Red Blooded American

Today's morning transfusion is of red blood. My count had at last dropped below 7, triggering an official judgment of "too anemic" and the decision to give me red blood.

The blood is "irradiated" (to kill any germs or live alien cells) and it has been "leukoreduced" (had the donor's immune cells removed as much as possible).

This fits with the medical alert bracelet that I ordered (cheap-and-slow delivery for Feb 6th when I am discharged)

Auto BMT 2018
Transfuse Leukoreduced,
Irradiated Blood
Products Only


If you ever wondered what kind of messages get written on medical alert bracelets, it turns out to be boring stuff like mine.

And interestingly, I will be getting more platelets later today. Based on yesterday's allergic reaction they are medicating me in advance with Tylenol, Benadryl, Pepcid, Allegra and Claritin.

Hair Trigger

7 Feldberg has its own Wahl electric hair trmmer, and we used it to buzz me to a uniform-ish 1" of hair on the sides and no more than 2" on top.

The hair is coming out pretty rapidly right now. While I still have lots of hair, for the first time you can see skin from the side (see below) and not just the top-back (which has long been skimpy).

There was a minor scare this morning as I had an allergic reaction to today's platelets.

I'd had only a 9 platelet level last night, so we started a bag of platelets at 5am.

After it was all in, my back started itching. I called the nurse and she observed hives, and gave me Benedryl through my port. That helped some but then came shortness of breath and new hives on my neck.

This attracts the attention of that flock of caregivers that Chemo Birders would know as the Great Blue Commotion.

Native to scrub habitats, the Great Blue moves fast, administering 50 units of hydrocortisone and calling for an in-room chest x-ray from this beauty, which I think is an ostrich of some sort:

WBC = < 0.1
HGB = 7.3
PLT = 7 (transfused 6am Monday; new count in process)

Having received a bag of platelets already today, we are expecting a new Platelets number above the 10 threshold, and perhaps of about 14 from the complete blood count CBC that was taken at the end of the transfusion.

Update: My new platelet count (after this moring's transfusion, described above) was 12, about the doubling thatt we expected.  It is funny to think that the bag they transfused from had about as many platelets as my whole body had had.

WBC = < 0.1
HGB = 7.5
PLT = 21

There will not be any transfusions today. If things continue on Trend however I will probably need red blood tomorrow when hemoglobin will likely be below 7.

Apparently the lowest possible number that they will give you for white blood count is "less than .1"

Medical: Where I'm at: Nadir vs Reboot

Let's look again at this blood-lymph family tree:

Right now, inside you, there's a constantly-renewing stream of all the cells on this family tree. The cells on the right have specific functions and specific life spans, but generally the cells on the right are replaced every week or two by new cells made in the marrow and migrating out into the blood and lymph systems. The whole process in a normal person is driven by the fast division of the stem cells at the left, and their migration out to replace dying cells in the right column.

At some point in early 2017, the  B cells that worked as my Lymph's Mantle Cells went rogue, and, instead of dying normally and waiting to be replaced by cells migrating out of my marrow, started reproducing themselves in situ in my neck and colon. My Mantle Cell Lymphoma was the result of the fast division of the B Cells at lower right.

My old system had two types of fast dividing cells, on both left and right, when it should have only had fast dividing cells on the left.

Right now, I have two overlapping blood-lymph families living inside me.

• Old System, of which only the non-cancerous "rightmost" remain
• Reboot System of which only the presumed-cancer-free "leftmost" have been spawned yet

The purpose of the chemo last week was to kill off the very last cancerous B-Cells of the Old System but as a side-effect, ended up killing off all the "fast dividing" portions of my marrow (the left 3 columns).  So, as far as the Old System goes:

• my right-column B-Cell cancer is dead by design
• my left-columns progenitor cells were killed as a side effect
• my right-column siblings of my cancer will soon die of old age and not be replaced

My current-and-upcoming nadir will happen because the last of the old system's cells will die of old age before they have a chance to be replaced by the new system. 

Did that make sense?

My nadir will end when the Reboot cells have gotten numerous enough to repopulate my marrow and mature enough to be right-column cells (and start apprearing in my bloodstream).

Medical Arrangements

If Edible Arrangements can be a thing, I'm thinking Medical Arrangements may be next, such as this handsome bouquet of three white salines and a spray of spring green toothettes:

My blood counts have, as expected, dropped again.  I think I'll start posting them.

