Tuesday, March 31, 2015

Bald is Beautiful

I know that losing your hair is usually more difficult for women; so much of women's social image and self-image is tied up with their hair and how they look with it that it is very difficult to lose it.  For men, I think there is less emotion with this, although I'm sure that varies from man to man.

For me, one of the nice side-effects of the transplant is that I barely have to shave (I shaved today, first time in 3 days), and I think my head looks pretty good.  So, bald is beautiful, I say!

I had more energy and felt better this morning, so I think I overdid it a bit.  This afternoon I've been a bit shagged.  But we are moving in a positive direction.  We have a follow-up visit at the BMT clinic on Thursday.  I'll let you know how it is looking.

Here I am today:

And to give you all a reference point (because some have been asking me):

Red Blood Cell Count    Normal range:  42-52    My last score was 26.1 I think?
Platelets                          Normal range:  140-440  My last score was 21 or so, if I recall.
Absolute Neutrophils      Normal range:  2.2 - 4.8     I hit this one out of the park the day after my last neupogen shot, at 4.7  I expect that number has now dropped.  It was at 0 for quite a while.  The 500K threshold I mentioned before would be 0.5 on this scale.

So, I still have a bit of ways to go, but I hope my numbers look better on Thursday.

And that's the latest!

Monday, March 30, 2015

The small energy cup

My best estimate right now is that I gain about 5% in energy each day since I left the hospital, so I have 10% more energy than I did before.  I am hoping this is like compounded interest and keeps growing!  If it does, I can probably retire off of it in a few years!   :)

Having some trouble sleeping at night -- I think I need to adjust my new CPAP and do a few other things.  We'll see how it goes tonight.

However, I am enjoying the beautiful sunlight as it streams into our house through the front door in the morning, the snow on the mountains (although we need more of it), my wife's company, and we had tacos for dinner tonight!  Last time I had tacos was probably six weeks or more ago.  Beats hospital food, let me say.

That said, I have about the strength of a four-year-old, so please do not send your kids over to beat me up just so they can grow their confidence.  I couldn't open a jar today, but I am enjoying my walks.  Temperature is supposed to be VERY warm tomorrow, so we'll walk early and then maybe in the evening cool.  When it gets cold on Thursday, it may be more of a challenge, but I'll be up in SLC again.

We have an appointment on Thursday just to check in and see how things are going.  If it all looks good, then we will probably schedule a time to get the trifusion catheter out of my chest.  A shower with no worries!!  Huzzah!

The little things really do matter.  They are part of the fabric of our lives, the connections we have to each other and to the world around us.  I appreciate them more than ever.

OH!  The title of this post.  Dr. Asch told me (may have said this before) that each day it is like I have a little cup of energy.  It gets slightly bigger each day (thus my 5% estimate), but I have to decide how I will use it.  Will I get excited and burn it all and then spend the rest of the day in bed?  Or will I parse it out to use it as needed while resting in between?  That, as my friend William used to say, is the question.  And although your cup may be bigger than mine right now -- we all have our little cup and decide how we will use it.

I am going to continue the blog for the next several months probably because I'm a narcissist!

In a way, this is my journal of this journey, and I don't want it to be limited to just the worst possible days.  I want to remember, and my children and family to remember, the journey, not just an event of being hospitalized.

So, if you want to stick with me, please do.  I'll be back again, soon.  My love to you all.

Sunday, March 29, 2015

Home Sweet Home, Redux

It is official -- I am home.  WAHOO!

We left the hospital around 2 pm yesterday, stopped for some Hatch's chocolates (you gotta have priorities, right?), and headed home.  I will say this first:  every piece of furniture in the house is more comfortable than any furniture in my hospital room!  :)

Patricia has been wonderful in helping me pack and get home.  I did leave a little bit of shampoo and body wash, but otherwise, everything made it back.

