3 days til transplant

Hi everyone, Steve's sister Cindy here. My husband Brian and I are here visiting Steve, mainly watching him lie in bed :) 

My dad spent a few hours visiting with Steve today. Unfortunately, Johanna developed some cold symptoms and was turned away at the hospital when she came to visit in the afternoon. My mom is also coming down with a cold, so she hasn't been by in a couple days. Major bummer. I hope they start to feel better soon so they can visit.

Here is a picture of Steve that Johanna took this morning. Lookin' good, Stever! Steve is feeling more nauseated today than yesterday and has been asking for consistent doses of Adovan, the anti-nausea drugs, which help a little. He says it feels better if he stays still, so he has not spent a lot of time out of bed. He did manage to get up today and walk two miles, which is more than I can say for myself, so that's pretty impressive! Woohoo! Nic and Rachael came by and walked with him for part of it. 

Steve's platelets and blood counts are going down a little each day since he was admitted on Monday, which is to be expected. But they are still far higher than they were a few months ago--thanks to the last round of chemo he had, which brought them all up into the normal range. Today his platelets are at 115 (down 27 since the day he was admitted), and his hematrocrit is 33 (down 9), and neutrophils actually went up a little to 3.91 (from 2.38). White blood cells are at 4.77 (from 4.84).

A couple days ago, we decorated Steve's room with tons of pictures that he can see from his bed. Here's a picture of the pictures! 

That's about it for the update. Steve says "hello." He has a chocolate milkshake to drink now.

Transplant day -4

Here's a picture of Steve today. I think the doctors are doing an excellent job of managing the fluid retention and reducing that puffy look. Every day Steve likes to tell me how he gained 10 lbs and then lost it again. Steve is still eating well and managing the nausea. When I left last night I was worried about his balance, but I was excited to see that his balance was good this morning. I talked to the nurse and she told us what we could do to still get exercise if he is not quite stable on his feet and they have a cool walking apparatus to help. So far we don't need it and Steve did his typical morning mile - after which he gets a well deserved nap.

I got to talk to his PA this morning who did one of his spinal taps and lumbar punctures at the SCCA. It's really nice to have familiar faces who know Steve over time. We got to talk a lot about keeping Steve moving and out of bed. She confirmed my suspicion that a day of downtime and sleeping all day can be a set back - making it that much harder to get moving again (succumbing to the "jail" effect as she says).

This is day 4 of his preparative treatment so every day feels like a big accomplishment - closer to transplant day! Steve says "Hello blog audience! thanks for sending me strong thoughts! Hopefully I'll be feeling better soon."

Day 3 post (transplant day -5)

Steve's been twittering so maybe he'll end up posting before I do - bear with us if so. Today Steve had a successful day - despite his feeling yucky he still walked 2 miles (morning and mid-day). He is battling nausea with some meds that leave him sleepy, so he's- sleeping. Truth be told he seemed a bit unsteady on his feet in the evening. His team of doctors rounded early this morning so I missed them but heard they were impressed with his ability to eat.

I'd like to get a schedule set up for visitors though visiting may really be more of a spectator sport of watching Steve sleep (and keeping me company). I'll try to post a picture tomorrow morning.

Day 2 update (Transplant day -6)

Here's an updated picture of Steve from after dinner tonight. Even though he had a rough night, I was still able to convince Steve to get out of bed today and he had a rather successful day. He ate normal portions for breakfast, lunch and dinner and we walked 1 mile after breakfast and 1 mile before dinner. 1 mile on his wing of the transplant floor is 10.5 laps so it's a lot of pushing his IV pole down a cluttered hallway but I'm excited he can be convinced to do it still. He's setting up the network hub as we speak, because they don't have wifi here. His parents also visited today. The TV in his room has a channel that they broadcast movies on (sans commercials). The selection of movies is decent (steve says a lot of chick flicks and box office thrillers) but in addition to the regular channels there is always something on.

Now, imagine that you are plugged into a wall 24hrs a day and there's a TV right by the bed and you aren't always feeling good - you can see it would be difficult to get up and do anything. So I'm pretty excited when he's willing to sit up or get up and do something.

