OVERLOAD, OVERLOAD, OVERLOAD

Day three of my current round of chemo is coming to a close. That seems weird to write at quarter to six in the morning. Let me explain. I checked in at Club Sunnyside at 7:45AM on Wednesday, November 3rd. During that day there were preliminary record-keeping and preparation activities, as well as significant down time. Then, at 5PM, I had my first dose of chemotherapy. That was the beginning of the process that I came here to accomplish. 

The schedule for the chemotherapy doses is two doses of Cytarabine, twelve hours apart on days one, three, and five of my visit. So, day one really begins when the first dose is connected to my PIIC line. So, dose two happened on Thursday morning at 5AM. It's kind of like the Hebrew way of counting days: "And there was evening and there was morning, the first day."

So, I am currently receiving dose four, which is the second dose of day three. Now, that wasn't so hard was it? Please be aware you will be required to draw a diagram of this process on your next class exam.

One thing that has happened to break up the routine this visit is that on Thursday afternoon, they removed my PIIC line, which had "migrated" out of my arm by a total of about 6 centimeters, or just shy of 2 1/2 inches. That meant that the delivery of chemotherapy was not happening at the optimal place inside my body. So, I hear you saying, why not just shove it back in? Well, the problem with that is that there is no way to sterilize the part that would then be reinserted into my vein. And that could lead to infection and maybe sepsis and IV antibiotics. In other words, a big mess. 

So, I have a new PIIC line in my other (that would be my right) arm, properly inserted with the use of ultrasound and electronic positioning at the optimal location, and sterile to prevent infection. 

Yesterday, Friday (relax there is no evening/morning business here; it was just Friday at 11AM), we had a phone consultation with Dr. Rachel Cook from OHSU oncology. She works with the Hematology/Oncology team at Kaiser and specializes in bone marrow transplants. As I mentioned in my last post, bone marrow transplant seemed not to be an option that was being considered for me earlier in my treatment. So, now we have new information (and lots of it) to consider going forward. 

For example, given that my genetic markers for leukemia put me in the intermediate category of the disease, there is roughly a 50% chance that the chemotherapy alone could eliminate the cancer. Bone marrow grafting could increase the odds for a cure, but not to the level of 100% confidence. Mortality rates would likely be reduced to 20-30%. 

Then there are problems with finding a donor. Ideally, a donor would be someone with  very similar DNA to my own, in other words a blood relative. My only living blood relative is my brother, who is 79 years old. Dr. Cook said he wouldn't be considered, because of the toll that transplant takes on the donor. So, that leaves me with the possibility of finding an anonymous, volunteer donor, someone who, out of the kindness of his heart has offered to donate his marrow. 

Now, I hope this won't stir up any racial animosities, but Dr. Cook mentioned that, because I am a white male of European extraction, the chances of finding such a donor are pretty good. Of course even that is not so simple. Although there are rosters of volunteer donors from around the world, any one of whom might be a match, the operative word here is "match." 

There are some 14 genetic markers that come into play in matching a donor and recipient. Of course, the more of these markers that match up the better the odds of having a successful transplant become. So, if all that math I took serves me well, the most perfect match possible would be found in one donor out of 14! (that's 14 factorial, or 14 times 13 times 12... 3 times 2 times 1, or somewhere around 87 billion.) Yes, one in 87 billion. I'm pretty sure that among all of the kind people in the world, there are not 87 billion volunteers hanging around waiting to donate some of their bone marrow. In fact, I don't even think there are that many people in the world.

So, the likelihood of finding a "perfectly" matched donor is pretty slim. What's a fella to do? Well, the remaining option is to get the best match available, which may not be too great at that. 

And what are the potential problems with bone marrow transplant? Among others there could be a tissue rejection reaction, requiring intense immune suppression. There can be damage to other organ systems (heart, lungs, bowels, etc.) resulting in chronic health issues that can severely affect quality of life. 

Now if all of the decisions implicit in the above information are not enough, Dr. Cook told us that, in ideal circumstances, transplant therapy should be undertaken earlier rather than later in the management of leukemia. In fact, usually it would be done after one round of consolidation chemotherapy, and here I am in round four of consolidation. 

OVERLOAD! OVERLOAD! OVERLOAD! Decision making in this scenario seems impossible. REMEMBER THE MANTRA, Tom: one day at a time. We will be scheduling a face to face consultation with Dr. Cook. There will be some blood work done to determine my 14 genetic markers, allowing the process of locating a donor to begin. That way, if and when we choose to go forward with transplant therapy, the groundwork is in place. 

As you can see, my need for prayer warriors just increased!! Continued prayers for healing now must be supplemented by prayers for clear-headed thinking (hard to do on chemo-brain), for location of a suitable donor, for calm and peace to reign while we go through this process. 

"...do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. ⁷ And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus." (Philippians 4:6-7)

And in the end the decision may be not to proceed with bone marrow transplant therapy for any number of reasons, and Jill and I will need plenty of that peace of God, which surpasses all understanding.