Tag Archives: bone marrow transplant

Allo Allo!

Hello there, before I get things going I think we should all stop and appreciate the pun that forms the title of this blog. I am saying ‘hello’ because I have been absent from my blog of late and I am saying ‘Allo’ because I am writing to tell you all about the allogenic transplant I am about to have. Get it? If you were not a fan of a 1980s sitcom, maybe you will not have understood it immediately, but as I have now explained it to you, a pause for you to guffaw is warranted. 

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Right then, here it goes. 

Tomorrow, two years minus one day after my first stem cell transplant and 1063 days after I was diagnosed with the glory that is Multiple Myeloma, I will start treatment for my donor transplant. One could argue that I started treatment last July for this transplant, or, that all the other treatments I have had until this point have led to this transplant, but in the interest of not over exaggerating the sitution, tomorrow the SCT treatment really starts a proper.

It has taken an age to get here, and yet, once again, it all feels like it is coming at me too thick and too fast. I have spent the last few weeks wishing I had more time to enjoy myself post April’s auto, wishing I did not have to waste my limited time and energy sorting negative things out like money and my gas bill. I also feel under prepared in almost every sense possible. The impatient part of me however, which I should add, is My Ruler, just wants to get it out of the way. I have heard all the things that could happen and could go wrong, that I  just want to see what is going to happen and what is going to go wrong.  I want to be able to tell somebody if I’ll be free in a month’s time. I would really like to know how much energy I will have in October for the London Film Festival. I want to see if I really have wasted my last few weeks of freedom fretting over my future instead of seeing my friends and visiting my nearest multiplex. I want to see if I am strong and if I will be lucky enough to to experience weight loss. Most of all, I want to see if the transplant is going to work.

I really want it to work.

I will not know the answer to any of these questions until the treatment starts. It’s not only me who does not know, the Medically Trained People don’t know either. 

Last week, I was informed on two occasions that I am currently in remission. I didn’t believe it. On the second occasion, I was told that I was in complete remission and I was the healthiest I have been since all this started. It made the dire biopsy I had the previous week and discovering that I did not secure the lid on my 24 hour urine sample all worth it. It was news that once upon a time, would face me screaming from the roof tops. For now, it is news that bodes well going forward, only because I am exactly where the seven cycles of treatment and autograft intended me to be. It is exactly where I wanted to be. 

At the very least, it proves that my body is ready to fight the next fight, even if my mind is lagging behind. 

Some people may question the point of Transplant Number 2 when I have already achieved remission. If the last 1062 days have taught me anything, My Myeloma is a stubborn little bugger and any remission I have without the transplant will not last long. I remember June 2014 well. It’s a fact of my life. No transplant, no chance of freedom.

I’m backed into a corner with my treatment. My only true option is the transplant and I know this. Despite this, a question that has been plaguing me over the last few weeks, is that even if I do manage to get a long remission with Transplant Number 2, has the damage already been done? Myeloma came along and dropped a massive bomb into my life and there are times when I feel like I am frantically grabbing at the remaining pieces and failing to retrieve them. What sort of life will I awake to in 5-6 months time? An uncertain one. I have not been able to fully celebrate my current medical position because I have bogged myself down, with sleepless nights with these questions about my future. People tell me to focus on my health and worry about the later, well, later. That is easier said than done, especially when it is me who is staring into an abyss. Sure, my health is the most important thing, but what is health without the means to have a life? 

I know that I’ll think about the above more than once as I go forward, I may even take it out on others.  I also know that tomorrow when I wake up, my job is going to be getting through the transplant. My job is going to be getting myself out of bed everyday to get to the hospital for treatment. My job is going to be looking after my body, monitoring it and doing everything I can to ensure Big Sister’s cells do what we all want them to do.

I first heard of this procedure on 20 August 2012. At the time, I was told that there was a high chance of dying from it, there was a small chance that it would cure me and it was a rare procedure to undertake. I disregarded it. It scared me, it still does. I have had many a conversation about it since and all I know now is that I am ready to take the risk. I would be ready even if the risks were as high as first told. The prospect of being able to have a few years (conservative estimate) without treatment makes my mouth water. I’m blowing bubbles with my metaphorical saliva, I’m that ready for it. 