WBC = White Blood Count, where 4.5 to 11 is normal
HGB = Hemoglobin, where 14 to 18 is normal
Pltlt = Platelets, where 150 to 450 is normal

Every night at about 10pm, a Complete Blood Count is drawn (an RN pulls a test-tube's worth out of my port).  The results are in by 2am and are communicated to me when I wake up, and then determine my care for the rest of that day.

Thursday Night (determining care for Friday)
WBC = 0.4
HGB = 8.0
Pltlts = 70

Once Platelets were under 100 they stopped administering the anti-clotting shot (that had been daily since my first day).  With WBC that low, I was officially "neutropenic" and they officially got more vigilent about fever or infection.

Friday Night (determining care for Saturday)

WBC = 0.1
HGB = 8.6
Pltlts = 46

So today, Saturday, my care adapted to these.

If HGB gets 7 or lower, they will tranfuse red blood cells to keep me from getting any more anemic.  Those would have to be "leukoreduced" (purified to be red-only) and irradiated (to destroy anything that is not a red cell)

With platelets below 50, they  worry about bruising, and my gums.  Below 50 I'm barred from using a toothbrush, and must use a "Toothette" (a coffee stirrer tipped with a banking-soda-infused sponge).

I am officially neutropenic, with a white blood count of  0.4 vs a normal 4 to 11. I have at last reached that immunocompromised state that we have been worrying about for a month or more.

I am also anemic, with hemoglobin of 8, vs 11 to 14. So I am easily fatigued.

Platelets are at 70, which is still above the risky level. Between 20 and 50 they worry about bruising during normal activities, and if it drops below 10 I will get a transfusion of platelets.

Thursday Jan 25th

Mrs Blogger was joined by Bloggette #3 (12 yrs old) for a midday visit.  Bloggette Three is something of an old hospital pro, having had her appendix out a couple of years ago.  But true to the Spirit of Homeschooling, I made sure to explain as much as I could about my room and treatment, and she made sure to extract the promise that Mrs Blogger would take her to Wendy's for lunch.

I felt pretty good today, both inside and out.  Working from unjustified optimism, I was a little too reckless at lunch and ordered the vegetarian chili, which struck the wrong balance on the nausea/appetite ratio (it was far too disturbing/nauseating).

For dinner, I'm going to avoid anything red (chili, ketchup, burger or hot dog) and stick with things that are whiter and creamier.

• Strawberry Chobani yogurt to be mixed with a dry bowl of Special K*
• Blueberry Chobani yogurt to be mixed with a dry bowh of Rice Crispies*
• Side of 2 slices of bacon, just in case "savory" ends up being more appetizing
• A milk (for tomorrow's coffee) and two waters (for later)

*Yes, it is a little sad that variety at dinner comes down to the shape of one's puffed rice.

Being generally in good form is important because the personal care schedule keeps getting more elaborate.

Almost every symptom or body function is riding a crazy sine wave.  Nothing is expected to have constant anything. What's up is likely to go down and then up, while others will go slow-fast-slow or down-up-down, and you never know when to fire the booster rockets or the retros.

The Daily Schedule

Med Schedule

• Morning, Noon, Night = Acyclovir (anitviral), Ursodiol (liver protect)
• 10am & 10pm = Cipro (broad antibiotic) to be replaced with a targeted antibiotic in case of fever
• Bedtime belly shot of anti-clotting (daily until platelet counts drop, then likely replaced by a bedtime Neupogen to boost platelet counts out of their nadir).

Oral Care Schedule

• Morning, Noon, Eve, Night  = Brush teeth with Sodium Fluoride, rinse with Calphasol, wait :30, chew Troche pill
• Morning, Noon, Night = Drink dissolved L-Glutamine ("with food" except I don't eat that often)

Intervenous Schedule

• Continuous fluids (Saline 100ml/hr), so I'm always tethered to the wheeled IV pumps/pole
• Supplemental minerals (today it was Potassium, previously it was Magnesium)

Testing Schedule

• Every 4 hours vitals (blood pressure, pulse, temp, oxygenation)
• Daily weigh in (has been stable last few days)
• Nightly blood draw (as ports are flushed and rotated so that none get stale) (Mostly looking at blood count so we can see the nadir coming on, and at liver/kidney function, and at mineral leves)
• Nurse Practitioner or Physician Assistant "stethoscope check"
• Official Physician's rounds "stethoscope check"
• Stool test to track change from constipation to nausea (sorry, this is a medical blog and my poop is a constant source of conversation with my caregivers. Every nuance is lovingly examined: the objective timing, consistency, flow contents, and my subjective attitudes toward it both before, during and after. My literal hot s--- is figurative hot s--- around here.)

