Sunday, September 13, 2009

So Now What?

OK, so you've been brought up to speed on the history of this whole thing. Honestly, my recollection doesn't come close to telling the whole story. It would take Clyde and everyone else involved in the long process for the story to be complete. Now the question is, "what happens next?"

Before a transplant like this, there are specific steps for the donor and recipient to go through. For Clyde, that process has already started. She went a couple of weeks ago to have an insanely thorough physical and emotional evaluation. They tested her blood (11 vials worth), her lung function, her heart function, x-rays, and about everything else you can test in a nine-hour physical. She reported that it was grueling. The results came back that she was doing very well. There were only two issues to deal with before she was ready for the last phase of her pre-transplant preparation.

An x-ray of her jaw revealed that she had an impacted wisdom tooth. As often as things like that result in an infection, and with the level to which her immune system will be suppressed by chemo, it was decided that the tooth had to go right away. A week ago Friday, Clyde paddled off to the oral surgeon and had the tooth extracted. I was concerned that her low platelet count would result in a lot of bleeding, but as I mentioned before, I am not a doctor. Things went off without a hitch and she has that hurdle behind her.

The other issue raised by her uber-physical was a matter of lung function. It seems that during some test, she didn't exhale enough, or quickly enough or something. The medical team is giving her a re-do on that test and it doesn't seem to be a huge concern to anyone.

With those two issues behind her, Clyde will be laying low and getting stronger in preparation for her "conditioning" phase of chemo. In this round of treatment, doctors will administer a rather robust round of drugs attempting to knock down as much cancer as they can, while at the same time reducing her white blood cell count. With her counts down, her body will be better able to accept my t-cells when they show up.

For me, the process hasn't really begun yet. I got a call on Friday from the transplant coordinator. "Jan" has been counseling Clyde for a while but this would have been my first contact. As it was, I was in a meeting and was unable to take the call. When I returned the call, it was late Friday afternoon and Jan was on her way to Margarita-ville already. I'm confident that we will get together via phone on Monday and she will lay out the plan for my preparations.

I know already that I will need to travel to Wisconsin for my own day of lab tests. It's my guess that the focus will be on my blood and the quality thereof. It's important that my blood be free of pathogens (diseases) that would be passed along to Clyde. It's likely that that lab day will be September 21. Clydes follow-up visit with the oral surgeon on the 14th will confirm that schedule.

Beyond that, I know that the medical team will be "harvesting" my t-cells on two or three consecutive days beginning on or around October 1. Prior to that I will be given a drug that will put my bone marrow "on steroids" for the manufacture of white blood cells. That will interesting in that I will be giving myself the shots. I'm treating that as a good opportunity to teach my kids that shots are no big deal. Of course, we all know that shots are awful and the idea of giving them to yourself goes against everything we've always considered to be good. I will, for Kate and Jack's benefit, be a brave little soldier and just stick that huge, nasty needle into my own body. No big deal, right?

The way the schedule is written right now, Clyde will get my t-cells on or about October 6.

Something that has gone un-said to this point is that this entire story has played out under the remarkably capable guidance of the medical team at the University of Wisconsin Hospital. From top to bottom, the staff there has been top-notch at every level. What would you say to a team that has worked to keep you sister healthy for two decades? My family's gratitude will never be sufficiently expressed to that amazing team of medical professionals.

That's about all I know about the process going forward. We will learn more tomorrow after I speak with the coordinator and Clyde sees the oral surgeon. Check back for the update.

Be well.

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