I have to face it, my life is not what it once was, but that is a fact that will not change by not having the transplant. In all probability, my life would be worse. Like I said, that damage has been done. Taking a risk with Transplant Number 2, the cost of doing, knowing how physically and mentally difficult it is going to be for me and those around me, has to be worth it. It has to be worth it. 

I’m in this for the long haul. 

So, tomorrow morning, I will go to St Bart’s where they will put a tube in my arm that will stay for much longer than I would like. I will have the first of five doses of chemotherapy and one week from today, I will have a bone marrow transplant. 

It’s the end of this blog, but, what it is the beginning of, time will only tell.

EJB x

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Something Borrowed

I am often being told that My Myeloma is not all my own. It would be correct to say that my illness is not all about me, the people around me have suffered effects of the illness just as I have; they’ve metaphorically and actually held my hand, they have lost a drinking mate, they put up with me and fained interest in me describing in minute detail what I have cooked on any given day, they have dealt with my mood swings and there are many, many more things that are too long to list here. 

Very soon (with my fingers crossed), somebody is going to be physically affected by My Myeloma. I will be borrowing something quite exceptional from my Big Sister. It’s beyond exceptional. It’s a minor miracle.  Just as this will be a new experience for me and a potential lifeline, it is a brand new experience for her. I’m not even sure if the word ‘experience’ encompasses the enormity of what she is about to do. I really isn’t just about me anymore…

Two weeks ago, Big Sister travelled to London for her pre transplant tests. From this, among other things, we learned that it is not only me who has to wait around a hospital.
And so, without further waffle, for one time only, I give you Big Sister:

I had known for 33 months that I was a match for my sister and that I carried round her magic medicine and possible cure. Just a few days after Emma’s diagnosis, my tissue was tested to see if I was a match. There was only a 25% chance that I would be, so we were all thrilled when it was confirmed I was a 10/10 match. I can still remember everything about the call from the hospital telling me this, and my phone call to Emma to tell her.

It’s been quite a responsibility carrying the stem cells around, if I had had my way they would have been taken as soon as we knew I was a match. I even carry around an ICE card in the event of an accident which states I am a living donor and they meant let me die until my stem cells have been harvested.

A few months ago, we were told I would need a medical before I donated. After months of asking, my medical for stem cell donation was arranged for the 11 June. I was anxious to say the least. What if, after all this time, Emma’s own stem cell transplants and our hopes, I couldn’t donate?
I caught the 7:21 train to London, sat in my reserved seat and tried to revise for my upcoming exams. Instead, all I could do was listen to the moron diagonally opposite me, try desperately hard to make conversation with the barrister next to him. Among the many conversation starters he came up with was ‘we all have cancer you know?’ I sat there wondering if I should say anything about his rather random and insensitive comment; in the end I figured my thoughts would be wasted as he was a proper know all. 
I hopped out the train and grabbed a taxi to St Barts. I was there a few minutes before my appointment. I was weighed and measured and then sent to see a consultant. The consultant was nice and cheery, he told me a load of things I already knew and completed a questionnaire about my health. I signed a consent form, the same one I give women at the hospital I am training at, before they have a caesarean, except this time ‘donate stem cells’ was written in the blank space.
Next, I went to meet my CNS, my very own CNS, how about that? She talked to me about dates, and we agreed that the harvest would start on the 22 July. I assumed this meant I had passed the medical, although no one said. My CNS then sent me for an ECG, and some blood tests.
I wandered round the huge hospital to where I was told I would get my ECG, only to be told the department had recently moved and I now needed to be at the other end of the hospital….so off I went. I was called in immediately, it took about 5 minutes to stick on all the sensor thingies and then just a minute to do the trace. I was handed the trace and told to take it back to the CNS. I was a bit reluctant to hand the ECG trace over before I knew it was ok, so I quickly Googled what a good trace looked like. Mine was similar, what a relief, so I handed it over.
Next it was time to take ‘some’ blood samples. Off I went, back to the main building and up to the 6th floor. I went and sat in a bay where other people were having chemo. A nurse came and started taking out the empty sample bottles. Now I am not going to lie, I hate needles, I always have and always will. Trying desperately hard not to embarrass myself in front of these poorly people that have to under go needles frequently, I let her take my blood…..all 16 bottles.