Hygiene

• Wash hands every time I'm near food or the bathroom
• Gather equipment for towel-bathing (but haven't re-summoned the nerve)

Wednesday Jan 24

Today's word of the day is fatigue--at least for the first half of the day, when the only question was whether I felt more like lying on my left side and facing the door, or on my right side and facing the window.

Now I'm doing much better and waiting for my lunch to come.

They've added another step to my oral care regimen: 3 times a day, I will wash down 16 oz of L-Gluatmine solution with the aim being to aid in the repair/health of my throat & gut.

VISUALIZATION EXERCISES

THE FEMURS OF CHATEAU BLOGGER

Stem cell = 1 grape
Femurs = each a long and skinny wine-growing estate on a sunny hillside
Other long bones = outlying plots of land that are attached to Chateau Blogger
Marrow = the actual vines, old and overlapping of Chateau Blogger

In a good year, Chateau Blogger can have as many as a billion individual grapes on the vine. But we will have to burn the vines and start over.

Knowing we would have to burn all the vines at Chateau Blogger, a small crew went out, with Mozabil grape shears and cut 18.28 million of unripe grapes from the vines. These were separated, sprayed with DMSO and put into the freezer at the local cooperative.

Soon thereafter, the vineyard hands set fire, repeatedly, to the vines for 5 days of burning.  After a day of rest, the grapes were retrieved from the co-op and planted in the ground.  Unfortunately, we will miss a season of harvest, and will be dangerously short of grapes, raisins, skins/tannins, and wine for a season (a week) while the freshly-planted grapes take root, grow, and produce fruit.


GILLETTE STADIUM

Gillette stadium holds 66,000 people.  I have a crowd of 9 million people (stem cells) that I'd like to get settled in their seats.

It ends up being something like 4 million stem cells per femur, with a million more scattered across the rest of my marrow.

I want each of my femurs to soak up 60 Gillette Stadiums worth of stem cells.  In my mind's eye, I picture 66,000 white cells nestled in their seats, and then I shrink that image and nestle it into my femur's core.  Repeat 60 times each side. there's plenty of room and what's important is that they get settled, not that they settle in any particular bone.

Stem cell infusion

The flavor of the day turned out to be creamed corn which was the smell that those around me detected as my stem cells were re-administered at about 10:30a this morning. Personally I never smelled anything, but they will keep giving me IV fluids until it is no longer wafting out of me.

They gave me pre-meds similar to those that they have given in the past when I got Rituxan. Namely they gave me Benadryl and Tylenol, just in case my fever system accidentally decides to spike a fever in reaction to a sudden appearance of a large number of immune-related cells.

I was expecting a bit more fanfare when the cells returned (below). Something more medieval, like a courtier walking backwards holding a golden bowl, or a guy with a mace leading a procession.  Nevertheless, here they are, my new lease on life:

Monday Night

My mother and brother grin broadly during their visit Monday night.

Medical Monday Rest Day

Today is/was my Rest Day before getting my stem cells back tomorrow.

Yesterday, Sunday, was largely uneventful, too.  Sunday was my first and only day getting Malphalan (the final "M" in the four-part B-E-A-M chemo combination I've been undergoing).

Both days, everything from my rib cage and "outward" looked and felt really good. Good complexion, good hair, good mood.

But then my innards felt slow, or made of wood, like all the organs of the chest and thorax had been replaced with something inert.

We're up to 4 drugs for managing anti-nausea (successfully), doing tricks like dialing back on Compozine (because it might make my upcoming nadir worse) and introducing a new one (whose name escapes me).  And 3 drugs for anti-constipation.

Unlike the way that a fever can be an important part of getting better, or at least an important symptom, there's also no sense that nausea is a necessary or helpful part of chemo: It is solely a bad side effect, and not an indicator of anything or an important path of action, so we have no hestiation going after it when it peeks out in the form of a hiccup or a knot near my belly botton.


Cipro is a broad-spectrum antibiotic (because we're anti-germ). and Ursodiol for protecting my liver.

A READER ASKS: " I do have a silly question: will the scent of creamed corn accompany the injection of your own stem cells... apparently that can be a thing based on how they are preserved or something."

