Saturday, August 25, 2007

Howdy,

I'm sitting in St. Joseph's Hospital due to an infection at the site of my CVC (central veinous catheter), the line in my chest. I noticed that it was itching Thursday during the day and then that night I could see and feel a big knot just above where the line enters my chest. That was not a good sign, so we went to the ER knowing that we had to quickly get any infection in my chest under control. This is extremely important given that my white blood count (white blood cells fight infection) is 100. Normal white count is 4,000 to 8,000. My white count is always low because of the ongoing chemotherapy. But right after chemo the white count goes to nothing. Shortly thereafter the red blood count plunges, so I have about a two week period of fighting low counts.

So, after getting antibiotics through an IV for a day and half, the infection is stabilized. But they are going to remove the line from my chest in the next hour. The thought being that with the foreign material in my chest, complete healing of the infection will be difficult. My new transplant doctor at M. D. Anderson, Dr. Hosing, is in agreement with the removal. But I'll have to have another put in before the next transplant. In the meantime, they will put a PICC line in my arm so that I can continue to get IV antibiotics that I will hook up this coming week at home. I was actually looking forward to removing the CVC in my chest after more that a year of having to maintain it. But a PICC line is the same thing except that it is in a vein in the upper arm, so it will have to be maintained too. After a week or two the PICC line can come out, so I might still get some relief.

Transplant wise, it now looks like I'll have the second transplant in Houston at MD. The doctor in Seattle changed his mind after talking to his colleagues and now favors a conditioning regimen of Cytoxan/TBI, TBI being total body irradiation. He originally said that this might be too toxic and put my liver at risk. But they now favor this regimen. MD on the other hand think they can get just as good of results without TBI. They use a conditioning regimen that goes by the acronym BEAM. They were emphatic that there are no studies that say that TBI has any better long term effects.

The conditioning regimen is the chemo that they use to finish killing off your bone marrow immediately before the transplant. Last transplant they did not completely kill off my bone marrow. This time they will. They typically will try the milder approach first in what they call a "mini-transplant." The more extreme approach is called a myeloablative transplant. Myelo means blood and to ablate is to kill off, hence the myeloablative transplant is one where they completely kill off your bone marrow. Both Hutch and MD would use the myeloablative transplant procedure, so the difference between them is just what regimen they use to do the ablation.

I talked to Dr. Hosing from MD yesterday, pumping her for information. The local doctors had already talked to her about the infection around the CVC site, to I knew I was already on her radar screen, so to speak. She advised that they did get insurance approval to proceed with the transplant and they would try to line up the donor in short order so that I won't have to get another round of the chemo that I had last week, which was aimed at killing off the lymphoma. Given the toll that that chemo is beginning to take on me, I won't mind skipping a fourth course. Timing will be important and a little tricky, as always.

Back to whether to do the transplant in Seattle or Houston, I talked to the doctor in Seattle Thursday to ask why he changed his mind about the irradiation question. In that conversation he said that their institutional approach favored TBI and that MD's favored BEAM. He said that the statistical results were about the same between the two and that I should choose a hospital based upon convenience, family support, out of pocket expense, etc. That sort of blew me away. I didn't expect that much honesty and lack of ego from a doctor! So based upon the support and convenience factor, I go to Houston again. That's how the decision has been made, although it's still subject to change. I really like the people in Seattle.

Gotta go. They're here to take out my CVC.