Days 33, 34, 35 and 36, Sat-Tues, March 2nd-5th, 2013

For the last several days, I have been getting GCSF injections (neupogen), in preparation for having my stem cells harvested. I've had GCSF before, and I didn't like it. After each round of chemo this past fall, I gave myself a series of subcutaneous injections of filgrastim (which, it turns out, is the exact same thing as neupogen). This was to keep my white blood cell count from plummeting below the minimum level for base functionality, thereby preventing opportunistic infection. GCSF compounds, or granulocyte-colony stimulating factors, work by forcing your body to hyper-express stem cells. Left alone, these stem cells will differentiate into red and white blood cells. The primary side effect of repeated injections of a gcsf is bone pain, caused by the buildup of stem cells inside your bones. Stem cells are manufactured by your bone marrow, so this makes immediate sense. You can also feel your pulse, all of the time, and so can everyone near you, since your heartbeat will actually make things that you are in contact with throb along with you. This time around, I was being given neupogen, and lots of it, in order to facilitate the harvesting of my stem cells through apheresis (or plasmapheresis, same thing, different names). In fact, I was receiving four times my previous, post-chemo, dosage, twice a day, which means that I was actually receiving eight times as much, on a daily basis.

When I was receiving filgrastim, I would get the bone pain. More specifically, by the sixth day, I would develop hideous, throbbing, incapacitating lower back pain. In Saskatoon, they gave me hydromorphone for that, which was pretty adequate, but is essentially pill form morphine (it is not technically morphine, but it is very similar). On this dosage, which I started on Friday morning, I developed said back pain by Saturday evening. I had preemptively requested (and received) high potency painkillers, knowing that this was an extremely likely event.

I was right.

I spent Saturday and Sunday doped up on oxycodone and watching cartoons on Netflix, because it was necessary. I only got up to eat, visit the washroom, and return to the SCCA for more injections of neupogen. I also spent Monday and Tuesday with a non-trivial amount of oxy in me, and I also received GCSF injections, but that was overshadowed by stem cell harvesting, and other things.

Monday morning started early, if you consider four thirty in the morning to be early, and I do. I woke up to go to the bathroom, and, staring dully at myself in the mirror, noticed blood on my shirt. Not a lot of blood, but enough to make you change your immediate priorities. When I lifted up my shirt, I discovered that my Hickman line was oozing blood from the base, where the line enters my body, and that it had begun to leak out of the bottom of my dressing. After I cleaned up the excess blood, I woke Mom up, we called our Super-Secret Cancer Patient Hotline, spoke to Debra, and then we took a cab to the UW Hospital. Because I had taken basic first aid (and you really ought to, you know), I knew enough to put a clean cloth over the dressing and maintain gentle, diffuse pressure on the area, which meant that by the time we got to UW, the bleeding had already stopped, and the nurse congratulated me, then sent us home. So. By the time my eight am apheresis appointment rolled around, we'd been up for a while.

Apheresis, or plasmapheresis, involves being hooked up to a machine for three to five hours, while it takes blood out of your body, separates out the plasma fraction, and then gives you back the rest of it. For stem cell harvesting, this can require multiple visits, but many patients accomplish it in one. Given how well I was responding to the neupogen, I probably would have only needed the one visit, but because of the bleeding that prompted our early morning adventure, my team was reluctant to harvest at full speed. Instead, they cut out heparin, one of the anticoagulants they use, and reduced the flowrate by half. I then spent five-and-a-half hours at it, only to be told later that we had only collected two-point-five-nine million out of the five million necessary stem cells. This meant that I needed to come back in during the evening for another dose of neupogen (in addition to the one that I received upon arrival for apheresis). We missed the last shuttle bus from the SCCA House to the SCCA, and ended up taking a cab there and back, so as not to antagonize my line.

Tuesday morning, we took the shuttle back to the SCCA for my second round of apheresis, and more neupogen. Because my line appeared to have clotted nicely, and no new bleeding had occurred during the night, we proceeded all-ahead-full with collection. I took a very necessary nap. Sadly, upon awaking from that nap, I discovered that my line was bleeding again, and we were forced to stop harvesting. Luckily, this was three hours in, and we had collected an additional seven-point-three million stem cells, so I was free to go, and would not need another collection, or any more GCSF. Free to go, in this case, meaning go upstairs to Triage, and lie still for another couple of hours with a pressure dressing on my chest to settle things down.

I have had better times. Have you ever been in a really serious car accident? Rolled a car? I have felt almost identical to the way that I did after I rolled my brother's Jeep when I was twenty.  

Side note: I am growing the worst beard. I wasn't allowed to shave with a blade razor before surgery on Friday, and since then I've felt too crappy and been on too much oxy to care. I beard badly.

Side Side note: both hydromorphone and oxycodone bung you up, and the day after you stop taking them, you shit a golf cart. The more you know.