For the three days prior to the stem cell harvest, I was given G-CSF growth factor injections every 12 hours. This was to stimulate Stem Cell Mobilization to coax out the number of stem cells needed for the transplant.
Beginning the aphaeresis process
For two days before the stem cell harvest, we tested the White Blood Count (WBC) for indications that cells were increasing. The results were remarkably good with a jump from 6,000 to 32,000 on the first day. The day of the stem cell harvest we did a CD34 test that is the more definitive test as to the volume of stem cells. It is a go/no go inflection point; the test that determines whether to proceed to harvest or grow more cells. The target was a value of 30; my result was 37. It was a rollicking GO!
I was quite comfortable with the aphaeresis process. I’ve been hooked up to hundreds of aphaeresis machines in the years before cancer, when I would be matched to a leukemia patient, or a struggling newborn, and I’d show up to donate my O-neg platelets every three days or so. On this day that I was about to harvest my own stem cells for my own cancer treatment, I was a strange mix of completely relaxed and silly excited.
And then things got interesting.
There was a problem with some tubing as we were getting the aphaeresis machine up and running. Both nurses, one newer, and not at all bamboozled by technology, the other a seasoned pro who has seen every aphaeresis anomaly possible in her 35 years on the job, tried all they could to no avail. The problem involved a short bit of tubing that was just a tiny bit too long. Flappity, flappity, flap went the line with every pulse of the machine. I’m not clear if stem cell collection is a more precision demanding process than collecting platelets, but was for sure was that the tubing was not engineered to take such abuse over a six hour process. The tubing kit had to be replaced.
Fortunately the problem revealed itself early in the process, during the boot up, before the centrifuge was set to harvest the precious stem cells. The only blood product that had been collected to that point was plasma. We had to waste about a cup of plasma cells. Not a big deal.
What was a big deal was that we had lost time. The collection process had to end by 4:30 in order for the plump bag of cells to be whisked off to arrive at the lab, a few block away, by 5:00, not 5:01.
Given the excellent test results leading up to the collection, hopes were high. We pumped and pumped and managed temperamental alarms due to a “positional problem” with the Hickman line. (Come on Gloria, what do you need Girl?)
End of first day of collection
Once the cells were on their way to the lab, it was time to head home and wait for the call that would tell us if we had met our goal. Given the circumstances of the day, I was expecting the very call we got. We fell short.
We did manage to collect nearly seven million cells; however, we were shooting for eight to ten million and it was agreed all around that another day of collection was prudent. You only get one shot at stem cell collection. All bets are off after the next step when we bring on the high dose chemo, Melphalan.
To prepare for the next day, Jackie and I had to return to the clinic that night for me to get another round of G-CSF to keep stimulating the stem cell growth. And we added a kicker of something called Plerixafor that causes stem cells to move out of the bone marrow into the bloodstream; sort of like a bouncer. That injection has to be given eleven hours before the collection is to resume. That meant we had to wait until 9:00 pm to receive the injection and then we had to wait another 30 minutes in the infusion clinic for observation before being cleared to go home. That observation time should have been a clue.
Jackie and I were both exhausted from a very long day when we arrived back at the apartment. We were promptly off to bed. I had no idea that my little one-two punch was about to have a heavy impact.
I felt increasingly miserable throughout the night but found it difficult to put my finger on what was wrong. It felt like everything was wrong. My first thought upon waking after far too little sleep was “Did that ceiling actually fall on top of me and I did not wake up for it?” My bones ached. My head felt like it was in a vice. I was definitely nauseous, though able to keep morning medications and a bowl of Cherrios down. I was heavily fatigued and I’m not talking tired from too few hours of sleep. This was mind boggling f-a-t-i-g-u-e like, “somebody help me make it to the other room please” kind of fatigue.
A second run
It was a rough night but Jackie and I managed to pull me together and we arrived at the aphaeresis clinic at 8:00 a.m. We were fortunate to have the same team of nurses and the same procedure room, referred to as the VIP suite. The veteran nurse said, “My goodness. What’s happened to you? You don’t look like the same woman who left last night.”
My said, “I’m not entirely sure I am.”
I gave the nurses the customary low down on all the symptoms I’d experienced. We waited for a few minutes for the results of the morning blood draw so we’d know, not only the likelihood of a good harvest, but also to figure out what could be done to ease my discomfort. There was far too much talk about available snacks and beverages and I finally had to say, “No more food talk please.” Jackie was able to give me a dose of Marinol1 and, combined with some serious, deep meditation I was much more myself and comfortable within a couple of hours. As we removed and captured those excesses of stem cells that were now crowding my bloodstream, I felt steadily better.