ANSWER: I've been told to prepare for more of a garlic smell, that I will give off as the stem cells are transfused.  The DMSO (Dimethyl Sulfoxide) that has been mixed into my donated cells and used to protect my stem cells from the freezing cold, being a sulphur compound, can be stinky.

Saturday

Not much to report today: I slept late and so far have only eaten Special K with milk or yogurt or most recently two bags of potato chips.

I finished my last dose of atopica side at about 2 and we'll have my last dose of heresy tonight at 9 p.m.

Tomorrow I will get my first and only dose of Malphalam, the M that will conclude my BEAM therapy.

Monday will be a rest day and then Tuesday I will get my stem cells back. 

Blocking is going to get less frequent simply because I don't think you're going to be that interested in the different nausea and platelets side effects.

Maybe tomorrow I will do a hair inventory but right now I would say I have plenty of head hair a thinning of eyebrow hair, and a lack of nose hair.

I did get a new-in-box Norelco shaver (germ free) that I will now try a quick shave with.

Friday

Somehow it is Friday already. And Friday is almost over. Mrs Blogger and I began a 500-piece puzzle today that's just about the only thing new.

Mostly it feels like my whole insides have slowed down: my heart rate is slower, my appetite can barely support two meals, and they are giving me injections to help me pee. My entire alimentary canal feels slow: full, unhungry, and unmoving. The staff reminds me to order food.

I woke up this morning weighing 194 lbs, a 10-pound gain since admission and apparently almost 100% of which was water, since after the lasix (sp?) injection I started peeing immediately and didn't stop until I had lost 10 pounds.

Because they were overfilling me with water they have disconnected the tube that was pumping in water. As a result for the first time in several days I'm entirely without tether and can Pace back and forth in the room for exercise without hauling my IV stand with me.

Medical: Physically well, Mentally scattered

Maybe it is the hyperness of the steriods, or maybe I'm just bored, but my blogging output seems an interesting reflection of the fact that I'm physically pretty well off. My only complaints:

• Gums seem itchy, but I'm on an elaborate 4-times a day regimine of sodium flouride gel, a 2-part rinse, and an anti-fungal tablet (to prevent thrush, a fungal infection typically seen in nursing babies that's otherwise hard to fight)
• Constipated. The anti-nausea Zofran, key during chemo, but very constipating, is always way ahead of the Colace, Miralax, and Senna coctail they give me. As they'd say in the olden days, "I feel my bowels are in uproar"
• Agitated & Tired. Probably the steriods and so far I've refused the sedative.

Right now I'm supposed to be sleeping (early) as the hour-long last chemo of the day goes in (a second dose of Ara-C (Cytarabine), but I realized that I han't brushed my teeth and that only after waiting 30 minutes post-rinse could I take my anti-fungal and go to bed for real.

Lyrical: Chemo Birds: Notary's White Taped Partridge

Notary's White Taped Partridge

The small Notary's White Taped Patridge thrives in ecosystems that still rely on paper documentation.

Medical facilites are extremly fertile in this regard.  The White Taped is particulary fond of 4th generation xeroxed forms (whose image is slighly askew) such as pre-procedure release forms, Power of Attorney forms, or indeed any form that a patient is inclined to sign or date in the wrong place.

Named for the unusually strong, opaque, and useful excretion it makes through its beak, it used to be common when typewriters were common.

With the adult being much larger than size of a human thumb, the bird and its nest are easily overlooked. It can still be found, as shown, having built its nest out of collected shiny objects, usually a mass of paper clips.

Lyrical: Chemo Bird: The Great Silver Crane

The Great Silver Crane

Among the largest of common North American birds, is the Great Silver Crane, which has prolifereated as patients have grown more obese and Hospitals have sought to avoid both dropped patients and care-team back injuries.

Like the Barn Swallow, the Great Silver Crane nests exclusively on celings among the beams.

Like the Baby Delivery Stork on steroids and growth hormone, the Crane lifts humans in a giant knot of gathered bed linens, except that in the case of the Crane, the human is way bigger.

Capable of lifting a stated maximum of 200Kg (440 lbs) and apparently quite vigorously-attached, these powerful birds are nonetheless motionless for much of their lives.

At right are shown a nesting pair of cranes with their tails harnessed to their keeper's yoke.

Nests are built from a combination of anodized aluminum, steel hangars, and amortized elbow grease.