I am able to go outside and walk, although I must wear a mask if it gets breezy or dirt is blowing.  I'm still on a low microbial diet so I have to be careful what I eat.  No large dinner parties just yet, and they strongly recommend against being around groups of people at all right now.  Later on, they said I could go out into areas with groups with a mask (yuck but may work out).  So I'll miss church for several weeks yet and no substitute teaching @ UVU.   :)  No visitors for the first few weeks, if you would, but I'll be able to start seeing a few visitors maybe in a few weeks if you're healthy.  We'll have a vat of bleach for you to dump on your head when you come in........

My energy level is about the level of a Snow White dwarf's work environment, but it will get better!

Thank you all for your support and help.

Here's the joke of the day from Larry Hill:

A policeman radios into Headquarters.
"Sarge, is that you?"
"Yes, go ahead."
"We've got a bad case here.  A woman shot her husband when he stepped onto the floor she had just mopped."
"So you've arrested the woman?"
"No, Sarge, the floor is still wet."

Friday, March 27, 2015

Stop -- in the name of love!

Oh yeah, that dates me doesn't it (the title of this post).

This may be fairly short; of course, I'm know for being verbose, so we'll see.

Good news today:  Platelet count was up to 26 on its own -- no more transfusions since the last time I mentioned it which was a while back.  No fevers for 3 days -- HOORAY!  Red blood count slight increase from 24.3 to 24.9.  I could really use more of those suckers to help bring me oxygen and energy.  Last, the neutrophils -- this is what everyone is counting.  They will not release me from the hospital until my neutrophil count is 500.  These are the cells we use to fight infections.  Days ago, they were at 0 -- then up to 100; for the past three days, they jumped up to 300......and stayed there.  Come on, guys!  Rally to the flag.  Today, they were 400.  Getting close!

Dr. Mitchell thought a one-time additional dose of neupogen might avoid the fever complications I've had while stimulating the stem cells enough to hit the 500 mark.  I agree to try it, so we'll see what happens tomorrow.  So far, no fever today.

Summary:  there is a chance that that might release me from my bondage tomorrow!  If there are any complications, or we do NOT hit 500, it might take another day or two.  I'm hoping for tomorrow.  Who's with me?!

Once more into the breech, old friends!  

I'll let you know what happens.  In the meantime if you were planning to visit in the next couple of days -- Stop!  Keep your eyes glued to this blog.  If I go home, I'd be happy to see you, if you are well, sometime in the next few days or weeks.  Just text or call me to let me know you want to come over.  In the meantime, prayers for tomorrow are appreciated.  I'll accept whatever happens, but I'd love to be released from Monte Cristo if I can tomorrow.

Tuesday, March 24, 2015

Two rough days

Well, it has been hard to write much in the past two days.  Today is day +12, and it is a monumentous one in many ways.

But going back to Day 10 (can you hear the Tardis whooshing?).......

For the past couple of days, starting on that day, I developed a fairly serious fever going up to 39.8 or so C which is about 103.6 Fahrenheit [Note: It went a bit higher later on into the 104 range].  They don't even "count" it as a fever if it is below 101 degrees.  Some of you have probably had fevers that high, and it fries your brain.  I felt like those old anti-drug adds:  this is your brain on drugs.  It also suppressed my appetite which was already weak, so that even though we were controlling the nausea, I still didn't want to eat.

To try and make sure they got on top of this quickly, the BMT folks went immediately into culturing my blood (thus the soy sauce in my last post).  They did this at first 2-3 times that first day and then once daily after that.  I also went on major antibiotics, antivirals, and antifungals, but they had no effect on me, I'm sure......they also increased my check on vitals to keep track of my temperature, etc.

They couldn't give me any meds to control my temperature until they verified the temperature and then very carefully so as to not mask any existing fever.  Trying to walk became almost impossible, and it made for two difficult days.

