AML: Round 8 Chemo & Home again

So I got a nice surprise yesterday afternoon.  My Oncologist stops by the room in the hospital and says "Are you ready to go home?".   No smart ass answer needed.  I was very much ready to go home.

So as of yesterday afternoon, I am once again a free man;  so to speak.   My counts are still in the normal range, but will drop fast as the chemo takes effect.  I'll have blood work every couple of days.  For the moment I am not on any meds, but that will change as soon as my immune system is compromised., which will be just a few days.   I kind of forgot about the cumulative effects of the chemo.  I can already tell this one has me tireder then the last. 

On the home front we are once again blessed.  There are so many people helping to get us prepped for the bone marrow transplant.  Now, I've never been one to mind having the attention of others... for inconsequential things, but accepting help like this from others is a bit of a struggle for me.  For good or bad, I really don't have the energy to put up much of a resistance right now.

Turns out maybe we needed the help.  As I've allowed myself to think about it, there are so many things around home that need attention.  Normal upkeep stuff that as my energy level started being affected two years ago (wow, I've lost track of time), have just never got done.  And thinking ahead, we need to get addressed so that they are not issues for me or anyone else during my recovery. 

So here's what's going down.  The church youth group has volunteered to stain our deck.  Someone else is coming to power rake the yard.  My sister has organized a work day to help Andy get the patching/painting she wants done inside while we rebuild the kids swing set in the back.  Somehow my 4 little ones are not so little anymore.   It will be wonderful to have everything done and easy to maintain for the year.   Considering the rotation of caregivers and family members that will be helping with the kids as we deal with the treatments, it should make everyone much more comfortable. 

Then there is the upcoming benefit.  I will save that for another post.  I am still processing all that is going on.  I just want to extend the invite to everyone to hang out with us for the evening of April 21st in Volga.  One big celebration before the next step.   I'll never be able to say thanks enough for all that people are doing, but I'll try a bit harder not to fall behind in that too.  

Thank you all so much...

AML: HLA Typing ... A is for Awesome

Even though we are waiting on results from one last potential match, one of the five people tested will be selected for my transplant.  So with that known, I have a window for the transplant.  Late April to early May.

I mentioned HLA typing before.  I thought I'd elaborate to illustrate why the HLA typing has been difficult in my case. 

First, A well-matched donor is important to the success of the transplant.  It also means the new cells are likely to take to me and the chances of graft-vs-host disease is less.  There are usually 10 markers compared between me and a potential donor. 

They have identified several good (9/10)matches for me.  The one 10/10 match though is female with children, which they prefer not to mix genders of they can avoid.  So I have been told.  It lessens the chance for graft vs host. 

Ilustration A on the right illustrates the markers they test for and a 10/10 match.  Illustration B shows one marker different and a 9/10 match.

However, after the doctors at Mayo met me, they felt it important to test for an 11th and 12 marker.   As you can see from illustration C the high level of awesomeness in my DNA has been difficult for them to find a match.  Hopefully this last person they are testing is either Chuck Norris or the guy from the Dos Equis commericals.    Can't argue with DNA.

New Look, New Address

Hey all,

Perhaps you noticed the new look of my blog.  It's much closer to the style and sophistication expected of anything associated with me.

Also, you can get to this site by using www.goaheadpokeme.com instead of the longer URL from before.

Just making it a bit easier to keep tabs on me...

AML: Chemo, Round 8.... Ding, Ding

Tomorrow will begin round 8 of chemo.  After this many rounds, I am starting to feel a little bit like Rocky. 

This is just a consolidation round to keep me in remission until the bone marrow transplant is scheduled.  Not much new to tell regarding my treatments right now. 

Good news; the lymph node surgery went fine.  The node was hard, but the doctor noted it was all scar tissue which was basically the dead cancer cells.  More evidence the chemo is doing its job. 

On another note a benefit is being planned.  Family and friends are putting the thing together.  Since my treatments have happen in Sioux Falls to this point, there have been few extra expenses beyond what is covered by insurance.  With having to relocate to Rochester for a while and Andy having to take unpaid time from work, the situation has changed and we are so greatful that people want to help. 