Imagine everyone’s surprise when a few hours into the procedure the aphaeresis machine simply up and rebooted! Fortunately this was not a “blue screen of death” event. It was more like when a MacBook restarts spontaneously but comes right back with all the active windows still active. We were having the same “positional problem” with the Hickman line and it was causing repeated alarms. Once there are too many alarms, the machine simply reboots. Again our veteran nurse had seen this problem before and assured us all would be well. My only question was, “If the problem does not resolve for some reason, will we still be able to use the stem cells collected so far?” The answer was “Yes.” With that I had no worries. I knew we were close to our goal the day before and the combination of both should put us over the top. Sure enough, the machine rebooted, and we resumed the collection. We finished and the stem cells went off to join the lot from the day before to be processed and preserved for the main event — the stem cell transplant — in nine days.
The goal was to harvest enough stem cells for two transplants— that’s eight to ten million stem cells.
We harvested 23 million stem cells!2
Yes, that is more than needed for four transplants. The docs will figure out how to divvy out the counts, but in any case, we’ll be putting a lot of cells on ice should they be needed in the future. I wish I could donate some of the excess cells for some good purpose.
Emotional and energetic work
As I write this, I’m less than 24 hours from what was a pretty big wallop, and I am significantly improved. I’m duly impressed with the resilience of my body. It’s one of those things I keep in mind, particularly when the going is rough, or, as my friend Bill promised it would be, gnarly.
The docs have the medical aspect of this cancer treatment well in hand. I’ve been actively addressing the emotional and energetic aspects. I’m working with a provider at Healing Partners of the Central Coast - Healing Touch.3 I am doing therapy work, and I am doing daily meditation and visualizations.4
As the second day of stem cell aphaeresis was drawing to a close, I had a powerful instant when many things fell into place in my mind. I said to the nurse, “May I hold the bag before we send it off to the lab?”
“Of course. Of course you may.”
As she carefully placed the pudgy bag of creamy liquid into my hands, I embraced those millions of life giving seeds of immunity against my breast as if they were a precious infant.
This cancer treatment experience is having a profound impact on every aspect of my life. The good things are getting even better, and the not-so-good things are falling away.
I love symbolism. I was pleased to learn that the Comet Nishimura made its closest approach to Earth at the same time we collected my stem cells, and the comet now continues its trajectory toward the sun. I like to think of my stem cells that are poised and ready for transplant back into a clean, resilient, ready environment, as also on a trajectory toward powerful energy and brightness.
Marinol, also called Dronabinol, is used to treat nausea and vomiting caused by cancer treatment.
I’ve been controlling my peripheral neuropathy pain for several years with a 1:1 CBD:THC edible formulation. The CBD works to titrate the THC to offset issues of “getting high.” I also used the 1:1 CBD:THC combo to successfully treat nausea during my early cancer treatment. This simple and inexpensive solution is not possible at this point because my immune system is becoming more and more suppressed and is about to be completely wiped out. By nature, all cannabis products have fungus. Fungus is harmless to most people, but it spells big danger, even life-threatening danger, for someone with a compromised immune system.
Marinol is a man-made form of THC, without the fungus. I was concerned that missing out on the CBD element would make me high, not a place I’m willing to go after 42 years of sobriety. I have been pleasantly surprised to find there is no high involved at all.
I do not respond well to opioids nor to medications frequently used for controlling nausea. Interestingly enough, Marinol is typically used only when other drugs to control nausea and vomiting have not been successful. Huh? From my years of experience with effective, treatment of pain with cannabis, I wonder about the politics that have impacted medicine in this area. That a topic for a whole other discussion.
Yes, 23 is, in fact, Mary’s favorite number.
While in Carmel Valley California, Healing Partners of the Central Coast - Healing Touch learned during the COVID shutdown how to provide service to women managing cancer by phone. I kept and open mind and heart as I approached this opportunity and am humbled and pleased for the tremendous benefit I’ve gotten from this work. For me the work is giving me all the benefits they it can.
I was pleased to have two people recommend Belleruth Naparstek, and within a week of one another. Bellaruth Naparstek has numerous guided visualizations, including one entitled, “A Guided Meditation to Help with Stem Cell Therapy.” This is one of those, “Nuf said.” moments, except perhaps that you should know I love that her meditations are available on Audible, making for easy access for me.