At the same time, Dr Asch reassured me that all of this was fairly normal, even routine.  We are at the nadir, the low point, of the hospitalization.  She suspected that I was not actually experiencing an invasive infection (although that can happen even from within your own gut as bacteria cross over into the blood stream).  She thought it was something called Engraftment Syndrome -- this means that the body is reacting to the rapid settling in (engraftment) of the new stem cells and the ramping up of production of my own new immune system.  She said it was also common to have headaches (check) and body rash.  Speaking of which, no rash on Day 10.  I go into shave on Day 11 and unbutton my shirt to access lower on my neck and What in the world??????  My entire torso is covered with a rash that doesn't itch or hurt.  My legs all the way to my waist look similar, but look more like petichae which is small ruptures of the capillaries caused by insufficient platelets and leaves a forest of red dots.  So -- check.

Today, I was told that my white blood counts were at 500 total with 300K neutrophils (the cells that attack invaders and infections).  They usually want to see 500K neutrophils before they consider discharge so you can hold your own outside.  They also said that my red blood cells went from 24K to 25K -- above the limit for transfusion -- and they did this on their own!  Also, I have been getting platelets for the past two days; they think the fevers were burning them up as they went into my body.    So they checked today, and my plates were up to 22!  Without any transfusion - they did this on their own.  I was saying:  way to go, boys!!

So it looks like Dr. Asch was right (Dr. Mitchell was thinking the same way today).  I am beginning to produce my own new immune cells.  If my neutrophils go up over 0500, we will begin discussing discharge, although it also depends on whether I have any more fevers.

I see this progress (despite my misery) as evidence of prayers being answered.  Thank you all.

Friday, March 20, 2015

Mango juice and soy sauce

Just so we are all on the same page of understanding:  my immune system is dying, and we are waiting for it to go.  It reminds me of the old song lyrics:  Don't it always seem to go that you don't know what you've got 'til its gone?  Although, in this case, my immune system betrayed me, so there is that to consider.

In recent days, my neutrophils (the white cells that fight infections) are at 0, yes, 0:  Nada, zip, zilch.  My platelets dropped so low that yesterday and today I received infusions of platelets.  These are the cells that keep you from bleeding to death if you get a bruise, cut, scratch, etc.  I am now living off of borrowed platelets!  This does make me think to thank ALL of you who have ever donated blood.  You are literally saving lives when you do that.  You often don't get to hear from those who benefit, so let me say it:  Thank you, thank you, thank you.  My red cells counts are also dropping, so I am severely anemic and boy oh boy tired to the max.  I'm sleeping 8-9 hours a night (with interruptions), but now have had to add 2-3 naps during the day just to get through to beddie-by.  I may get an infusion of red cells tomorrow or the day after - they want to delay it if possible because you can build up a tolerance to infused blood products; we'll see what 4:30 am brings.  (That's when they do my lab draws).

The staff?  By and large -- awesome.  Especially given my ceaseless demands for jokes.

So to share with you some of these recent events, I am posting a couple of pictures here of a platelet transfusion.  I called this "mango juice" for what I think are obvious reasons.  See what you think:

Can you guess which bag has the platelets?  

This is a cool little basket that they use to keep the platelets from sticking or clumping together (and thus getting stuck in the hose).  They are supposed to clump together (very friendly, those platelets), but we need them inside me first.

Then today we had a little setback, hopefully.  I began running a fever of around 101 degrees which is their cutoff for action.  They immediately jumped up, started screaming and waving their hands -- no, not really.  This is not unexpected although I have been doing so well (relatively speaking) that I was hoping we could avoid it.  Their first suspect is the trifusion catheter in my chest (see other posts).  It is the major way that we put things into my body and get them out, so it is a potential source for infection.  So, they brought me some soy sauce.

