Thursday, March 19, 2009

It Looks Like a "Go!"

I know some of you have been anxiously checking this blog as to how Sabine's tests turned out. We, too, have been anxiously awaiting a call from the transplant coordinator. Well, last night we did. And it's a go -- and a fast one at that! Sabine goes into the hospital for the first phase of an autologous stem cell transplant tomorrow morning (Friday). In the next month or so we will be drastically changing our life routine.

But first I feel a need to share this lovely poem as a "preface" by Pablo Neruda which has been translated by Nicholas Lauridsen...

Soneta de la Noche
(Sonnet of the Night)

When I die,
I want your hands upon my eyes:
I want the light and the wheat
of your beloved hands
to pass their freshness over me
one more time:
I want to feel the gentleness
that changed my destiny.

I want you to live while
I wait for you, asleep.
I want your ears
to still hear the wind,
I want you to smell the scent
of the sea we both loved,
and to continue walking
on the sand we walked on

I want all that I love
to keep on living,
and you whom I loved and sang
above all things
to keep flowering
into full bloom,

so that you can touch
all that my love provides you,
so that my shadow may pass
over your hair,
so that you may know
the reason for my song.

Now for the journey ahead... and the preparation for the stem cell transplant...

Sabine will go into U.W. Hospital tomorrow and receive cytoxan as an initial chemotherapy. She will most likely stay in the hospital overnight. Then we will return to the cottage. This first phase will try and knock out more of the cancer cells -- a massive dose.

Her immune system will be severely repressed during this time and we will essentially be living at our cottage in Mazomanie for therapeutic and sanitary reasons. I will be injecting her with a drug called neupogen to stimulate her bone marrow cells (in which the cancer resides). The cytoxan will also cause her wonderful gray curly hair to fall out again. I told her that I was hoping this time she could be a red-head -- you know, like Maureen O'Sullivan, Rhonda Fleming or even Bette Midler!

A period of about a week or more will transpire before she goes into the hospital again for the purpose of spinning stem cells out of her blood (phoresis). The stem cells will be harvested and then stored.

Sabine will return home and wait for a period of time. During this period she will be "neutropenic;" that is her white blood cells and immune system will be sorely depressed and she will be greatly susceptible to infections.

At the same time, we will be doing home hemodialysis and watching very carefully any rise in her temperature which could indicate an inflection brewing. Obviously Sabine should not be in any crowds nor around anyone who has a cold or other infection. The same will be for me; that I need, as her caregiver, to keep myself free from a cold or infection and be careful about public contacts.

Then, at a time to be determined, Sabine will return to the hospital and be given an even more powerful chemo-- melphalan -- to knock down her immune system and cancer cells once more.

It is at this time that she will be re-infused with her harvested stem cells and then kept in isolation in a special unit within the hospital for a period of two to three weeks as the implanted cells have a chance to flourish and grow. It is at this time that she will be most vulnerable to infections. Unfortunately, we cannot be home at this time because of the special risk she has due to her kidney failure.

Sabine's sister, Barbara, has offered to come up from Missouri during the critical stages to help us out just like she did a year ago when Sabine was hospitalized.

If you wish to know more (and my explanation may be medically off a bit) please look at my earlier blog which gave reference to some web sites on stem cell transplanting.

As you can imagine, all this is a little more "dicey" because of Sabine's kidney failure, her tunnel catheter, and need for dialysis.

Both of us will need your prayers. The outcome we seek is a hardy, growing transplant of stem cells which will "elbow out" the cancer cells. If things go well, Sabine could be off chemotherapy for a year or so and have a much better quality of life. This would enable her fistula to be connected in her arm and get the catheter removed from her neck (it could cause problems and be a source of infection in the future). Who knows, swimming and kayaking could be something she can do again in the near future.

Needless to say, this is an extremely scary time for her and for me. I do worry. A lot. And I try not to let the fear control my life. We both are grateful for all of you who continue to pray for Sabine and/or send her "good vibrations!"

I will keep the blog updated as to how we are doing. In the next month or so you may not see much of us...

P.S. If you are interested in knowing more about stem cell transplants there is this is from the Multiple Myeloma Research Foundation website:

"Autologous stem cell transplants refer to stem cells that are collected from an individual and given back to that same individual. Autologous transplants are also referred to as autografts and are by far the most common type of transplant performed in myeloma patients today. With this type of transplant, the patient's stem cells are obtained prior to high-dose chemotherapy, frozen, and stored if necessary, and are then given back afterward.

"Several studies have shown that high-dose chemotherapy with autologous stem cell transplantation improves the response rate, event-free survival and overall survival in myeloma over that obtained with conventional chemotherapy..."

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