Before I could officially donate my stem cells, I needed to have a full physical to make sure I was healthy enough to donate. Patty made an appointment for me at the Rocky Mountain Cancer Center for Friday morning, July 16, 2010. As I walked into the cancer center it was apparent that I, as a healthy person, was the minority. The first person I saw was a woman, probably in her 60s wearing a ball cap to cover her balding head. I immediately thought of my patient. The only thing they could tell me about the person who would receive my stem cells was that she was 62 living with Leukemia somewhere in the United States. Seeing this other woman at the cancer center started making this process for me very real. Seeing everyone else made me thank God right then and there for my health.
My physical consisted of an EKG, a chest X-Ray, more vials of blood, a urinalysis and a meeting with an oncologist who asked me a lot of questions, listened to my heart, lungs, etc. and checked out the veins in my arms. He jokingly told me that if he didn't know any better he'd think I was on Digitalis my heart rate was so slow (50). I explained it was probably because I was half asleep! The night before I returned from a business trip at midnight and had to leave the house at 6:30 the next morning to make my appointment. He did mention that he thought my veins were just "fair" but that the nurses at the donation center would have a better idea if they would be strong enough to handle the aphaeresis.
Not surprisingly, I passed my physical with flying colors and the August 3rd donation was set in stone. On Friday, July 30 I went to the Presbyterian St. Luke's Hospital Infusion Center for my first injection of Neupogen. Because it was my first day they had to take more blood (to get a pre-injection baseline of the levels in my blood), ask me a slew of questions, take my vitals and check my veins. Dr. Rifkin, the oncologist, was right. The veins in my arms are wimpy!
They explained to me that this process was very different from donating blood. My veins were always okay to donate blood because that donation was all based on gravity. I’d sit there, my blood would drip into the bag, and when they got a pint I was done. In aphaeresis, they would need to draw out a larger amount of blood at a faster rate. The veins in my arms just wouldn’t be able to handle this. Alas, they would have to do this through a central line (more explanation about the central line later). About 18% of women and 3% of men find that the veins in their arms aren’t adequate and need to have a central line put in.
Then they asked a question that I couldn’t believe they had to ask: Was I still interested in donating? It’s not my place to judge other people’s decisions, but I couldn’t imagine saying no just because the donation process might be a little more complicated and a little more painful. I had the same feeling as I did when Patty asked if I wanted to postpone the donation until after my vacation. Ummm, I don’t think so! Again, I couldn’t imagine asking a cancer patient to wait until I came back from vacation to start a process that might save her life. So, back to the first question: Was I still interested in donating? Hell yeah!
It was time for the 2 shots of Neupogen. I had them injected in my belly. I could barely feel it. The needles are very thin. It burned slightly as they injected the Neupogen into my stomach, but all in all, no big whoop.
I must have been more nervous than I thought because as they took my blood pressure (for at least the 5th time), it had dropped to 85/45. My blood pressure is normally low (100/60) – might have something to do with living at 8200 feet! I felt light-headed, so they had me stay seated until my pressure rose to 95/55 and I felt better.
Once my blood pressure rose to an “acceptable” level I was able to leave. My cousin Sue just so happened to be visiting from CT that weekend, and she promised to keep an eye on me. We left the Infusion Center and went to spend the day in Boulder. I was told to take it easy and pay attention to any aches and pains that I might feel from the Neupogen. I was prophylactically taking Tylenol, but I was surprised that I really didn’t feel much achiness or pain. I had a little achiness in my lower back, but I was also premenstrual, so who’s to say where it was coming from.
The next day, I went to the Infusion Center at P/SL first thing in the morning for my 2nd round of injections. I hadn’t slept well the night before despite taking Tylenol PM. I wasn’t in pain. I just couldn’t sleep. That is one of the side effects of Neupogen. Because this use of Neupogen is still in the clinical study phase, they asked all sorts of questions about how I was feeling. “Do your bones aches? If so, which ones? Do you have a headache?” Etc. They continued to take my vitals (blood pressure, temperature, pulsox, etc). My blood pressure was still low, but I wasn’t feeling light headed, so they administered the second set of injections. The second set was as easy as the first. They took my vitals again (this would happen multiple times per visit), saw that I was okay and sprung me for the day. Sue and I spent the rest of the day hiking in Red Rocks as I still had little to no pain from the Neupogen.
Day 3: I didn’t sleep well the night before again, so despite having little to no pain, I was really tired. After the third set of injections, Sue and I took it easy for the rest of the day. I knew I must have been tired as I didn’t even have any desire to go shopping!