  
Finally, I was sent to the pharmacy to get my G-CSF injections. I waited over an hour, but they never appeared. It turns out that the prescription was wrong. As a result, I couldn’t meet Emma for lunch and Emma will now need to collect my injections for me at some point.

A week or so later, I had a text from my CNS to say all my blood tests were ok. The next day, I received a letter in the post from St Barts. My heart pounded a bit as I opened it, luckily it was a confirmation to my GP that I was suitable to donate, requesting they do check up on me following the harvest.

  
So after all that, and after 33 months, on the 18 July, I will start to inject myself with G-CSF, the growth hormone to make more stem cells. I’m not entirely sure how I will do this, but I will cross that bridge at the time. On the 21 July, I will go to St Barts for my pre-op tests. On the 22 July, I will have my stem cells harvested. They will be cleaned up and given straight to Emma. 
It all sounds quite simple. If simple means needles, stem cells and giving your little sister a lifeline. 

Can it really, finally, be happening?

EJB x




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Training

My requirements on Monday were not restricted to signing my life away. Some people work out before a marathon, my pre marathon training is something else all together. In order for Transplant Number 2 to go ahead, I had to have a collection of tests done, the purpose of which, I think, was really for me to get used to the grounds of St Bartholomew’s Hospital and not for the Medically Trained People to see if my heart, lungs and kidneys are tickety-boo. Okay, maybe checking that my body is up to the challenge of an allogeneic transplant had a lot to do with it, but the morning meant five reception areas and their accompanying waiting areas, four medical technicians, one nursing assistant, one doctor, a room of Clinical Nurse Specialists and one trip to the loo. Essentially, I went into a lot of rooms. For me, it significant energy usage and exploration. I have somewhat expertly denoted this on the map below, each dot represents an area requiring my attention. It does not include the lift journey that came to a sudden halt inducing panic among everybody in it that the day out to the hospital had taken a sinister turn.

  Medically, I was required to have an echo, an ECG, a plethora of blood tests, a urine test and something called a spirometry test, which included something called a gas transfer. Sounds exciting right? Just a walk in a maze.

The blood tests, all eight vials of the stuff was straight forward. It’s as familiar to me as cleaning behind my ears. Part of me would like to have had the chance to have caught a Sexually Transmitted Disease since my last transplant, but alas, the bald head, lack of socialising and general lack of any resemblance of physical attraction put paid to that, and still, the hospital was still required to check my blood was ‘clean’ as it were. the hospital tested my paraprotein post transplant during my last transplant, and thus, I doubt I have anything to worry about with these set of tests. My paraprotein was less than five by the way, which the doctor said was fine. I should add that when I say I do not worry about these results, what I mean is that I worry about them the least. My superstition has gone absolutely nowhere.

The blood tests, which were the third test I had done on that windy day were immediately followed by me urinating into a cup and then me leaving said cup on a shelf in a toilet. Again, I am used to peeing, so this was no great shakes. 

Before I gave away my bodily fluids, two Medically Trained People looked at my heart. As the hospital is in a state of change, the tests were not done in the same building. The echo took place in a building that resembled the set of 28 Days Later (Big Sister is there as I type and described this building as a “dump”), whilst the ECG on the other end of the refurbishment scale occurred in a room with newly painted walls and a chatty technician. In defence of the technician doing the echo, it is probably difficult to be chatty when he was required to lift up my left breast like he was opening a cat flap. Apart from that specific indignity, I could have fallen asleep whilst he pushed the ultrasound into my chest and throat. I did arrive at the hospital at 09:00hrs after all, so by 11:00hrs, I I was waning. The sleepiness was not due to me likening an echo to a massage. To be doubly clear, I did not find a stranger touching my skin relaxing. I have had an echo before, as well as an ECG, so Monday’s tests were nothing out of the ordinary.  I am surprised I have managed to write a paragraph about them.

