The biopsy from back on my birthday shows significant infiltration of the bone marrow by the more aggressive of the two lymphomas that I had before. This pretty solidly explains why my blood counts have been so low; there isn’t any room for the bone marrow stem cells to operate properly. In fact, the pathologist reported that it was difficult to spot any stem cells in the sample at all!

My spleen is bigger, but not as big as last time. Some lymph nodes are bigger, but not as large or as widespread as last time.

In addition, there may be some water around my heart. I’ll be getting that checked out further to see how that will impact treatment.

Today is my day off from medical stuff. Tomorrow, a transfusion and an LP to make sure it hasn’t spread back into my brain. The next day: into the hospital for heavy duty chemo.

And when this new type of chemo wipes it away, I’ll probably be getting another stem-cell transplant. The scarier type this time.

This time I wanted to do everything I could to avoid suffering through the joint pain on Saturday morning. My lizard brain considered trying to stay in the hospital a few extra days (or checking into Extended Observation) to be somewhere that had IV pain medication available.

My rational brain said this was silly. Checking into an expensive room for a night to avoid a few hours of pain seemed excessive. And my rational brain won, as it often does.

Besides, the pain showed up a day early. Friday morning my knees and ankles hurt like the dickens for a few hours. Engage opiates! And ibuprofen! I got up and read stuff for a few hours, and eventually (after an hour or two) the pain subsided enough for me to go back to sleep.

I did the same thing on Saturday, and on Sunday. That would’ve been a lot of days in the hospital!

I’m glad that’s done with.

Next we scheduled an appointment with a transplant specialist doctor at the SCCA to see what she recommended as the next step. Apparently the speed with which the lymphoma asserted itself in my CNS suggests that we ought to do a stem-cell transplant.

My case was discussed by a bunch of well-regarded doctors at the SCCA, and the consensus was that I ought to do an autologous stem-cell transplant.

This is a biblical-flood sort of treatment. When we collected the blood stem-cells back in November, that was us preparing am ark. Now we’ll irradiate my entire body and fill it with a crazy amount of chemo, in a stage known as “conditioning”. This will hopefully kill off any remaining individual lymphoma cells. Unfortunately it also kills offy bone marrow (and along with it, my body’s ability to produce new blood cells).

A few days later they give back my collected stem cells and my body starts to rebuild. The stem cells find their way to my bones and start producing the cells that make up bone marrow.

As part of this, I think I’ll lose a lot of the immunities my body has built up over the year. We’re really hitting the reset button!

There’s one additional question to be answered: there wasn’t a solid consensus among the SCCA doctors on whether or not to recommend extra radiation focused on my brain and spine. Lymphoma in the brain can be sneaky (as we’ve found), and am aggressive approach is more likely to get it all.

This can, however, cause damage to healthy brain tissue. Possible decreases in memory strength, among other undesireable things.

I need to decide soon, but I’m leaning toward going for it. The goal of a treatment like this is a cure, and I want to do everything I can to get there.

Also, since I wasn’t in the same intense pain as last time when I started chemo, I’m not all hopped up on opiates today.

This means I’m fully awake and aware to notice the return of metal mouth. I haven’t had anything to eat yet, but my mouth already has a metallic taste.

Not to mention that my head and stomach feel hung-over. I already had a bit of that before I started sleeping for 10 hours though.

Another interesting point about today: my doctor felt that with how low my blood counts were before chemo, and with the expected drop due to the chemo, that I ought to have a round of colony stimulating factor treatments. These treatments use a genetically modified form of E-coli bacteria to deliver a message telling my bone marrow to ramp up neutrophil production.

Once a day for the next five days I’ll be filling up a syringe and injecting myself in my belly. This five days of treatment would have cost $1300 without insurance! With insurance: $34. And it’s got to stay refridgerated or it’ll go bad.

Now I will sip my coffee and hope it takes not of metal. Cheers!