Sorry for the fuzziness.  You can see the soy sauce bottles on the left side.  There were 7 of them.  For each line, there were two bottles to culture bacteria and viruses.  The tall one with the red is the one for checking on fungal infection.  They'll use that on each line in sequence, starting with my blood line today.  All those papers are syringes in their sterile wrappings.  They did not inject me with anything -- they just drew blood out of my trifusion and then put it into the culture bottles.  We may know some answers from this within 24-48 hours.  In the meantime, I'm on a broad spectrum IV antibiotic every 8 hours.  It could turn out that this fever is what they call an "engraftment" fever which is when your stems cells get settled in and start production -- wouldn't that be AWESOME?  But it could be an infection from somewhere else.  So, stay tuned.

And that's the latest!

Wednesday, March 18, 2015

The Funny Bone (Marrow?)

Just a quick post right now.  Here in the hospital, each patient can list three things they want the staff to pay special attention to in order to ensure personalized care.  My top three things right now are:
1.  Joke of the Day -- I ask the nurse to tell me a joke every day; 2.  Ask me how often I have walked; and 3.  Ask about my nausea.  

I have found that even though the nurses are both professional and very friendly, they have a hard time with the Joke of the day.  Maybe it is working on a cancer unit and the seriousness of what they deal with, as well as how busy they are, but many struggle to come up with a good joke.  They seem to enjoy being asked to come up with one, though!

The benefits of humor have been demonstrated with regard to health, so I keep that up on my list -- I know I benefit from even raising it with them every day.

Today, we have nurses in training shadowing the experts, so when I asked John, my nurse, for a joke, the trainee (Ben) chimed in:  What do you call a cow with no legs?  ......

Ground beef.  

I asked them if they heard about the terrible accident a college professor was involved in on his way to a conference when his car went off the road.  They hadn't.  It turned out he was grading on a curve.

That's the latest!

Tuesday, March 17, 2015

The Great Escape

I want to start by wishing you all a Happy St. Patty's!

I've had a lot of visitors lately -- my dear wife has been here regularly, my father came to see me as well as Deb and Barry, my sister and brother-in-law, not to mention my Aunt Or, my Uncle Larry, and friend Robert.  Between the visits and the ongoing daily routine of the hospital, things have been fairly busy.  Thank you all for your love and support.

On the cancer front, so far, no major complications yet (mouth and throat sores, infections).  My blood counts have been dropping every day, and this morning the Physician's Assistant told me that as of today, I have almost no white blood cells.  This is expected, and Dr. Hoda told me that the fact that my counts came down somewhat slower may be a good sign.  

The nausea has really ramped up, so we have been working to try and counteract it and to enable me to maintain my calorie intake and fluids.  This has been more of a struggle, although today it seems a bit better.  Eating is much more difficult when there is little or no appetite.  We'll keep working at it.

To improve my outcomes, I have also been walking every day -- they strongly encourage this, and they have calculated how far around the unit equals a mile, so I've been putting in my time.  However, the other day when the sun was shining and the birds were singing, Patricia asked the staff if I could actually go outside.  There had been mention of something about this in our earlier meetings before admission, but for some reason I thought that would be for after the transplant.  They said that we could!  Thank you, Patricia!

So we conspired and got the whole group to go with us on our regular unit walk, but as we approached the elevators, we whispered to the family and friends that we couldn't stand it any longer and were going to make a break for it.  They looked shocked at first and somewhat anxious as we loaded the elevator, but we all made it out and had some fun with it.

 It was really good to get out for a bit, to see the sunshine not only through a window, and to feel the breeze.  Simple things that are of great value.  I wish I could go out today, but it will be a little while before that happens again.  Enjoy it for me!

 Deb and Anton make a break for it

 Don't try and stop us!

 Barry and Anton - view of the Capitol


Friday, March 13, 2015

On the other side

Yesterday was my 2nd birthday, and I'm sorry that I wasn't able to get anything posted about it until today.  Overall, it was both a high point and a bit of a low point.  Let me explain.

