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Part Twenty-five: The Edge of Modern Medicine (I)

This post contains some images that may be distressing to those with a phobia of blood!

Besides my recent efforts to match inspirational speeches by the likes of Lincoln, Obama or Churchill - this time, I have settled for a memoir of my autologous stem cell transplant. This two-part post will detail my experience at the edge of modern medicine.

Monday 5th October was the day of admission to Ward 4B at the Queen Elizabeth University Hospital. Upon arrival, we were tucked in a room out the way of the general ward population, and things quickly picked up pace. Lots of information came thick and fast from various sources; nurses, doctors and dieticians. As well as multiple tests, bloods, ECGs, physical exams and the all-important COVID-19 screen for both myself and mother - who had the honour of accompanying me during my stay.

In the context of stem cell transplants days are referred to as a number based on their proximity to transplant day. So transplant day is referred to as day 0. The day before is day -1 and the day after re-infusion is day +1. So, this made Tuesday 6th October day -7. Anyway, on day -7 absolutely nothing happened bar a game of Monopoly, which of course was won by myself.

Now would be a good time to check out "Autologous Stem Cell Transplantation: A Background" if you haven't already, or to refresh your understanding of the process.

7th October or day -6 was the beginning of the conditioning chemotherapy, with the sole aim of destroying any remaining Hodgkin's cells and felling your immune system in order to replace it. The drug I received was called Carmustine, originally derived from the chemical warfare mustard gas - it contained alcohol. The alcohol combined with the codeine that I was prescribed for the headache it gave me certainly made the night pass quicker. Thankfully other than intoxication and a headache, there were no more side effects to report. However, one did ponder, why could it all not have been like this?

The following day, day -5 (08/10/20), our COVID screens came back clean - so we were re-located into the central part of the ward. This particular day I began what would be the first of three days on both Cytarabine and Etoposide. Cytarabine twice a day, morning and night over thirty minutes, and Etoposide once a day over three hours. The next three days again passed pretty event-free. The only affairs worth commentating on were me stretching my unbeaten run at Monopoly to six consecutive days and a pretty lousy rash that the Cytarabine kindly left me across my arms and legs.

That brings us to day -1. The final day of "chemo." What a horrible word "chemo" is, but the drug that day -1 brought was equally as horrific. Melphalan commonly termed the "domestos of all chemotherapy" has an unrivalled ability to strip the lining off every mucous membrane from your mouth to the reverse end. To minimise the damage you are given, PLENTY of fluid and diuretics that make you pee like it's going out of fashion. Alongside this, to prevent your mouth eroding, you are prescribed a mouthwash to use four times a day - a completely vexatious undertaking. You also get as many ice lollies, as you can eat over the thirty minutes it takes the drug to dissipate into your jugular via the Hickman line. I managed twelve lollies (they were rockets as well, result!) which must be some record. That night in a jovial mood, I made some changes to my blog, and authored the post "War and Peace."

The five days of conditioning therapy passed pretty quickly and weren't too arduous. A personal highlight must have been my newfound superpower, the ability to eat a single dish of the hospital menu...the chicken tikka curry. Another prodigious gain was not being sick - those of you who have followed previous posts will realise the minor miracle that this is.

I received my 4.5 million stem cells back on Tuesday 13th October 2020 in a process that was anticlimactic but pretty cool none the less. Before the infusion started, I got some hydrocortisone and piriton to prevent any adverse reactions. Then a lady from the laboratories came with my cells in a liquid nitrogen vault and defrosted them bag by bag in a bath of warm water before they were returned to me. The first cells entered my body at 2:19 pm and the process took a few hours to complete. Some people tell me this is a second birthday and I will be sure to make capital of that fact next year! Waareehhouuusseee.

The Liquid Nitrogen Vault Frozen Stem Cells Defrosted Stem Cells

The stem cells disperse through my Hickman line into my body. You can see the individual clusters of stem cells go through the line - truly magical!

The cells were in and to top it all of I had found out I had been successful in gaining a promotion at work. Now it was all about implementing the four "gets." Waiting for it to get bad, get better, get home and get on with life.

Click here to read "The Edge of Modern Medicine (II)"

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