Stem Cell Collection

Grant has been going in for neupogen injections all week to stimulate stem cell production. Early this morning he went in for one more shot and then his stem cells were collected by apheresis later in the day. Here is a photo of him hooked up for the morning with his blood coming out of one arm, spun around in a centrafuge to collect to white blood cells and then the rest returned through the other arm. This took about 5 hours and I think they said 16 liters (about 3+ times his blood volume) was circulated through. Will hear later today if enough stem cells were collected. If not, they will hook him up again tomorrow. Andrew went in for one round of radiation and a transfusion and we are about to go back for the second round. Tomorrow Grant's stem cells will be transplanted into Andrew via IV. Both snoozing now, need to wake Andrew to go back.

Well, we enjoyed the weekend off :)

Waiting for Grant and Andrew at Stanford. We came in yesterday for treatment and was told we should have been here on Saturday and Sunday. No-one told us! We blissfully thought (and enjoyed) a hospital free weekend. It did cause some confusion and delay etc. because it meant Andrew had not had labs done (to determine if he needs transfusion etc.) and hadn't had anti nausea drugs etc. administered in preparation for radiation ... but we got by and all done by 7pm. Hope it is earlier tonight so we can have a birthday dinner with/for Eliza tonight. Grant not noticing any ill effects from his shots yet he says. Andrew coping very well ... lack of energy issues (expected), skin infection which looks yuk but being treated, appetite good, spirits good not missing the big outdoors in this heat wave. So for those who have been complaining about not having much of a summer --- now you can quit your whining!!

Sunday

Wow, what a busy weekend. So good to have Andrew home and he too is happy to be home. Friday night we picked Andrew up about 7pm. and after instructions from pharmacists etc. it was home for a weekend of rest. Hospitals are not really restful places, even in isolation units. Friday night was also the wrap up party for my Ironteam. I tell you, Team in Training is the greatest organisation. We have made so many wonderful friends through TNT over the years. I was sorry to miss the party and seeing all our buddies we spent many fun (and challenging) hours with over the last 9 months. Like pennies from heaven the team delivered a ton of yummy food, gift cards and lots supportive and encouraging notes. What a team! We have a huge family of friends from walk/run/cycle and now TNT ironteam.
Our friends Una and Ken also popped dinner in the oven tonight and Maritza shared some delicious homemade Mexican food. It's a couple of months before training revs up again for the new season. I'll be ordering a larger wetsuit at this rate. We are so lucky to have such a great circle of friends. Again, a huge thank you to you all for notes and messages etc. They are the best medicine ...
Lots of soccer and xc running etc. for the kids and a huge gathering/picnic for our friend Tom who passed away from cancer earlier this month. Andrew could not join in but visited Tom a few days before he died. Tom gave Andrew some of his treasured airplane books - a passion they shared. I think Tom and Andrew shared a lot in common including their bright, positive outlook, their warmth and charm which attracts people to them, their good humor and determination to make the best of their situation and enjoy and appreciate each day.
Tomorrow Grant starts his regime and Andrew returns for more radiation. That continues for the week and transplant is scheduled for Friday.

Discharge from E1 - Stanford Hospital BMT Unit

Good day to report. When the ATG infusion (which they sped up a bit today they said) is done we can go and pick Andrew up from hospital. He was feeling pretty tired and a bit agitated (result of medications and hospital schedules) so will be very happy to be home. Weekend of rest at home before he and Grant go in each day next week as outpatients - Grant to get neupogen shots and Andrew for radiation. Just got to get them to schedule them together so we are not going out and back and out and back each day. At the moment they have Grant scheduled in the early morning and Andrew in the mid afternoon. My mum has scrubbed and sterilized every square inch of the house. We are all ready for the low microbial diet etc. Andrew's counts are very low so need all these infection control precautions. He has a special mask etc. He has been eating a LOT ... and puffing up with the steroids but not worried about it unduly as there is bound to be a time when he won't be feeling like eating much. Such a gorgeous day we have been able to sun dry all the bed linens etc. Apparently we are in for a hot weekend here in the Bay Area - for the first week of fall. Andrew wants the stationary bike set up in front of the TV. He is really keen to keep up as much physical activity as he can. He trotted around and around the nurses station with his IV pole daily in hospital earning him the nick name Phar Lap. Will update (or see if Andrew wants to) when he is settled in at home. Thanks to all for emails and messages etc. Andrew loves to get them.

Yay Andrew

Day 1 of radiation and ATG . Andrew seems to have had no side effects what so ever. They expect headaches, fever, shakes etc. etc. but he felt fine and no fevers. He hasn't slept much so a bit tired but doing well. It is only his second day and already the nurses are fighting to get him as one of their patients for the shift! He is a wonderful patient - very positive and cooperative etc. He told me on the phone that he has been having a bit of a walk around the room today - although he is tethered to his IV so has to take all his equipment with him so doesn't go far. Last night he had trouble sleeping due to running legs syndrome (which he is a bit prone to).  Grant (who has been so patient waiting to do his bit) and I are just going out to visit him now. Grant has been here for a month and has to be here for 2 more weeks. I'm sure he is missing his family (and visa versa). It is a long time to be hanging around. He said work has been pretty understanding, lets hope they too can hang on patiently for another couple of weeks. Will report again soon, hope Andrew continues to tolerate the treatment as well as he has so far.