Recently Revised: Dial Faced Constrictor and Screen Faced Bower Bird

Search for  all the Chemo Bird postings.

Lyrical: Zillow Listing of My Room

 Longwood Efficiency 1/2 Bath with Riverway Views & Honey Oak Interior Accents, Throughout

Foyer

Enter through the luxuriously-wide honey oak door, wide enough for a team to wheel a bed through. Unburden youself in the curtained and privacy-controlled foyer. Refresh youself at the sink.

Charming door hardware allows elbows-only operation. Foyer contains the thermostat and the servant-call (and cancel) buttons. Look up to see the postive-pressure air handler


Library

Just off the Foyer is the Library.

Relax in your favorite reading chair and slippers. Oxygen ports help daily cares to melt away.

Chrome plated shelves keep your library close at hand. Perfect library for your busy blogging lifestyle. Convenent bin storage breathes new life (and sealed medical supplies) into this new-concept library for our post-print world, giving the look of an educated person's library without the guilt of feeling like you need to read books.



Dining Area

In this open plan apartment, your dining area is just steps away from your Library. (Note that for the open house, we'll re-stage this photo with better tablewear) Owner will consider separately selling or leasing the Mid-Century Modern crome infusion stand with upgraded triple pumps.

Sleeping and Changing Area

A fully-adjustable, easily sanitizable bed awaits in your sleeping area, just steps from the library and dining and offering easy access to the kitchen and master bath. Handsome honey oak built-ins powerfully evoke nostalgia for the late 1980s and early 1990s.

Nurse Cave

Escape to the nurse cave to relax! A unique experience entering blood pressure, recent medications, chemo adminstrations, and urine output.  Serves as a hub for all your care activities!

Efficiency Kitchen

Enter the cozy kitchen area with the confidence that you actually hate to cook and the only thing you can make is a room service order.  

Fridge stores only single serve waters and tiny packets of Wegman's Wasabi Sauce that you've saved from past sushi orders. Requires virtually no cleanup because all your food arrives and leaves by tray anyway.

Imagine indulging your inner environmentalist knowing that you can sort your garbage 4 ways: Trash (grey), Plastic Recycling (pink), Biohazard (red, lower left), and Sharps (left wall)



Master Bath

Your key to independent living, this marvel of space efficiency has premium built-ins like a dual-roll, high-capacity toilet paper dispenser (left) and a servant-call intercom panel (right).  Not quite a built-in bidet, the long, chrome central arm on the toilet is actually a down-facing bowl washer, not an up facing you-washer.

Office

Dramatic city views from the panorama window overlook the Winsor School, with the Riverway of the Emerald Necklace and Longwood D-Line Station just beyond.  Free hospital WiFi only requires cumbersome re-login about every 2 hours.  Svelte guests can perch on the long Corian-topped window ledge.

Medical: Transplant Day -7

I'm all checked in to room 777 Feldberg. Mrs Blogger is napping. All my possessions (mostly electronics, like laptop, tablet, phone, two mice and two headphones and two pairs of reading glasses) have been wiped down with disinfecting wipes. I've doffed my arrival clothes and donned clothes that were new, hospital-issue, or freshly-laundered and brought in ziplocs.  The door has been officially closed on my room.

It does not have an airlock, but does have positive air pressure and a special door.  I don't have a shower, and will either go without or be moved to a room that has one when it becomes available. Mrs Blogger as "not the patient" has to wear gloves over disinfected hands.  I had to take a sanitizing shower this morning, but can go gloveless.

The best guess is that I will keep my venous line not just through chemo, but maybe until I go home. By then the skin will have healed more around the tube, and it'd be just too useful if I need transfusions or other help.

THE SCHEDULE FROM HERE

Unlike regular chemo, where day 1 is the first day of chemo, this week will be numbered from Transplant Day 0.  So all of this week's days have negative numbers.

Days -7 through -2 will be devoted to BEAM chemotherapy

BEAM is named after the initials of the chemotherapy drugs used, which are:

• BiCNU ® – carmustine
• Etoposide
• Ara-C – cytarabine
• Melphalan.