I do find it strange that the tests Bart’s require differ from those I had to do pre Transplant Number 1.  It’s easy to assume that two hospitals in the NHS, two miles apart would approach a transplant in the same way. You would be wrong. In March, I had neither test for my heart, instead I was placed in a machine and pretended I was a human toastie.  I also had a tiresome test on my kidneys, which in the City is replaced by a simple urine sample. One thing I have not required before is a the test on my lungs, also known as the spirometry test. In My Myeloma life, my lungs have never been tested, unless you count the peak flow meter for the return of my asthma.  
On the fourth floor of the King George V Wing, I went to a reception medically entitled ‘Lung Function’ and proceeded to go through a few doors via an irate woman lacking in manners, to a funny looking machine that required me to put a peg on my nose and blow. I blew a lot. The woman overseeing the test would have made a great motivational speaker. “Keep going, keep going, you’re doing great, keep going. Wonderful.” In fact, maybe I just need her around to help me out of bed everyday… Of all the tests I have ever had, this was probably the least intrusive. Like all the tests before it on Monday, it was nothing to write home about, except it is,  because I had never had to do it before. In my days of same old, same old, it was noteworthy. Plus, having a peg on my nose whilst placing my mouth about a large cylinder was a sight to be seen. A sight to be seen. And, it beats telling you what Bruce and I got up to on the sofa yesterday, because you can be damn sure it is exactly the same as what I did last week/month/year.

  
As with everything, I now get to wait for the results to be processed and reviewed and hope that everything really is tickety boo. Something big is afoot.

EJB x

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Best Laid Plans

When I eventually wake up today, the first thought I am going to have, after the one we all have first thing in the morning about emptying our bladders, will be ’16 days’. I know I will have this thought because I have had the same sort of numerically decreasing thought every other morning for the fortnight. It’s a countdown.  All being well, it is going to continue to decrease until I get to ‘zero’ and then I will find myself at what I have just decided will be called ‘Lift Off’.

I have been with this once,  silent countdown since 2 March and I have known of the less time bound specific transplant plans for slightly longer that that, but in the age of uncertainty and limited brain capacity, I have been quite loathe to write them down and explain it all. Since I only have a measly 16 days left to wait now, 16 days in which I imagine that my emotions are going to be here, there, under the stair and quite possibly anywhere else I can imagine, I thought it is high time for me to share this information with you.  The information of course, is also commonly known as a ‘Plan’. The Best Laid Plan. A lot can happen in 16 days. Coughs and sneezes spread diseases and all that, so, do understand my disclaimer. 

It has been quite a while since I did my MS Project training and I wager that I am in a minority of the population who have undertaken MS Project training, so my plan will only be presented to you in the form of words and potentially, the odd bullet point. Anyway, WordPress is not Microsoft Office, so I should just continue.

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I am having two transplants, you could say that they are going to be ‘back to back’, but that would depend on your definition of ‘back to back’ now wouldn’t it? Since my visit to St Bart’s on 11 February, during which I was bombarded with so much donor transplant related information that I had to take a 10 hour nap, I have slowly been trying to get my head around the implications of their plans for me. For your information, based on my discussions with the Medically Trained People, ‘back to back’ means a three or four month gap between transplants. Subject to the outcome of the first transplant. 

A month since my appointment at St Bart’s Hospital and I am none the wiser about whether what I was told was expected by me or not. I was told that I was going to suffer from severe fatigue post donor transplant for an undisclosed, but probably a long, period of time. I was also told that they will want me to have a little of something called ‘Graft vs Host Disease’, but not a lot of it, because if I get too much of it, the result could be worse than My Myeloma itself. Read from that sentence what you wish, but I have a full bottle of water next to me, so I am hopeful. To cut a long story short in terms of the graft and my host, they want me to get some rashes. Sexy. 

There are three possible outcomes to the procedure (they negated to mention a negative fourth outcome and so I will do the same). The first outcomeis a quick relapse, the second is a long period of remission and the third is a cure. They do not know which door I will get, and my, my, my, is that like, The Most Exciting Game Ever.

Prior to the appointment, I knew all of this information. That said, there is quite a difference between knowing it by piecing information together from various conversations and leaflets in isolation, to one Medically Trained Person confirm it all to my rash free face. 

What I did not know and what came as surprise to me way back on 11 February, is that I will not behaving a full allogeneic transplant. I will be receiving Big Sister’s stem cells in all their maroon coloured glory, but I will do so without any high doses of chemotherapy and radiotherapy. I will in fact be having what the Medically Trained People at St Bart’s call, ‘a Mini-Allo’.

There is a 50:50 chance that the mini-Allo procedure could be administered to me as an outpatient. News I welcomed with pleasure and a mental image of my television screen. On the downside, I feared this news might confuse my people over the severity of and longevity resulting from the procedure I will be having. I was told that whilst doing it this way removes some of the immediate risk that comes with high dose treatment and a severe lack of neutrophils, everything I will face in recovery is the same as if I were to have had a ‘full’ transplant.

