Free at last, free at last!

Jimmy, with Val and Jamey in attendance, ascended his chariot, and pronounced himself ready to depart.

Dr. Khoury and Dr. Akhtari deemed Jimmy fit to leave the hospital this afternoon, and although we don't anticipate any problems, it's reassuring that we're only five minutes from Emory.

Dr. Akhtari checks Jimmy out one last time before we're discharged.

The Rack

We thought we might be able to check out and go to the apartment this morning, but Jimmy's still hanging on to that 100+ degree temperature, so we're spending one more night, just in case. Another blood culture is being done as a precaution, but the fever is most likely caused by Jimmy's body being in high gear, manufacturing all those new cells.

Seventeen nights in a row on this thing I'm sleeping on is enough already. But what we DON'T want, is to move back to the apartment, then Saturday night have Jimmy's fever spike to 103, and we have go to the Emory emergency room at 4AM trying to get Jimmy re-admitted to the hospital. We've done that before, and do not recommend it.

Looking good!

Christina has often been our night nurse, and she is a sweetie-pie. Jimmy and I cannot say enough about the wonderful staff here.

Jimmy's WBC was 1.0 this morning, and things are looking up. Last transplant he got Neupogen (growth factor) shots, and his counts jumped up more quickly, but they're coming up just fine on their own this time. (4500 - 10,000 white blood cells per microliter is considered normal. This morning Jimmy had 1000, but, hey, it's a start.)

Jimmy had a good day. He telephoned in to a two hour bank meeting this morning, then Jamey spent the afternoon with him while I took a break, and they talked business. Jimmy's mind is sharp, and I expect his recovery to move more rapidly this time. We may get to go back to the apartment tomorrow!

This says it all

Jimmy is much better today, and the morphine pump wasn't necessary. Steroid injections have greatly relieved the fever and inflammation, and we're hopeful that we are now going into the upswing phase. His WBC is still only .4, but his hematocrit and platelets look good, so maybe we'll see a big jump in the white blood count soon. It takes the body a year to completely recover from a transplant, and Jimmy's had two in four months, so he's doing extremely well, considering.

Our little lap chart in the hall speaks volumes about Jimmy's condition from day to day. Yesterday it took intense badgering from Nurse Lisa and me to get two reluctant laps out of him, and today he walked the prescribed mile without complaint. I walk a lot by myself when Jimmy's sleeping, and started marking those laps with small dots.

The only thing peachy is Jimmy's diet

There's no such thing as an easy transplant.

The Kepivance, administered for several days before and after high dose chemotherapy, proved less effective this time than it was in January, and the lining of Jimmy's mouth and throat is inflamed and very painful. He probably hasn't had 200 calories all day: more canned peaches and a few bites of the ramen noodle soup I fixed for him in the microwave, and he had to force that down. If the discomfort hasn't subsided by tomorrow, they're going to put him on a morphine pump for a couple of days. They would have done it sooner, but Jimmy didn't want it. He hates feeling so doped up.

The endless parade of bags of intravenous fluid continues: platelets were needed today, and his low potassium level still needs constant bolstering. His temperature fluctuates from normal to 101, so the antibiotics and anti fungals are added to the mix. There's always something.

Did I mention that he can't get any rest because, with all the liquids being pumped in, he has to get up and go to the bathroom every hour or two? Needless to say, he is very grumpy and out of sorts. As well he should be.

Things should start getting better soon.

Day 10

Last year on Memorial Day, we were right here, on 7E. Today while doing my sixty billionth lap around the corridor, I was trying to decide how many different rooms on this floor we're stayed in at one time or another. It's either five or six.

Jimmy's had a little fever again, but we're hoping that we're about to start engrafting. His WBC was .3 this morning: minuscule but detectable. He has not needed blood or platelets today, just antibiotics and electrolytes

His hair started falling out last night, so we shaved it off again; when he starts shedding, it makes such an awful mess. This is the third time we've been through this, so the only trauma now is over how hot he wants to keep the room to keep his bald head warm.

A fluid situation

Jimmy's feeling better: not great, but better. The bags of fluids he's had pumped into him in the last forty-eight hours could float a boat, but it must be working.