Day -7: B = BiCNU / Carmustine .  We know it is a mustard-gas family chemical because of its "-mustine" suffix

Day -6 EA = Etoposide & Ara-C (Cytarabine, the "fake Cytosine" that jams the DNA zipper)
Day -5 EA = Etoposide & Ara-C  (Etoposide disrupts the enzymes that mediate DNA division)
Day -4 EA = Etoposide & Ara-C
Day -3 EA = Etoposide & Ara-C

Day -2 Melphalan

By Day -2, all my stem cells and most fast dividing cells (hair, mouth, gut) have reached their nadir,  and I'll have stopped production of new platelets, white & red blood cells, so these will begin their own trip to their later nadir as the surviving blood cells die of old age

Day -1 = Rest day (as chemo clears in advance of giving my cells back.

Day 0 = I get back half--9 million--of the stem cells I donated. The life sustaining minimum would be 1 million. A standard transplant has 5 million.  Healthy humans have billions and by Day 0 I will have near-none.  Growing back from 9 million cells, I only have to regrow by a factor of 100,000x instead of 1,000,000x (which, put logarithmically is an advantage measured in hours, not days)

Day 1 through 7.  I'll probably be sedated, since there's not much to do but wait, and my brain may be foggy (or at least trouble concentrating) from the Chemo.  They say reading is basically impossible, but books on tape or the Food Channel are sufficiently untaxing.

Worse, this is where the mature blood cells will die of old age and I'll be left with low everything (low platelets, low white cells, low red cells) and will likely need transfusions

Day 8 through 13.  Somwhere in here they declare the "engraftment" of the stem cells to have worked.  Engrafted stem cells will have migrated back to my marrow, found a niche, and started dividing, making new stem cells, new platelets and reds, and new white progenitor cells that will still take a little longer.

"Day 13" is 21 days from today.  Sometime around Feb 5th

Lyrical: Chemo Bird: Hememingbird

Hememingbirds / Dickenson's Vacutainer

This family has the strictest pecking order of any social bird.

Members of the flock will always feed in the same order, as established by medical priority and the type of internal preservative, and enforced by their flamboyant head coloration.

The entire process is usually overseen by a phebotomist or Registered Nurse. The flock can be unruly, and the process traumatic, but if the tubes behave well, the human drawing the blood rewards each with a sticker with a happy, uplifting message, such as the patient's name and medical record number.  The tubes then wear these stickers for the rest of the day, similar to an "I Voted" or "Best Speller" sticker.  It is really quite cute.

All of these birds feed the same way: After inserting a small gaged needle into a peripheral vein, they nestle head-first into small, sheath-like tube, amost like a lilly or honeysuckle blossom.

Impaling their colored stopper plumage onto the stigma of the flower's spike-like pistil, they draw venous blood into their abdomen using air pressure (their abdomen has been evacuated, and the vacuum draws the blood).

Photo Credit MatthewLammers, Wikipedia

While rarely all present at the same feeding, the established order never varies.

Pecking Order - Color - Social Role

1) Sky Blue Phlebotomy: feeds first to assess coagulation
2) Gold Phlebotomy / Tiger Top Phlebotomy: chemistry tests
3) Ruby Red Hememingbird: any tests requiring serum
4) Royal Blue Phlebotomy: detects trace minerals
5) Pale Green Phlebotomy; liver tests
6) Dark Green Phlebotomy: tests for ammonia & calcium
7) Green Heparin: tests for bacteria
8) Lavender Phlebotomy: complete blood count (frequent chemo ward visitor)
9) Bald Phlebotomy: viral tests
10) Flamingo Phlebotomy: for blood typing and blood bank testing
11) Tan Phlebotomy: test for elemental Lead
12) Grey's Phlebotomy: Sugar tests

The Pecking Order, in chart form:

Lyrical Chemo Birds (Pending; Note to Self)

Just updating the list of birds I'm resolved to describe at some point

Recently Identified:

• Intravenous Tick Bird (Symbiote. Rides on the arms of larger mammals, removing blood suckers)
• Infusion Pump (whose calls of alarm echo through the forest at night, at just the right frequency to be heard by patients but ignored by nurses. The calls seem to say Bob-O-Link or Air-in-Line)
• Long-Necked Showy Monitor Multi-hued and with a seemly-endless 99 channels of communication, patients seem entertained to watch for hours at a time)
• Halyard's Silver Nitrile (unlike the individual Halyard's Purple Nitriles, the Silver nests in colonies of Small, Medium, & Large)
• Screen-faced Bower Bird (discoverd that the Velcro-Collared Constrictors / Dial Faced Bowers tend to be wall mounted, and all the migratory / five-footed bower birds are screen-faced these days)
• Chrome-Billed Platypus. Amphibian found in aquatic environments. Red-ringed male and Blue-ringed female nest on either side of hospital sinks.