Day 4: I dropped Sue off at the airport early in the morning and headed back to P/SL. Didn’t sleep well again, and Sue and I had to get up at 5:00 am to get her to the airport on time. Oy was I exhausted. The Colorado Donor Program was nice enough to put me up at the Doubletree Hotel in Denver that night so I wouldn’t have to get up at the crack of dawn on donation day. They thankfully let me check in right after my fourth set of injections. I hit the sack at 9:00 am and barely woke up for my 3:00 conference call. I was actually able to get in about 6 hours of work, had dinner with a friend and then went to sleep. It was the first night that I only took Tylenol, not Tylenol PM. I slept like a baby! Turns out it was the Tylenol PM that was giving me insomnia not the Neupogen! Go figure.
Day 5: Donation Day! At 6:30 am, I met Tish, the donor coordinator who was taking Patty’s place while she was on vacation. I was a full-fledged patient today, so I went through admissions and headed up to the Infusion Center for my final set of injections. One of the things I worried about was whether or not my bone marrow was producing enough stem cells. I really wasn’t feeling any pain – what if that meant that I wasn’t producing enough white blood cells to give the patient? Well, my fears were relieved when they took another blood sample. My white blood count was nice and high. PHEW! The Neupogen was doing its job, and I didn’t even feel it.
Then it was time to head to radiology where they would insert my central line. This, I have to admit, was the least pleasant part of the entire experience. It wasn’t overly painful. It was just weird and uncomfortable. I laid down on a gurney and they covered my head with a surgical tent. There was a small hole in the tent that exposed my neck where the radiologist could access my jugular vein. He injected the area with Lidocaine to numb the area and went to work. I felt like a toilet being snaked! I told him that I didn’t want to see how big or how long the catheter was that they were inserting in me, but it felt like it was going all the way down to my feet. He tried to alleviate my discomfort by talking about our mutual love for folk music, and after 10 minutes, it was over. Again, it wasn’t overly painful, but it was definitely freaky, and it grossed me out!
I headed back up to the Infusion Center where I got into the bed they had prepared for me. I’d be hanging out in this bed for the next 6 hours with nurses Barb, Rhonda, Tonya and Mary. The nurses hooked me up to the centrifuge which would spin and separate the stem cells from the rest of my blood. The stem cells would be deposited into a bag, and the rest of the blood would be returned to my body. They took one more vial of blood – this time straight from the central line – no more pokes! They just wanted to take one last pre-donation baseline of my white blood cells. The count was even higher than earlier that morning. Neupogen works fast!
It was 8:30 am, and I settled into my home away from home. The good thing about having a central line meant that I could use my arms – I could read, surf the net, continue on this blog, post pictures on Facebook, etc. I’m embarrassed to say that I also checked work email and even responded to a few. Yes, I’m hopeless.
I couldn’t even feel the blood moving from my body to the centrifuge and back. Since the entry point where they inserted the catheter was a little sore I continued to take Tylenol after the Lidocaine wore off. It also helped to alleviate my menstrual cramps (sorry to all of you squeamish dudes out there)! Other than that little bit of discomfort, it was like I was just hanging out in bed. I ate 2nd breakfast (they kept raving about the breakfast burritos – how could I resist?) and continued to catch up on this blog. Of course I had to post a picture of myself on Facebook – a friend entitled it Tubezilla. Once the Lidocaine wore off, I felt a little queasy for the rest of the day. I think it was mostly psychosomatic – having a tube in my jugular was still grossing me out! Yes, there is a valid reason why I never went into medicine.
The next 6 hours went by very quickly. Before I knew it, the nurses were getting ready to disconnect “the product” (my stem cells) from the centrifuge. Tish was meeting a courier at 2:45. The courier would transport the product to the airport where it would be flown to wherever the patient lived. It was amazing. She would be starting the transplant later that night! While I was never told where she lived, I suspected that it was somewhere on the East Coast based on the arrival time.
After the product was disconnected from the centrifuge it took another 15 minutes or so for the rest of the blood to be deposited back in my body. Then it was time to have the central line removed. Mary promised that taking the catheter out was much easier than putting it in. It definitely was easier, but for this squeamish patient it was still gross! I actually asked to see the tube – mega gross! It was about 8 inches long and about twice the width of a Q-Tip stem. Ick!
I had to lie there for another 30 minutes so I took my first nap of the day. And just like that, I was done.