We love all of our nurses, but Jessica, who took care of Jimmy a lot in January, has a special place in our hearts. She calls Jimmy "Rock Star" and makes him laugh, which isn't easy these days. She's a very special person.

Notice Jessica's uniform that she wore today. Jimmy loved it!

Magnolias

9 PM Another down day: fever again and Jimmy feels miserable. It's good that he's sleeping a lot. I just counted seven different bags of intravenous fluids he's getting right now, including four kinds of antibiotics and two big bags of platelets. It's going to be a long night.

I was looking out the window just before sunset, at a magnolia with so many blossoms it looked in the distance like a Christmas tree loaded down with big white ornaments. Last month in Valdosta, Jimmy and I had remarked to each other about what an exceptionally fragrant spring it has been: the ligustrum and the magnolias, the gardenias and the jasmine and the tea olive were heavenly. We had wondered if maybe the drought had concentrated the smells and made them more potent, or if it was just our heightened perception of things. We tend these days not to take too much for granted.

Day 6 (9th day in hospital)

Jamey came and sat with Jimmy for a long time this afternoon, so I could go to the apartment for a while: do some laundry, take a bath, make Jimmy some blueberry muffins. It's the only thing he'll eat lately, muffins and canned freestone peaches and vanilla milkshakes. Poor baby's running a fever again, and he has some ulcers in his mouth, and he's not too happy right now. But I keep telling him that we just have to get through the next few days, and he'll bounce right back.

Jimmy asked Dr. Langston exactly where we are in the process, and to illustrate, she drew a graph on the message board in our room: we are where the star is, almost to the bottom. With his white cells (and his immune system) almost completely wiped out, he's neutropenic, and will stay that way at the bottom of the curve until his stem cells engraft and start creating millions of new healthy cells, and then we'll be on the upswing of the graph. (Mrs. Massey, my 10th grade biology teacher, would be so proud that I'm beginning to grasp this stuff.)

True grit

Jimmy's white blood count is down to .7 and he doesn't feel so hot. We've only walked five laps so far and it was a bit of a struggle. The beeper on his IV kept going off all night, and people were constantly in and out of our room, and we didn't get much sleep, but it's only noon, and I'll nag him into some more walking later today.

There's a thin pale young man, twenty-one years old but looking younger, a couple of doors down from us, who had a bone marrow transplant for aplastic anemia four weeks ago. His mother has been up here with him the whole time, and she told me that they're leaving this afternoon.

We often see them in the hall walking, sometimes Chris by himself, wearing a baseball cap on his bald head and dragging his IV pole, but most of the time his mother is right behind him, pushing it for him. He's a fast walker, and easily does two laps to our one. Some days he's been too sick to even leave his room, but his mother said that he's somehow managed to clock in 85 1/2 miles since he's been here. We wish him well.

Day 4

This afternoon Jimmy's great old friend, the legendary John McNeill from Thomson, was in Atlanta and came by for a visit, and we loved seeing him.

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Jimmy's numbers are dropping, but we still have a way to go before they bottom out. He still feels pretty good, and was saying today that in some ways it's harder, because last time he was too sick to be bored. He's still reading a lot, and doing some sudoku puzzles in an attempt to stave off the inevitable chemo brain.

He has to wear a mask outside our room, and everyone entering it wears one, except me, thank goodness. The nice weather we've had has permitted us to take walks outside, in addition to our laps around the 7E wing.

Steps

A sporadic wireless signal here at the hospital has made accessing the internet difficult most of the time, and we apologise if we've been remiss with the blog output.

So far this transplant experience has been a far cry from January's, when Jimmy was running high fevers and was so weak and sick he could hardly put one foot in front of the other. He's still eating fairly well, and we're doing a lot of walking. Right now our biggest issue is boredom.

Explanations

Several people have commented that this second transplant seems less involved than the first one, and yes, that 's true because this time the stem cells were already collected and could be used immediately. The problem we had last fall was that they had so much trouble collecting Jimmy's stem cells, and had to get special approval for a drug still not yet approved by the FDA to make that possible. Until we harvested enough stem cells, we couldn't do a transplant.

This time, with the frozen stem cells ready for us, all we had to do was to start Jimmy on a preparatory regimen on Sunday, check into the hospital Wednesday in time for them to drop the big chemo bomb on him, and reintroduce the stem cells on Friday. Now we're waiting for the cells to engraft.

