Prep Days

The word chemo makes me shudder. I witnessed how it made family members sick and how it turned my father from a muscly and robust man into a diminished version of the guy I often thought of as a hero. He was a war veteran and grew up with adversity. Chemo sucked all of that out of him, leaving him a husk of his former self.

Chemo is still a dreaded word, but it's not a one size fits all anymore. The experts have dialed it in so well that they can reliably predict how much to apply given a patient's age, weight, height, and the presence of other illnesses. Oncologists can prescribe it in ways that don't turn grapes into raisins. 

While new therapies are on the rise, chemo still serves a purpose. In my case, my hematologist described how my scarred bone marrow needed to be erased. Notice, I didn't say 'killed'. The last thing I want is to take-in anything that kills. My doctor used the word ablate. It's a better word. Ablate means destroy or simply put, erase. He chose a mid-level ablation chemo protocol. The treatment promised that I would be able to walk and exercise as usual.

On Day -8 (8 days prior to bone marrow transplant), I checked-in to the hospital to get a PICC line inserted into a vein in my upper arm. 

A PICC line is now the gold standard for chemo. If you were ever around a chemo patient, you might have heard the word 'port'. Ports and PICC lines are similar in that they're catheters. Ports require lots of care. PICC lines require less vigilance. Both have to be taken seriously because they're access points for bacteria that can lead to infections. My PICC line insertion was not a surgery. It merely required a small scalpel nick on my inner arm and a quick tube placement. The line itself was a very thin twinned tube that ran up my arm and dropped down above my heart.

Day -8 also included the first a series of daily doses of fludarabine, a light chemo that stopped my cells from making and repairing DNA. The daily outpatient trips left me feeling a slight light headedness, but nothing more. This lasted for a total of five outpatient visits.

Day -3 was different. I got an single dose of melphalan. This high dose of chemo wiped out what was left of my diseased bone marrow before my stem cell rescue. But it also wiped out my energy. Lucky for me, the hospital admitted me as an in-patient.

An interesting phenomenon would happen because of the chemo. It's an intentional nudge of my white blood cells to help in wipe out my bone marrow. This is called the host versus tumor effect. What was left of my immune system came to my rescue too. My attack cells finished the job started by the chemo, but it would come at the cost of zeroing out my immune system.