Enough of that. That is my main course, which I will apparently be hungry for at the end of June or beginning of July. Plenty of time in my future to go through the minutiae. Plenty of time. For now,  I have my starter to contend with, which is provisionally booked in for the 1 April. Saying I am concerned about my next transplant would be an understatement. Unlike my previous autograpt, and to extend this  metaphor, I have been continuously snacking for these last eight months on various forms of chemotherapy, and so, I am not particularly hungry for more right now. I fear the overindulgence my adversely impact the proposed high dose course of Melphalan on that Wednesday, 16 days away.

As with July 2013, I have been told that I will be in hospital between 3-4 weeks.   I will be at the place where everybody knows my name, UCH and I will initially be staying in the hotel again, within the confines of Tottenham Court Road, until I become too unwell at which point I will return to quarantine in the Tower. Unlike in July 2013, I have been told that I cannot come in with painted toenails as the MTP may need to look at them. They did not need to look at them last time, and if memory serves I was sporting a hot red near my bunions, by I best not complain… I have other, more important things to plan for.

Having had a transplant already is a doubled edges sword. It’s both a blessing and a curse and for the life of me, I cannot decide if I am better off knowing what to expect or not… Let me tell you something for nothing, it does not make me any less scared nor emotional about doing it. 

Depending on the outcome of some tests I have tomorrow, in 16 days time I know that I am going to start a course of treatment that is going to have me clasping my stomach in pain, a pain that will last for well over a week and unrelenting.  At the same time, I am more than likely to once again, as an adult go through the embarrassment of soiling myself.  My mouth is going to become so dry due to a lack of fluids that I will have at least a week long film in and around my mouth, with cracked lips and a dagger for a swallow. My hair, my beautiful hair will once again fallout. I am going to need a lot of sleep. I will then get discharged from hospital and become reacquainted with solids and fresh air. And all the while, I will be the only person I know going through it…  Then, just about when I am starting to feel better, the main course will start  and that is something I have not tasted before. In 16 days time I will commence a course of action that leads to a plethora of unknowns.

I have purposely arranged this month, my time now, where I have a reasonable handle on my limitations, so that I can enjoy myself as much as my body will allow. It’s a crucial part of my plan. Fun is a tonic, as is completing things on lists. I suppose that, however, is another story. 

When I officially wake up today and say to myself ’16 Days’, I am telling myself that I have 16 days of freedom left before I become, well, before I become, I do not know what. I am telling myself that I have 16 days of normal left, 16 days to find the strength to get through the x number of days that will come after it, as well as the strength to manage all the other unknowns I, my family  and my friends are going to encounter.  

A Best Laid Plan

  • 11-31 March – Drug free. Attempt fun. Avoid snot.
  • 1 April – Day -1. Temporarily relocate to Tottenham Court Road, stayin in the hotel. Recieve Melphalan.
  • 2 April – Day 0. Recieve stem cells transplant. Spend the next few days waiting to get sick.
  • A Few Days Later – Be very unwell and spend several days shut in a room with little to no privacy. Await the happy news that I can be discharged.
  • Two to Three Weeks Later – Get discharged. Allow Mamma Jones to look after me until I am strong enough to put things in the microwave, which would mean I will be at the point where I am able to eat again.
  • Sometime in May – return to London Town to do some more recovering and more sleeping.
  • June/July – have the next transplant.
  • August, Autumn and December – recover. Avoid germs. Perfect drug cocktail. See signs of weight loss and hair growth. Attempt to keep personality intact, 

So there it is, the big plan. A plan that is probably as clear as it will ever be. A plan that I know all too well from past experience, is subject to change. I hope it does not change, for the simply fact that I am ready to move on now, or at least I will be in 16 days time. 

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I will leave you with one final musing. Getting over my last transplant, the months of recovery after it was the hardest thing and I mean the sort of difficulty that is weighted in isolation, lonliness, endless broken sleep and fuzziest of fuzzy brains, hardest thing I have ever done. I am not the same person because of what I experienced in  aftermath of that transplant. And the memory of these consequences is usually my second thought after I wake up and recommence the countdown.

EJB x

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