I want this to be a fun for all and it sounds like it will be. Mark your calendars for April 21st in Volga, SD.  Why Volga?  it's fairly centrally located between Carpenter, Brookings, and Sioux Falls.  It's a little tough to find a place on short notice and more importantly; small towns are easier to work with on the furnishing of adult beverages.    

Check back for more details as it gets closer.

AML: RIP Waldorf and Statler

Next Thursday I am to have another lymph node in my neck removed.  I had one removed on the right side of my neck back when they did the original biopsy that helped diagnose this whole thing.  Now they are removing the one on the left side of  my neck. 

When  I found out I relapsed right after Christmas, this particular cluster of lymph nodes were the ones that swelled up.  The swelling is all gone, but one is still hard.  So my oncologist refered me to an ENT (ear, nose, throat) doctor with the instructions that if this one is easy to get to, remove it.  The Dr. tells me he's not too worried about it, he just wants it gone.  I think he'd prefer to have my tonsils gone as well but the procedure is too invasive considering the chemo affects my ability to heal.

We've done this before.  So I'm, not all that concerned with the procedure.  I kind of like the whole anesthesia thing and as I learned early on; when they perscribe pain meds, take them.   At least I'll have matching scars on my neck. 

As I ponder the removal of these matching pair of lymph nodes, I keep getting another pair stuck in my head.  Waldorf and Statler from the Muppets.  I love those guys.   So as my mind wanders... I picture the following conversation between my lymph nodes who will now be affectionately be remembered as Waldorf and Statler. 


Lymph node Statler - I hear the doctors are going to remove you tomorrow..
Lymph node Waldorf  - Why are the doctors going to remove me?
Statler - Cause the dentist was sick. DOH OH OH
Waldorf  - That makes no sense.  I want a second opinion. 
Statler - OK, you've got a horrible singing voice. 
Waldorf  - That's not what I meant, and what's wrong with my voice.
Statler - Well, can you sing tenor?
Waldorf  - What? 
Statler - Can you sing tenor, as in ten or eleven miles away from here. DOH OH OH!
Waldorf - That was a bad joke
Statler - I'd say that was a medium joke.
Waldorf -  A medium joke?
Statler - Yes it wasn't rare and it certainly wasn't well done. DOH OH OH!
Waldorf - Surgery scares the pants off me.
Statler - Are you sure you didn't just forget to put them on?
Waldorf - So this is it huh?
Statler - Yep, I guesss so.
Waldorf - As they say in France: adios
Statler - That's Spanish
 Waldorf - I know. I don't speak French

AML: The Match Game...

Since we achieved remission with more chemo, and the tests were coming back with the results we want, the next biggest concern is finding a matching bone marrow donor.

For those just joining us, I don't have a related donor.  So I had to go to the national donor registry to get a match.  I must say I was a little overwhelmed at how many people asked to join the registery on my behalf.  Even the school nurse at my kids school, sent out a flier and info for a local bone marrow drive.  (join at www.marrow.org)

The good news is that there were 4 preliminary matches found in the national registry.  After further testing I know I have a 10/10 match, a 9/10 match and one more that is still pending. 

I have been asked about how a bone marrow match is determined.  Here is my short hand version.  

First, a bone marrow transplant is really a stem cell transplant. Stem cells are essentially these blank cells can the become more specialized cells, in my case bone marrow.  Bone marrow, along with creating the various elements of the blood is where much of your immune system comes from.  Essentially I need to get these stem cells from a donor to create a new immune system in my body.  When that happens, the new immune system will see my leukemia cells as foreign and will attack them.  The trick is we don't my new immune system to take out anything important along the way. 

Second, it has nothing to do with blood type.  What we are woking with is something called HLA typing.  (Human leukocyte antigen for those taking notes).  In simple form: HLAs are proteins.  This particular proteins are in pretty much every cell we have and tell the body which cells belong in our bodies and which do not.  So the goal is to get donor stems cells that have an HLA type as close to mine as possible. 