After receiving that lethal dose of melphalan, we need to restart my immune system, to recreate a new chance for life, hopefully one in which cancer plays a back role.  So, I was excited, interested to see how this would go, and what it would be like.  The staff was also supportive, excited, and helpful.  My Aunt Or brought me a little birthday cake and my lovely wife brought me a superman hat for my balding palate.

It was very interesting and exciting.  They got me prepped with medications that were designed to help reduce the chances of negative effects from the stem cells (mostly the preservative they were in), and to ensure a good transfer.  At one point, we had something like six, maybe seven, people in my small room getting things ready.  

Here is Aunt Or watching the proceedings:
Here is my nurse, Shirley, helping to get everything set up.  
Here is where it gets even more interesting -- Mahmoud from the Red Cross brings in the nitrogen bucket, we all called R2D2.  He had to put on blue protective gloves to pull the stem cells out of the storage unit.  In the following picture, you'll see the warmer they use to unfreeze and warm up the stem cells and you will see Mahmoud holding one of my bags of stem cells to make sure it is working well.  

The technology here is truly amazing.  Everything was checked and double-checked.  Then Shirley put up the bag of my stem cells on the "Patient Pal" IV pole -- they did NOT filter or mess with the stem cells in any ways in order avoid any potential risk of damage to the cells.  They infused them directly into me.  You can see the clear IV tube and then the bag next to it with the red fluid -- those were my stem cells coming home again.  Hooray!  

Here I am on the bed watching this happen, seeing the stem cells come back, and playing Imagine Dragon's On Top of the World.   It was pretty festive at that point.  Patricia came over to hug me, and after two bags, the process was done.  

So all of this was a sense of great relief, that we had put into place my future survival, that things had gone smoothly.  Everyone cleaned up.  But.....they had warned me that the process ultimately could be a bit anti-climactic.  For one thing, the preparatory drugs they gave me to help make this a smooth process also zonked me -- I could not stay away for the last parts of the procedure.  After I woke an hour or so later, I was fuzzy and pretty tired.  

I think in many ways, things we look forward to in life, even the answers to our prayers, sometimes may come in ways that leave us feeling just a bit let down -- like they weren't as spectacular as a hollywood film or something.  I didn't leap out of bed and dance a jig.  And that is OK.  Life is full of beautiful moments, ordinary moments.  Life is not about living a series of spectacular, amazing things from one second to the next -- I think it is more about acceptance, about learning and growing, about becoming better people.  That means accepting our more ordinary moments and celebrating them for the threads they play in the weaving of our lives.  

So the latest?  Today was also wonderful -- my father and lovely brother and sister got to visit with us most of the day, but I have also begun struggling with persistent nausea and the fatigue is growing stronger.  This next week may be a bit more of a struggle, but we knew this was also part of the process.  The hardest thing today was to watch them all leave to return home while I remain here.  But this, too, shall pass.  I look forward to better days, weeks, months, and years ahead.

By the way, some have wanted to comment but maybe didn't know how?  When you are reading the blog, at the bottom of a post, it will say something like posted by Anton Tolman.  To the right will be a link that may say "1 comment" or "No comments".  If you click on this link, you should be able to post a comment or reaction to what I wrote.  Make sure to click on the Publish button at the bottom of the comment or it will not save it.

Wednesday, March 11, 2015

Day -1

Today is my "rest" day.  That means no chemo today.  It is a day to make sure that the melphalan is flushed out of my system.  Good news this morning is that so far, kidneys and liver appear to be doing OK despite the assault on them.  I can feel some side effects from the chemo, but not too bad yet.  It will probably get worse in the next few days before it gets better.  My blood counts are also starting to drop, but all of this is expected.  Given that most of the drug has been moved out already, we believe, they have taken me off of my bag of IV fluid -- freedom!  It was so much better to walk without pushing the "patient pal" around with me, not to mention that taking a shower in the morning will be SO much easier.

