Rituxan in Richmond

Monday - July 23, 2012

Another title worthy of the Magic Tree House series!

We are off for a full medical day at VCU!  Blood work and THEN Rituxan infusion, intrathecal chemo, and finally our Bone Marrow Transplant consultation.  Rev the engine - we're late!  Let's get started!

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Well, THAT was a long day even by recent measures!  My blood work came back very strong and - after Joe took one for the team and chatted up Reverend Jim thus running interference for me - my rituxan infusion was smooth.  The 2 hours plus went very quickly.

Next came my intrathecal chemo, medicine delivered via a lumbar puncture.  Ah, the downside of a teaching hospital is the actual hands-on teaching.  I do enjoy the collaborative aspect of a medical college but when Kevin, my beloved spinal-tap practitioner, introduced the young oncology fellow and said that she would be doing my procedure, I confess that I was NOT excited.  After ascertaining that I was not her first LP, I hunched over on my pillow, humped my back, and closed my eyes.  One bad moment (shooting pain down my right leg - ouch! - I don't think I cursed!  Hurray for me! ) and 5 minutes later, I assumed the familiar prone position, flat on my back for the 30-minutes of let-the-chemo-spread-around-and-not-pool-below-your-waist.  Not my best lumbar puncture by a long shot but not the fodder of medical horror stories either.

Then we rushed up to the Bone Marrow Transplant Unit for our consultation.  Happily, I already knew the consulting physician from my chemo round #2 admission on the BMT floor.  In addition, my background research was worth the angst as it put me in a good position to understand options and to participate in the conversation. I entered the room with the realization that the aggressiveness of my lymphoma most certainly indicated that a BMT would be recommended.  However, I had thought that the path would be an autologous transplant with my own (clean!) bone marrow harvested and then transplanted back.  Again, given the unique manner in which my lymphoma symptoms have presented and the cancer's involvement beyond my lymph nodes, the recommendation seems to be pointing toward a more aggressive approach, an allogeneic BMT with bone marrow coming from a donor rather than from me.  Essentially, an allogeneic BMT may optimize my long term outcome but in the near term it is a more delicate procedure, raising the specter of graft-versus-host disease and general infections.  I am coming around to "calm acceptance" that I may not work until 2014 and won't be going out into crowds much in 2013.  Oh, my ...  NOT what I wanted to hear!  In fact, the doctor suggested that I may need to preoccupy myself with a mental outlet - perhaps an online Masters!  Hmmm ........  With either transplant, I will need to live within 30 minutes of the hospital and will be visiting the clinic 7 days a week for more than a month after being released from my 4 weeks in the hospital. 

So, much to think about .....  Are we still moving to San Francisco?  If so, when?  Do we rent or buy an apartment or town house in Richmond?  So many things to contemplate .... Yet I remain keenly aware that I am in a very privileged position, with emotional and financial support and the time to devote to my health.  The full BMT consultation panel is meeting on Friday to discuss my case and to put forward an official recommendation of autologous vs allogeneic BMT.  But a transplant is coming.  Perhaps as early as Columbus Day.