While we were there, we also got the great news that my white count had finally gone up, from the 0.3 (or 300) that it had been for days, up to 1,000.

Now, 1,000 white cells is still a very low count, by most normal standards. In fact, it’s lower than my count ever got when I went through my first rounds of therapy back in 2002. But, in this circumstance, it meant that my marrow was rebounding, and that we could expect that there were stem cells being pushed out into my blood. Ergo, we could start the collection process. We were told to report back to the apheresis room at PSL at 0700 on Friday.

By the way, while we were at the clinic, I spoke with Jeff for a while. I knew that this procedure was at least relatively new for leukemic patients, being done primarily on folks with lymphomas. I asked Jeff how often he’d done this on leukemics like myself. “Never, you're the first. It’ll be interesting to see how it works out.” How about that? I was the first patient my other doc had done the FCR regimen of chemotherapy on, and now I’m the first to get this type of stem cells collected. I’m turning into a very expensive guinea pig.

We arrived there promptly as instructed. We’re never late, not with MY wife getting us around. Mary Kay wasn’t there. Angie was. Angie took a different view of my veins. She agreed that they looked pretty good, but she wasn’t at all thrilled with having to try to put two large IVs in my arms and keeping them there, functioning, for the five hour process. But she was willing to try. What else could she do, I had no central line in place. So, she expertly stuck a couple large IV needles into me, taped them in place, and away we went. Things went pretty well at first, but (and I had this problem last year too when we tried this) I soon had to pee. They tell us to “hydrate well” before coming in, so our veins will be full and offer easier access. But, all that fluid has to go somewhere, and that means peeing. But, with both arms relatively immobilized by having the IVs in place, I needed help. Just like last year, my patient wife was called upon to become a nurse’s aide and help me get Rover going into the right direction, into the urinal bottle. But, just getting up was a problem. One really can’t go from a reclining position to an upright one without some motion, and when you have two large, bare needles in your arms, motion translates into damage to the walls of the veins. And that damage compromises the collection process.

By the time I had gotten up twice to pee, over about four hours or so, the access line was kaput. They replaced it further out to a vein on the side of my arm, but it didn’t do as well as they wanted. After the completion of the five hours of collection, they had only passed my total blood volume through the machine four times. They wanted six passes of my blood through the machine. By now it was about 2 PM. We had been there seven hours, hadn’t had lunch, and were very tired from having gotten up at 5:30 that morning. I heard phone calls being made. They returned with a verdict. I needed to have the great big central line replaced before they would collect more stem cells. I had an appointment back in the cardiovascular lab at 3:00 PM. Meanwhile, we heard that my white count had now risen to 4,000. Still rising nicely.

So, we waited until the given time, went downstairs, and there, in about twenty minutes, with a little local anesthetic, another line was put in, a little bit different from the first. This line was called a Quentin Catheter, and didn’t tunnel up under my chest, but went almost directly into my internal jugular vein, down THROUGH the upper right chamber of my heart and into my inferior vena cava (the large vein in the abdomen). This line wasn’t designed to stay in more than a few days, but we didn’t expect to need it more than a few more days. It hurt a little bit, but not too badly. We were told to report back to the apheresis room again the next morning, at 7:30. Alright! We could sleep in a little bit. But sleeping with a big tube in one’s neck wasn’t at all easy.

The next day we got up. There was something else going on now. I was seriously molting! My hair was falling out by the handsful. I decided this was the big fall we’d been waiting for. It was time for the haircut! But, we had to go back to the collection room first.

We were back there at 7:30, as instructed. Mary Kay was there to take care of me. I was the only patient there; they had opened up the whole place just for me! She drew labs, like they always do, hooked my Quentin catheter to the pump and away we went again. This time, with the central line in, it went much faster, and I have to admit, I was much, much more comfortable. I wasn’t restricted nearly so much in my movements, as there were no needles to potentially dislodge. We got my white count back. Now up to 10,000! But my platelets were down to 50,000, as a result of having been skimmed off with the stem cells the previous day, normal being 200,000 to 400,000, but anything over about 20,000 being considered okay for clotting functions. We also heard that we had collected about 2,500,000 stem cells the previous day. That was exceedingly good, no, GREAT news. The minimum number of cells we wanted to collect was 2 million. We hoped to collect about 5 million. We were on track for a great collection.