My birthday is tomorrow -- I'll get my stem cells (some of them) back and we can start to reboot the immune system.  I'll let you know how that goes.  In the meantime, here are some pictures of recent events.

This is Becky who was my nurse yesterday.  The nurses here are great -- caring, warm, and knowledgeable.  I don't have pictures of all of them, unfortunately.
This is my "leave the room" outfit.  I have to wear the gown, mask, and gloves every time I leave the room, and I cannot leave the unit.  The contraption there is my IV pole, the "Patient pal" that I had to push around for two days.  They'll put me back on IV for the stem cell infusion tomorrow, but take me off after a little while.  

My luxury suite -- part of it:  bathroom, window, recliner, I'm sitting ready for the chemo.

One of the strategies to try and reduce mouth and throat sores and pain (which interferes with eating) is to get your mouth really cold to constrict the blood vessels when the melphalan is going in.  We don't know yet how well this worked, but I hope it helped!  No sores yet, but the effects of the drug are building as cells die off.  This was really painful until my mouth got really numb, but yesterday, I shoveled ice into my mouth for about 1.5 hours.

Here is Becky setting me up.  This is how the nurses protect themselves when they infuse the chemo. Tells you something about the potency of these drugs, right?

And here is a shot of my little friend -- my marrow killer.  I'm glad to see you go!  :)

Monday, March 9, 2015

Day Minus Three

What's the latest?

Around here, the date of admission is thought of as day -3 because it is three days until they re-infuse my stem cells (what they call my 2nd birthday).

So far today, I have:

  • With my lovely wife, set up my room including a beautiful picture of a group of wild buffalo in Yellowstone captured by my son Ben hung on the wall
  • Walked almost 2.5 miles and worked out a bit on some exercise equipment
  • Gotten loaded up with lots of IV fluids -- they want to protect my kidneys against damage by trying to make sure the chemo moves through my system as quickly as possible and want to protect the kidneys against the high dose chemo drug
  • At 4 pm, froze my mouth for an hour with ice (flavored with a bit of Italian ice which was nice) to try and reduce the chance of mouth lesions and sores
  • Got an infusion of Melphalan -the high dose drug that will kill off my bone marrow (given to me with the ice in my mouth)
  • Got visited by my Aunt Orlinda Prettyman and my uncle Larry Hawkins -- it was nice to see you both!
  • Eaten some interesting meals - a bit strange chicken pot pie, but actually quite tasty, and blueberry BBQ rib meat; overall not a bad kitchen downstairs
  • Got some work done for UVU 
Overall, a pretty busy day; I told my wife that about an hour after the infusion, that I could feel the chemo moving through me.  She said:  What does that feel like?

It is hard to describe, and I'm sure it is different for everyone, but it feels like a rolling or washing sensation that moves through my limbs and up over my head.  My eyes start to feel more tired or strained, and I feel more fatigued.  Uncle Larry said - it is kind of like it is sucking energy out of you, and he is right.  It is also a bit anxiety provoking because when the nurse came in to give me the drug, she puts on a special gown to protect herself, covers me up with a sterile pad around where the infusion goes in (probably in case of links or spillage?), and then wraps everything up in a hazard bag.  Yet this is what goes into my body.  This is the fun of chemotherapy.  

So, for day -3 a not too bad, pretty busy day.  The doctor today -- very friendly physician born in Czech Republic and now an American citizen -- told us today that usually the effects of Melphalan are not fully felt for most people until around a week later, so that gives me something to look forward to!  NOT!

The staff here are very friendly, caring, and concerned.  I feel like I am in good hands.  
Thank you all again for your prayers and expressions of support -- you are all the anti-cancer.  I can feel the effects of your love and kindness, but it feels GOOD.  

Sunday, March 8, 2015

Who Loves Ya, Baby!