And here is why this is uber important.  We are attempting to prevent something called Graft-vs-host disease.  Since the donor cells are creating a new immune system, the danger is not that my body will reject the new cells, it's that this new immune system in my body will reject the rest me.  At this point you should begin to see all the nasty things that could happen should my new immune system decide my liver needs to go.  (yes I know I have been at odds with my liver over the years, but we've grown close recently)

By finding a donor that has an HLA type close to mine, the hope is that we'll be able to convince this new immune system that the rest of me is not so bad and that we can all get along.  So they look at these various HLA markers in a donor, compare to mine and a 10/10 match is good.  For every step down (ex: 9/10) you decrease the chance of success 10%.  in most cases they will not do a transplant below 8/10. 

Now,  In my case I have a 10/10 match.  Sweet right?  Come to find out, that this match is a female.  The preference is that the donor be of the same gender.  As a result, they are testing one more person. So I am waiting.. 

As I understand it, in roughly 6-8 weeks we'll be able to do this transplant.  Recovery... will take up to a year or more.  Honestly, I have not even been looking that far ahead.  My advice to my chemosabes, do what you need to plan, but don't get ahead of yourself.  It just creates that much more to worry about.  Focus on the next step... the rest has pretty much fallen in line.

On a very happy note Andy and I were so happy to be part of the baptism for little cousin Isabella and niece Ava these last few weeks. 

Well friends, that catches us up to where we are today.    Lots more to come...

AML: This is Spinal Tap...

(In my thickest british accent)
Well, I'm sure I'd feel much worse if I weren't under such heavy sedation...

Ok for those that have never seen the 1984 classic (This is Spinal Tap) you've probably got no idea what I'm refering to... I'll come back to that.

So, It's been a while.  Good news is 7th round of chemo, which was another "induction" round after my relapse has put me back into remission just like we needed.  So one more step closer to my transplant.   This time the Dr let me out of the hospital on Day 7 instead of keeping me in for the full 3-4 weeks.  I managed to go to work a couple of days then when my couts dropped, was comfortable at home until they recovered.  I had meds to keep infections away, and it worked. 

Only 7 days in the hospital.  though I often went back for labs and transfusions when needed. 

So after my counts recovered we did another bone marrow biopsy (my 5th) to confirm I was back in remission.  Then a PET scan.  It's a full body scan after they make me basically drink some radioactive sugar.  Cancer cells suck up this stuff and it helps them determine if we are damaging any organs or if there is any obvious cancer anywhere. Then I had a Lunbar Puncture (Spinal Tap) to see if there were any leukemia cells in my spinal fluid.  Leukemia likes to hide there and not all chemo drugs can make it through the blood/brain barrier...  Survey says...  all clear!  One more step closer. 

Now, I have had 7 rounds of chemo and 5 bone marrow biopsies. I have had countless procedures and been poked more times then I can count.  The only thing I will fight tooth and nail to never repeat is my spinal tap.  Perhaps you could get by the fact someone is digging around in your spine where all of a sudden your left ass cheek and leg go numb (to which the Doc responded, "Guess we're in the right spot").  Turns out that can be normal when the needle touches the edge of a nerve, but some warning would have been nice.

The problem is that in 20-30% of the cases a lumbar puncture can result in a headache.   I got the headaches.  On a pain scale of 1-10, they were 11 (another Spinal Tap movie reference... anyone?)  The pain was in front of my head, behind my eyes and temples, then later moved to the back of my head above the spine.  If I sat or stood up it was much worse.  Prolonged periods would cause me to sweat and become nauseous. I went back to the emergency room the next day to get a "blood patch".  Essentially they inject a little of your blood into the spinal column, which should clot and fix the leak. 

The ER doctor felt it was sufficient to just treat me with muscle relaxers.  Which provided temprary relief considering they had me lay down the whole time.  I left the emergnecy room with the recommendation that I just really needed to lay down and take it easy.  So I spent the rest of the week in significant pain.  The problem was all I could do was lay down, it was the only relief. Pain meds did not work.  So for the rest of my chemosabes out there...get the blood patch.  As it turns out, it took 6 days for things to begin to get better on their own.  Those 6 days were worse then any chemo treatment I had.   

With that all behind me and with the good test results, we are that much closer to my transplant. 

On to the Match Game...