Treatment starts today

Andrew checked into Stanford yesterday (after he phoned to ask if he could watch Angus play soccer first). Nice room for a hospital. He is very comfortable and surrounded with enough books to share with all the patients and staff . plus a few more. Now the hard part begins whereby they make him sicker in order to kick the cancer (radiation and ATG today). Will be a long day for him. 

Back on Schedule

New catheter has been place on the other side and so ready to proceed. Andrew will be admitted to Stanford tomorrow (Sunday) and stay for the week for radiation and ATG therapy. This will weaken Andrew's immune system sufficiently so Grant's hematopoietic cells will grow and function after the infusion. Lovely dinner at friends last night. Thanks to everyone for messages of support.

At last ... a bit of time to update

Hectic few days with visits to hospitals ... both planned and unplanned. Friday included a couple of trips to airports to pick up reinforcements (my mum from australia and Andrew's brother Grant who had been interstate). Andrew's hospital visit was a short one. Only a few (4) hours for the last couple of bags of antibiotics and then labs. Counts were low, especially platelets (25). Result - one of those nasty nose bleeds (gusher) that don't stop without platelets for clotting. Back Sat am for a transfusion of platelets. Sat afternoon a phone call from Alice's soccer game in San Fran to say she is with the paramedics because she got a hit to the head with an elbow and was knocked out and then confused etc. so another trip to ER (Peninsula up near San Fran this time). Another long session. Both patients were feeling a bit knocked out on Sunday but both fine and the first day (Sunday) in 10 without a visit to hospital. Phew ... a day of rest (so I slipped out for a nice long trail run and we all got to watch Angus's first soccer game for the season). No more fevers so on track to start treatment with catheter placement on Thursday and then admittance to Stanford on Sunday for the week (radiation etc.).

Line Pulled

Yesterday they pulled Andrew's line to be on the safe side. First they thought the cuff had come out but then found that that wasn't the case . They thought it best to remove it anyway . It's thought that there might be tunnel infection at the site. Andrew felt much better instantly (he really doesn't like the catheter). Still it will have to go back in again. New schedule now is to go in to finish the antibiotic infusions until the end of the week. Have a week off with going in every second day for labs etc and then check in on Sept 19th (catheter put back in on 16th).  This is a 2 week delay.

Non Admittance

Bummer, have to delay for a week. Fevers still coming and going. Looks like a problem with the catheter so will have to go back into surgery tomorrow to fix that. Maybe that is what is causing fevers. They are filling him up with antibiotics of all sorts each day to cover all bases.  Pretty much all day at the clinic today ... needing platelet transfusions etc. Ah well, feeling better now home and a good dinner. Perhaps and movie and then bed before heading back in the morning. Kids are getting good at washing/cooking/vacuuming ...YES!!!

Red Man

Yesterday morning was the radiation dry run. Andrew has hieroglyphics all over his abdomen. I thought they were making a shield to protect organs etc but actually it is done by imaging (directing the radiation where they want). That took all morning and he was home for lunch but developed a fever soon after. It was back to the ITA (Infusion Treatment Center) because Andrew is neutropenic (low white blood cell count and neutropils). Home again after 4 hours of treatment. They don't know the source of the fever and may not know in time to start treatment this coming week. Back in this morning for more antibiotics (intravenously) and still a low grade fever. Last night I think they all wanted to go home so had the drip going in a little too quickly and the result was "red man syndrome" - poor Andrew went quite beetroot and was very itchy. Not pleasant and when it started to happen again this morning they slowed the drip right down. Home again now and resting. Back again tomorrow for more ... and to see the doctors to assess next step.

Thanks

Thanks to everyone for all your warm wishes and offers of help. The catheter is in place and apart from bleeding issues (which is Andrew's main symptom - a very low platelet count which means no clotting) all is well. A transfusion before the procedure to boost the platelet counts helped. With Lizzie talking about the possibility of a nursing career, I figure it is a good opportunity to help out with the home care, nursing type duties (like cleaning up blood spills and flushing out the catheter lines). Just need to convince her. ;)
Waiting for a "dry run" at the radiation clinic. As they only want to radiate the lymphatic system, they have made Andrew a custom fit shield so organs etc are shielded during the radiation. Includes free tattoos for placement. He is having a fitting - of his new costume.
With the catheter in his chest, Andrew has to sleep on his back. Takes a bit of getting used to so he is tired and would rather be back in bed. He is hoping for a "quick fit". We have been told that they are very efficient and punctual in the radiation center so should be out of here soon.

Welcome to Andrew's Updates

We have decided to start this blog to keep you (family and friends) updated on Andrew's progress over the next few months. This way we can post an update once and you can access the blog if/when you want to. Other friends have used this format for similar purposes and it seemed to work well.
Andrew has signed off at work, will go in to Stanford to have his Central Venous Catheter placed tomorrow (6am), have a dry run for the TLI (total lymphoid irradiation) on Friday and then admitted to E1 (Bone Marrow Transplant Unit) at Stanford on Sunday. So it seems like a good time to start.
Andrew is undergoing a Non-Myeloablative Allogeneic Transplant.- a bone marrow transplant using his older brother Grant as his donor. The preparative regimen involves radiation to weaken Andrew's immune system. Then Andrew's immune system will be replaced with Grant's which will hopefully recognise and destroy cancer cells.
It is expected that Andrew will be in hospital for a week receiving TLI and ATG (Antithymocyte Globulin). He will continue TLI as an outpatient the second week and receive the transplant on the 17th. He will then continue as an outpatient for 90-100 days.
He hopes to be back to work within 6 months.
We will try to update this blog regularly.