I stayed on the machine for the full five hours and they got my total blood volume to go through the machine’s innards six full times. I think that is amazing. The collection went off without a flaw, but just as we were about to finish, I began to feel weird. I was starting to tingle all over. That is a complication of the process, in that it takes off my serum calcium too. They gave me some Tums to chew, no better. They gave me an injection of calcium in the IV, no better. Another shot, still no better. They called the doc, he ordered a third shot in the IVs. I started to feel better, but slowly. It took so long because, I , being a doc, had ignored the tingling feeling for an hour or so until it got so bad I couldn’t ignore it. Eventually, the tingling, and the danger of seizures, went away.

At this point, we didn’t know whether I’d need to be “collected” again the next day or not. Mary Kay said she’d call us when the labs were back with the day’s count, but that wouldn’t be until five in the afternoon or so. So we left, but on the way home, we stopped by my barber shop, where the gal that cuts my hair was able to work me in for a buzz cut. Kathy was taking pictures the whole time. Hey, we did a Mohawk, got some pictures of that, and then took the rest off.

Then we went home and then out to get some late lunch/dinner. The call about the stem cells came right at five. We had gotten another 4 1/2 million stem cells! We were finished! With the previous day’s collection, we had over seven million of the little guys who were someday going to be called upon to save/prolong my life if things weren't going well. Plus, as a little bonus, we had a quarter million more cells from last year’s collection. But I had some unfinished business. I still had the tube sticking in my neck. What the heck do you do on a Saturday night when you want a tube taken out of your neck.

I went to my clinic, the local Kaiser clinic, and checked in. “What can we do for you, sir?” “I’m having a problem with my central line,” I answered. “Okay, take a seat and we’ll be right with you.” We waited a few minutes, the nurse came out. “What’s the problem with your line, sir?” she asked. “I want it out, I don't need it anymore.” She was a little taken aback. “We can’t do that here sir, you’ll have to go to the hospital.” But I explained that it was a simple line, the removal was simple, and that I had, in fact, recently removed a similar line in the shower. “Well sir, we still can’t do that here.” So I pulled the trump card. “Who’s working here tonight?” She began telling me names of the docs who were there. The first was a Dr. Boyer. Well, I know Dr. Boyer, actually helped with her recent pregnancy, and asked if I could speak to “Sarah.” She asked if I knew Dr. Boyer and I told her I did. Sarah came out. She knew what I wanted, and was willing to pull the thing but wasn’t really too anxious to do so, not knowing if I’d bleed or not. I told her all my blood counts, all adequate, at least according to the books. “Will you clot for me if I take it out?” “Well, in theory I will,” I answered. We went back to the procedure room, took it out, and all went well. Now I could sleep!

The next morning we got up and went to church. I was feeling itchy. I realized that all the remaining 1/16 inch stubble on my head was still falling out and was all over and in my clothes, making me feel like I’d just come out of the barber shop again. We met one of my patients after church. We joked about my new “do.” She introduced me to her husband, whom I hadn’t seen since she was pregnant about eight years ago. “Hey, you look good in eyebrows,” he remarked. I guess he liked my new hairdo.

We went back home, I got in the bathtub and got out a fresh razor and started shaving the rest of my hair off. Went through two fresh razors. Got a lot of cuts on my scalp, too. But, now it’s all off.

And I'm all done. The treatments are all done, I’m not on any more drugs, and all I have to do now is recover. Kathy and I leave in the morning for Alaska for the R&R I mentioned a few weeks ago. We’ll be staying with the lovely Clovis and curmudgeonly Phil at the Alaska Wolfhouse B&B in Juneau for a few days as I rest up, and Kathy will be able to rest as well, as she won’t be “on duty” the whole time, and will be cared for as well. She deserves a rest too.

It’s a bit surprising that, as long as it took to get there, and with all the complications and problems we had along the way, once we got on with the collection process, it was over in a flash. And I think that will be the end of Book Two, except that there will likely be a postscript or two over the next few weeks. For example, we haven't gotten back the lab tests that will determine if we can actually use the stem cells we collected. If there are too many leukemic cells in the batch, we might, in theory, toss out the whole thing and it will all have been for naught. But we're not going to think that. I’ll pass that information on when we get it. Until then, though, this will be the end of Book Two, and I hope not to start Book Three for a long time.

Bye for now,


“Frisbeetarianism (n.), The belief that, when you die, your soul goes up on the roof and gets stuck there.”

Work like you don't need the money.
Love like you've never been hurt.