The Big Push

Here we go, folks! It’s finally time. I say finally, but it’s really only been five months since I started chemotherapy. For many, it lasts much longer and involves setbacks that require changes to the chemotherapy regimens, so I truly feel fortunate. I had only one change to mine, and it was successful in helping me reach the low myeloma numbers I needed.

The above is an excerpt from an email I received yesterday, Monday, 3 May, from Nancy, the registered nurse who is also the Transplant & Cellular Therapy Coordinator at the Stephenson Cancer Center at OU Medical in Oklahoma City. She has worked very hard to answer all of my questions, relay messages to Dr. Selby, and now, coordinate my initial preparation for the stem cell transplant. I will try to explain each of the steps on the above schedule and what they entail.

Monday, 5/10/2021: Lab work at the Stephenson Center: This will undoubtedly involve blood draws to do various routine tests, such as CBC or complete blood count, as well as possibly an immunoelectrophoresis serum test. I will also receive a lovely container that I will carry to the bathroom with me every time I go over a 24-hour period to collect urine so it can be tested for myeloma cells as well.

Tuesday, 5/11/2021: Appointment with Dr. Selby to review the transplant process and sign consent forms.

Friday, 5/14/2021: Start Filgrastim injections at home. Now, this one should be fun! Filgrastim is used as part of the mobilization process, which increases the number of stem cells in the peripheral blood. As I understand it, I will be taught how to give myself these shots over a period of a few days. The way Nancy described it, the shot is very similar to the Velcade shots insofar as they go into a fatty area of the body, such as the belly, upper leg, or back of the arm. I have only briefly researched the drug and its possible side effects, but I intend to read more as I can over the next several days.

Monday, 5/17/2021: Central Venous Catheter (CVC) placement. This is a surgical procedure that will be done under “twilight” anesthesia. A CVC is similar to my port, but it is considered temporary. It is a tube that is placed in a large vein in my chest or neck with the internal tip extending as far as my heart. The external portion of the tube will have two or three “pigtails,” referred to as ports or lumens. It will be used to administer chemotherapy, medications, IV fluids and feedings, blood products, and to draw blood. My high-dose chemotherapy, stem cell collection, and transplant will be done through my CVC.

Tuesday, 5/18/2021: Stem cell collection begins at the Oklahoma Blood Institute. The process is called apheresis, and it is usually painless. The collection of stem cells takes approximately three to four hours for each procedure. My blood will be withdrawn through my apheresis catheter, which will be part of my CVC, and circulated through a cell-separating machine. This machine separates and collects white blood cells, including stem cells, along with a few red blood cells and platelets. The remaining blood cells are returned to me through my CVC. I will have two to four of these sessions to collect enough stem cells to get back after my high-dose chemotherapy.

Tuesday, 5/25/2021: Admission to the hospital for the transplant. I will receive a high-dose chemotherapy drug for the purpose of destroying cancer cells, but it will destroy normal cells as well. Most side effects from it are seen within two weeks, and my body will begin to repair the damage as soon as it occurs.

I know this process won’t be pleasant, and it’s a little troubling to consider that, because this is not a cure, there is always the possibility that the myeloma will recur and another transplant might be necessary in the future.

One day at a time. That will be my goal through this process. That, and a stronger faith that God will heal me.

And that is another matter altogether. I’ll try to explain in a post I’ve been working on for several days now and hope to have ready soon.