Birds identified early on that are still to be covered in future editions:

• Variably Billed Oncologist
• Migratory Nurse
• Great White Commotion
• Five Footed Stool
• Chrome Plated Stand
• Tube Tailed Saline
• Alcohol Swab

Wrapping up at Work

Today was supposed to be my last day at work before entering the hospital, but there's something about lose ends that turns them into teaching opportunties, and I was happy to share a bit extra about the systems I'm entrusting to my co-workers.  So there's this little bow-wave of details-on-details still in front of me.

Originally I thought that I'd be in the Hospital on Monday (because they would not be observing MLK day) and I thought that work would have a holiday (because in 2017 it'd been a holiday). 

Turns out the exact opposite is the case: It's the hospital staff that will be off Monday (and admit me, instead, 12:40 Tuesday) and work that will be going (and having the 7:30am call Monday).

Chemo Birds Index

I just found out that my principal oncologist, Dr. Robin M. Joyce, is a birder.  At some point, we're going to have to author a big coffee table book together.  To that end, I've figured out how to keep a live index in 1 place:

 all the Chemo Bird postings.

Kinda funny having an ornithologist oncologist.

Way Over Quota

Today's goal was 5 million stem cells. They knew (but didn't want to say) that I was doing really well.

So they initially downplayed both my high blood counts going in (they wanted at least 3 (thousand white blood cells per microliter), while 4.5 to 11 are normal, and I was 84) and downplayed the luscious raw salmon color of my cells coming out.  They noted these things, but downplayed the implications.

As it turns out they got 18.28 million stem cells and I will not have to come back tomorrow! This number is an actual count, made in a cytometry lab. It took so long to get my results because it takes just that much longer for the laser cytometer to count to 18 million vs 3 million which would be a normal "good day"

So I won't immediately benefit--they won't/can't reinject them all, for some reason, but I will have spare bags.

I have asked them to run them all through the centrifuge again and only give me the ones that are about 6'2", with an athletic build and decent calve muscles but they seemed evasive in their answers.

Horseshoe

I made this:

By getting hooked up like this:

And felt a kinship with this:

Just as I used to believe that spare ribs were surgically removed from pigs, I used to belive that  Horseshoe crabs were "donating" their blood, like cows being milked or sheep being shorn.

To my horror, while Googling around for photo-analogies to stem-cell donation, I've come to believe that the crabs are, in fact, being exsanguinated (like, to death), since the pictured bottles are (1) about the volume of a crab's entire innards and (2) not exactly being carefully metered. Shudder.

Lyrical: Chemo Birds (Apheresis Birds)

Clear-Bellied Crud Sucker

Onithologists debate whether the Clear-Bellied Crud Sucker is smallest member of the Greater Shopvacs, or in fact the largest of the Lesser Suckers.

Your Blogger classifies the Crud Sucker as the smallest and perhaps the most adorable of Shopvacs.

Even as the Emu is more Ostrich than Kiwi, the Clear-Bellied Crud Sucker, with its indirect method of feeding, clearly has more in common with Greater Shopvacs (such as the flamboyant Orange Ridgid or Sears' Wet Dry) rather than the Lesser Suckers such as the Common Dustbuster or the Showy Dyson.

The Clear-Bellied Crud Sucker perches on the end of vacuum lines in almost any urban habit that has vacuum lines.

Unlike the Greater Shopvacs, however, the Crud Sucker does not generate its own suction. Rather it relies on connecting its tail to the vacuum line, creating low pressure in its large polycarbonate belly.

The Crud Sucker is able to pull in great quanties of crud--up to 1100 milliliters in some varieties--without having its intake blown directly to excretion.


In many ways the Clear Bellied Crud-Sucker is like the carrion birds, feeding on the cast offs and leftovers in its habitat. Having no beak, it feeds through a long, flexible, tube-like proboscis.

Sublingual Sap Sucker / Dental Shopvac (not pictured)

While not found in hospital habitats, the Sublingual Sap Sucker is found in dentists offices, and easily identified from its graceful, swan's neck (Latin: saliva ejector), its rasping calls, and insatiable thirst.

Red Blooded Spinner

The Red Blooded Spinner, a member of the Centrifuge family, builds a small rotating nest inside a much larger, more elaborate outer nest.

