update

     I haven't had time to be with my dad much for his MD Anderson visits.  It feels weird but I've busy with school.  Since the ball is now rolling for stem cell transplant, those are becoming more frequent again.  As such, I'm not exactly clear on the protocol they'll be using because it can vary a bit depending on the patient.  But a LOT goes into a stem cell transplant.  You don't just walk up and say, "here, pump some of dem bone marra' cells into me."

• First things first.  The donor.  And first, the donor has to be cleared for takeoff.  My dad's brother underwent a series of tests this week and from what I understand, a LOT of waiting, and waiting, and waiting.  Welcome to MD Anderson.  And the tests came back as a 'go'.  So now, he's receiving multiple daily doses of Neupogen to tell the stem cells in his bone marrow to start replicating.  And replicate they shall, even to the extent that they start to spill out into the blood.  The advantage of that is that he doesn't have to have his actual bone marrow harvested so it's a lot less painful for him.  Just a stick in his arm.  They'll start the collection process next week.  They collect daily and count the number of stem cells they get.  They continue to draw on him like an ATM until they hit somewhere in the neighborhood of 4 million cells.
• Next, the patient.  Like the donor, the patient also has to be cleared for take off.  That means imaging in the forms of a CT, a PET, and x-rays to make sure he doesn't have any hidden solid tumors that we didn't know about (you know that for them to run that test means that happens enough to people to warrant the test).  After that are some various odds and ends stuff that are really quite time consuming.  It's basically a full time job.  Among those, I have to imagine, is putting in a central line.  Usually, that means putting a catheter in the vein that runs right below the collar bone, appropriately named the 'subclavian vein' because it runs below the clavicle (aka collar bone).  That's there to infuse the chemos, the stem cells, the rejection suppression regimen, antibiotics, antifungals, antivirals, and the multitudes of blood transfusions that he'll get.  All those tests and processes start for him next week.
• Then the fun really begins.  First, they'll hit my dad with a dose of Rituxin on the 27th as an outpatient.  He got that with chemo before and other than some flu-like symptoms for a day or two, it's pretty mild with respect to side effects.  I'm not sure if he'll get another dose of Rituxin a week later, again, I haven't seen the full protocol they'll be using for him.  Then after that comes the nasties.  These are the traditional chemos that cause the nausea, chemo brain, thrush, and all-around-feeling-like-shit.  Multiple days with multiple infusions.  At that point, he's in the hospital and he'll get the stem cells from his brother.  That date is not yet set but I anticipate sometime the first or second week of October.