The high dose chemotherapy Jimmy got acts like a delayed reaction time bomb, and the worst of it won't start for a few more days, with it bottoming out between Day 4 and Day 10. Today is just Day 1, so things are going to get worse before they get better.

Second transplant

Jimmy's been hooked up to an IV all day, and so far has received seven bags of stem cells, two bags of blood and I don't know how many other various and sundry other substances. He's bright red (again) from the Kepivance, has had a relentless case of the hiccups for the last two days, is all hyped up on steroids, but other than that is doing great. So far, so good.

We moved into our room at eight o'clock last night, and it was almost midnight by the time Jimmy had gotten his high dose chemotherapy. He said that he didn't get to sleep until five this morning. Today has been long but routine and tomorrow he gets his new stem cells.

Jimmy feels fine, and we expect the procedure to go smoothly for several reasons, the foremost being that he is in much better shape going in to it this time. Our familiarity with all of this helps too.

Waiting again

It's after five o'clock, and we're still in Interventional Radiology where we've been all day. The central intravenous catheter in Jimmy's chest was supposed to be re-installed this morning, but that didn't happen until mid-afternoon, and for the last few hours we've been waiting to move to our room here in the hospital. It was supposed to be available much earlier, but the poor patient that's vacating it is still waiting for his wife to come get him.

We're the last ones here except for a handful of employees. If the abandoned patient is not retrieved soon, maybe we'll be here all night: a grim prospect.

Ed and Janet Jared with Jimmy at Kyma

As we were leaving the Buckhead Diner yesterday afternoon, replete from our splendid repast (Jimmy stayed with his original intent of eggs Benedict while I walked on the wild side and had a crab cake with poached eggs in a Bearnaise sauce and braised asparagus) we were handed a promotional brochure about upcoming specials in the Pano's and Paul's restaurants around Atlanta. And everybody knows that Jimmy Dewar loves a deal. It's the Scot in him.

This particular deal advertised that for the next two weeks, nine restaurants (Nava, Veni Vidi Vici, Chops, etc.) would have a three course menu for $29 a person. Jimmy was enthralled, and after hours of thoughtful deliberation, decided on Kyma, a Greek restaurant where we'd never been, and invited Ed and Janet Jared to join us.

Our little enterprise turned out to be a huge success: we met the Jareds there at 7:15, and were surprised on leaving that it was already 10:30. Tempus fugit, and all that. We were brought three different appetizers, one at the time, which we shared: there were grilled scallops served with something that tasted sort of like tabbouleh, lamb meat balls with little potato patties, and arugula with mozzarella and walnuts.

A wine enthusiast and connoisseur, Ed Jared had brought an excellent 1999 Opus One from his cellar for us to enjoy, and by the time the entree was served, we were almost full, but it was too good to resist: two whole wood-smoked sea bass were filleted and divided between us, with wilted greens and little whole potatos and a wonderful eggplant stew. THEN two yummy desserts came and we passed them around the table. And while all this eating and drinking was going on, Ed and Jimmy regaled Janet and me with one funny story after another.

On the way home Jimmy was talking about what fun he'd had, and said that if it wasn't for this infernal transplant this week, he'd like to try out every special in every restaurant in the next two weeks. Jimmy just doesn't have time to be sick: I've never known anybody who enjoys life as much as he does.

A new apartment

Jimmy cozies up to a pulchritudinous nymph in the garden
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What a week. We are still shell-shocked that another transplant is even necessary, as great as Jimmy looks and feels, and we were so convinced that it was going to be a good summer. This recent twist has rained on our parade big time.

Before we left Atlanta, we looked at an apartment in our old complex, and Jimmy reserved it with his American Express card, and it was to be ready for us this weekend. Then Friday afternoon, some helium-voiced nitwit with whom we have only talked on the phone called to say she was sorry but she'd accidentally rented it to someone else, and nothing else was available.

Thinking that we'd have to stay in a hotel for a few days while we searched for a new place, Jimmy got on the internet to do some reconnaissance for corporate apartments in the area. He called a number he found, and yes, something had just come available, and it was ready to be moved in on Saturday. Jimmy told her he'd take it, and we drove up yesterday hoping for the best.