The title of this blog is a very old reference to a police TV show where the bald cop sucked on a lollipop and had a real attitude.  Many of you are probably too young to remember!  :)

This is a short blog today.  Here is a picture of part of my final preparations to go into the hospital tomorrow - thus the police show reference.  I will most likely lose all of my hair (although not right away), so I decided why carry all that in there only to have it fall out?  See what you think.  Patricia thinks I have a "nicely shaped head".

I probably won't have to shave for weeks or even a few months!  Alright!

Thinking about Carine's mountain quote, here is the thought for the day.  Apologies to my non-LDS friends; Jeffrey R. Holland is an LDS Church apostle, but I think this message is profound and comforting:
"Don't you quit.  You keep walking.  You keep trying.  There is help and happiness ahead.  Some blessings come soon, some come late, and some don't come until heaven....It will be all right in the end.  Trust God and believe in good things to come."

That's the latest!  Next blog will be from LDS Hospital.

Friday, March 6, 2015

The Ticking Calendar

What's the latest?

Well, we met with the Blood and Marrow Transplant team (BMT) on Thursday.  We were scheduled to meet with them at 11:00, so I thought we would be done by Noon.  Whoa -- not even close.  We were there until close to 4:00 pm.  They drew my blood for my lab work, changed my dressing (no more bloody episodes since I came home -- hooray!), then we met with the team.  In addition, we met with the Nurse Educator, the Pharmacist, and the Social Worker and got a tour of the unit.  Then I got an admission chest x-ray which is a standard operating procedure before admission, I guess.  They want a pre-admission to check against a discharge x-ray to make sure nothing is going wrong or sneaking in.

What was it like?  Well, the doctor we met with, Dr. Petersen, we had not met before.  He was a "no nonsense" kind of guy -- straight to the point.  He described the process, answered questions, and gave his own thoughts about the value of transplantation and post-transplant maintenance treatment.  He has been working on transplantation back when it was a new therapy, and he has treated a lot of patients.  He is very aware of the issues, and the team is very proactive; their goal is to make my hospital stay as boring as possible.  To them, and now to me, that means no significant infections, no major transplant issues, no complications.  It is a very serious procedure, but because I am still fairly young (although not to teenagers), and in good health otherwise, the risk of major complications is pretty low.

Listening to him talk and his answers to our questions, I thought about Malcolm Gladwell's book Outliers.  One of the major points he makes in that book, that I also point out to my students, is that in order to become really good at something, it takes a lot of practice, somewhere in the neighborhood of 10,000 hours.  This is why with surgeries and other important medical procedures, you often hear the recommendation that you check with your doctor to see how many of the procedures they have done, how many they do a year, etc.  This is all continuous practice and gaining of experience in how to do things even better.  I think Dr. Petersen (and by extension his team) has way more than 10,000 hours doing transplants.  That comforted me a bit.

I think this process will be difficult.  He described steps they take to minimize risks, to reduce side effects like mouth sores and risks of infection, and how closely they monitor patients.  I appreciate all of that, but I am under no illusions this will be a cake walk.  That said, I also fully agreed with Dr. Petersen's overall philosophy about transplantation.  He doesn't think it will cure my cancer.  His goal is to "buy time", to give patients more years of life and better quality of life.  That time gives medicine the chance to continue to make progress -- and in myeloma and other cancers, that progress has been significant.  He said that there are those, including himself, that still hope that they will find a cure for myeloma in his lifetime.  No guarantees there, but every year is another year with my sweetheart, another year to enjoy my kids, to help others, and to try and make the world a better place.  The goal is to make myeloma a chronic disease that we treat until we get to a cure.

Even though this will be hard, I'm in with that philosophy and those goals.  As my friend Carine Clark (a cancer survivor) said to me recently:
"A mountain, like a marathon, is just one step in front of the other.....Yeah. And I wouldn't be wary of it. I'd attack that mountain. I'd embrace it. It could save your life or at least keep you here a lot longer. Say thank you that you have the option."

So, thank you, Lord.  I go into the hospital on Monday.