Like all Centrifuges, it bears no more resemblance to its wild cousins than the domestic chicken does to any wild bird.  As with the Uranium Centrifugue, private ownership is illegal, except in Iran and North Korea.

Unable to feed itself since its domestication during the dawn of Agriculture (8000 BCE), for hundreds of generations it has been utterly reliant on the Apheresis Technician to connect its feeding lines to its preferred food source, stem cell donors.

The injection kit showing both used (right) and unused syringes (left):

Central Venous Catheter (coming Monday)

At around 10am on Monday, they'll put me in a Fluoroscope,* a kind of fuzzy-but-live-action X-ray so that they can snake a Central Venous Catheter into me.

This is a cropped photo of what mine will look like, taken from another cancer patient's blog. The key thing to note is that it has 3 heads that dangle out and which I'll need to learn how to clean daily:

They'll clean it for me every day I'm donating (Jan 8 & 9) .  They'll use on port for "blood out to the extraction machine" another for "blood return after extraction" and then the 3rd is a spare for tests out or medicine in.

Personally, I wish they'd have it come out the back of my skull, 'cause then it'd kinda look like a pony tail made from three fat hairs.

Once donating is done and I'm not going to BIDMC every day, I'll have to rinse it with saline and somehow add heparin (an anti-coagulant) when I'm home with it Jan 10 to 14.  My guess is that I'll do this from syringes that will "dock" Usually it is a process of:

1. uncap catheter, wipe with alcohol
2. uncap syringe, wipe with alcohol
3. screw or dock syringe onto end of catheter
4. push plunger to force the saline into the line
5. maybe pull on plunger to check for "blood return" (confirming 2-way flow)
6. undock syringe
7. wipe & recap catheter dock with a fresh cap
8. dispose of syringe, wipes, and old caps

The BIDMC takes over and uses it for chemo Jan 15, 16, 17, & 18, and then I'm not sure if they'll leave it in (for tests, drugs and transfusions) or maybe they'll take it out as an infection risk.


*Check out the fluoroscope, below.  I'm pretty sure it has a "lightning storm" setting which allows you to animate the monster through metal electrodes on either side of his neck, and then you tip the table up once he's alive. Going to clip two 10mm bolts to my shirt collar and see how it goes.

Public Domain photo from Wikimedia Commons

Self Service

• Given the big winter storm bearing down on Boston, and 
• CVS not having pre-shipped my shots (as my nurse/care-manager had been assured) and
• not trusting that UPS would deliver overnight by 8am and
• needing to start a course of marrow-stimulating shots promptly this morning,

I drove to Milford MA to pick up my shots (8 syringes, 2 syringes per day, plus alcohol swabs and a Sharp's nest)

Self-service gas is prohibited in Milford. It's a town bylaw.

Of course right behind the Universal Declaration of Human Rights, don't we all keep the bylaws of Milford written on our hearts?

We hold these truths to be self-evident,
that no person shall pump their own gas in the Town of Milford.  

It is so self evident that they don't put it on any signs, anywhere (no signs on "the islands" at the Milford Shell, for example) unless, if you look really closely as you're already pumping, you'll see it hand scrawled in a slanted, wandering Sharpie script, about 1" high on a worn spot on the pump itself.

So, yes, I'm a fugitive from Milford justice. Developing.

Speaking of self-service pumping, I have now pumped neupogen into the folded flesh of my own belly.  More on this process later.

De-Cluttering

It was a cold and delightful weekend, with a car-and-subway trip into Boston to see ice sculptures (20 minutes).  Much of the fun was in the mechanics of the trip: riding the Green Line trolley to Copley Square, emerging for 20 minutes*, and then fleeing the cold to huddle in the Boston Public Library and then, upon emerging, fleeing down the street to huddle in a Dunkin Donuts, then back to the Copley subway and homeward.

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Mrs Blogger is taking just a little too much satisfaction out of the fact that I have to de-clutter my shelves, desk, and dresser so that all may be wiped down, along with all walls, floors, and other surfaces.

Toss-or-store will be no fun, but then no fun for the family either to have to dust & wipe while I'm in the hospital in preparation for my homecoming c. Feb 7th.

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*I also took a few extra steps to the Philips Brooks statue next to Trinity Church in Copley Square  to acknowledge him as both the composer of O Little Town of Bethlehem and the builder-rector of Trinity Church.