We love it! It's at the Post Briarcliff on Briarcliff and La Vista, and much more pleasant than the place we didn't get and our old Gables apartment. It's close to the hospital and next door to Whole Foods and across the street from our favorite Thai restaurant, and it's bright and comfortable. We lucked out on this one.

We're at the clinic this morning where Jimmy is getting a pre-transplant infusion. When we get through with this, it's on to the Buckhead Diner for eggs Benedict and an afternoon at the High Museum. We're trying to improve our attitude.

Things are moving fast. We're going to Atlanta tomorrow since Jimmy has to be at the clinic at 10AM Sunday morning to start the intravenous Kepivance. We'll check into the hospital on Wednesday.

We're in Valdosta, starting to get things ready to move back to Atlanta, although a firm date has not yet been scheduled. They still need for the insurance company to sign off on another transplant.

We went back to our old apartment complex in Atlanta this morning, and they have agreed to rent us another one, as early as this weekend if necessary. Hopefully it won't be as hideously furnished as the last one, but the location is so good, and there is a certain comfort in familiarity. But ugly we can live with, and besides, this time we don't plan on being there all that long.

Jimmy breezed through the last transplant with comparative ease, and this time we know what to expect, so we aren't quite as apprehensive about having to do it again. The order of the day is chin up and mush on.

Here we go again

Atlanta 3PM. We are going to have to have another transplant. Jimmy's M protein level (marker for myeloma) is .6, the lowest since his cancer was diagnosed, but Dr. Lonial feels strongly that we still need to undergo the process again.

We are very disappointed, but have opted to get started as soon as possible. Our coordinator is working on scheduling and red tape, and we may go into the hospital as early as next week. That's all I know right now. Will update ASAP.

Art class

Rosey and Pat brought the children over this afternoon, and William and I went out to my art studio to paint. (Jimmy snidely commented that he was glad to see it get some use after such a long hiatus.) We pulled out some old poster paint and paper, and were engrossed in our efforts when we were joined by twenty-one month old Jake, who wielded a brush with great enthusiasm.

By the time we got through, all three of us were covered in paint, and Pat had to put the boys in the laundry tub and scrub them down before they could be loaded into the car. Our clothes were ruined, but we had a ball. I took some darling photos of my little budding artists, but for some reason cannot get them uploaded to my computer.

The Graduate

Jimmy, Jackie, Mary, Albert Mitchell, Mary's father, and Melissa Mitchell, Mary's sister. Al, who is a Baptist minister, and Melissa came from Pennsylvania for Mary's graduation.

Today our precious daughter-in-law Mary Oliver, who is married to my older son Jackie, graduated from Valdosta State University with a political science degree in legal studies. She's going to be a paralegal. Last month she received the Outstanding Legal Assistant Studies Student Award for 2008; she had the high grades to be an honor graduate, but she was a transfer student and only had 58 of the requisite 60 hours to qualify. But no matter: Jimmy and I couldn't be prouder of her.

Mary just finished her internship this semester with Coleman, Talley law firm. Besides that, she works as a computer librarian at Georgia Military College, AND she's taken care of my beloved Andy the whole time we've been out of town with Jimmy's illness, and Andy adores her. As do we all.

...and now we wait...

Having never had either, I cannot speak with any authority, but Jimmy assures me that a bone marrow biopsy is not terribly dissimilar from a root canal. Tuesday he endured his sixth one (bone marrow biopsy, that is) in the last twelve months, and has become so blase about the process that he opted not to have any sedation this time. For one who has always been so hypersensitive that he often cuts the tags from the backs of his shirts because they irritate his neck, he has shown impressive fortitude.

With all the testing over, we wait until next week for the verdict. Jimmy looks and feels marvelous, so we'll be shocked if we don't get a good report.

It's been two months since we made the trek to Atlanta, and we were amazed this week at how light the traffic is on I-75. The upside of the horrendous gas prices is how lovely it is to get in the middle lane, turn on the cruise control, and blithely drift down the highway. And despite all my complaining about the blue Buick van, it made it to Atlanta and back on less than a tank (an $85 tank) of gas.