Last night I decorated his room a little:

Today is his last day of Cytoxan (a myelo suppressive drug that heavily suppresses the bone marrow) and tomorrow he starts Busulfan (a myelo ablative drug that fully destroys bone marrow activity) which he will do for 4 days. Then he will have a "day of rest" where the drugs can clear from his system before he gets his infusion of donor cells. Steve says "I'm staying busy with the nurses and all of the blood checks and weight checks".- so there you have it!

guest post: hospital day 2 of prep chemo

hey everyone. Johanna here.
I left last night and Steve was in good spirits though a little puffy faced (this is from the steroids and fluid retention). This morning I arrived and he had tales of an awful night of nausea and vomiting. Sounds like he didn't get much sleep. I think after some rest and some food he may be up and about once again. We will be working with the docs today to get his symptoms under control so he can keep his appetite.

In hospital, first day of chemo

The first day of my hospital stay is off to a good start. We got here at 8 am and I was started on IV fluids pretty quickly, since at least 4 hours of hydration are required before they can start the chemotherapy. Compared with my stay at Swedish hospital, I'm starting to like UW Medical Center better. For one, they have much newer IV equipment. The pumps are quieter, the IV poll itself has a handle for pulling it around and isn't squeaky like my other polls have been, and the interface is pretty fancy and even shows the name of the current drug or chemotherapy being infused. The TV in the room has full cable and even a movie channel and includes a separate remote, which is one of those things you take for granted until you try and use one of those dysfunctional hospital remotes affixed to the bed. The last remote I used like that had just one button for the TV - you could only increase the channel. To turn the TV off you had to go through *all* the channels to the end. So something as simple as a real TV remote is pretty nice.

I also get to wear my own clothes here! This rocks, since the hospital gowns aren't that comfortable and it's hard not to feel like a sick person when you're wearing them. So I've got comfortable sweat pants, t-shirts and hoodies, and feeling much more like a normal person. The other cool thing is that the nurses have a chart of my blood counts posted on my bulletin board, which they update every morning. This is great, since normally I have to bug the nurses to get a copy of my labs, and then I put them in my own spreadsheet. With my own clothes and these kinds of attention to detail, I feel a lot more taken care of and less like a sick person.

So far the only downside is that the internet connection is wired only. No wireless! It's much faster than Swedish, but I may have to smuggle in a small wireless router or hub so that Johanna and her mom and anyone else can share the internet connection.

We started chemotherapy an hour ago and the first session just finished. The regimen is Cytoxin first, which suppresses the immune system, then Busulfan, which suppresses the marrow and everything else. I'm on a clinical study where they've reversed the order of these chemotherapy drugs. Normally they do Busulfan first, then Cytoxin, or "Byoo-sigh" as they call it, but it's been shown that doing Cytoxin first is less toxic overall so they're experimenting with that. Apparently they've been wanting to do it in this order for years, but until recently the Busulfan had to be taken orally, so they had to do that one first, otherwise patients would have problems keeping the pills down. Since it's a clinical trial, the researcher has been in on a regular basis to draw blood to check the levels of Cytoxin in my system for their research.

Other than having to pee all day, the only side effect I've experienced so far is right after the Cytoxin chemotherapy drug started. The feeling was like being drunk, oddly enough. I'm still a bit groggy, and things going on in the room feel sort of far away. The drug also irritates your sinus passages, so I experienced a side-effect like sniffing some toxic fumes, which is pretty much what's happening :) The Cytoxin infusion was only for an hour, so I'll just be on hydration fluids and various medications until tomorrow. For example, they're giving me a drug called Mesna to help the bladder, since the chemotherapy can cause bleeding inside your bladder. Fun stuff :)


My daily blood count chart


Not a bad view, it's nice to see the trees.


My fancy IV pole.

Last day at home, tomorrow in the hospital

Today is my last day as a free man for a while. Tomorrow I get admitted into the UW hospital to start the chemotherapy regimen that will wipe out my bone marrow. Next Monday is the actual transplant, which consists of just a simple infusion of the donor's stem cells. They're smart enough to make their way inside the bones and start producing new blood. No surgery or anything. On the left you can see the Hickman catheter that was put in on Friday. The white disc is called a biopatch, and contains antibiotics that keep the entry wound free of infection. You can't see it, but there is a small incision up by my neck where the tube actually enters the vein. Between the biopatch and the neck vein, the tube tunnels under the skin. This is partly for convenience so that the Hickman doesn't stick out of your neck, but I also found out from a nurse that the tunnel acts as a natural barrier for infection, since the distance between the vein and the entry site are so far apart. The ends have tape wrapped around them which the necklace clips onto to keep the whole assembly from dangling around. So far it hasn't been too uncomfortable and most of the time I forget I have it. Pretty amazing stuff.

Today I met up with a friend for tea at Remedy Teas on Capitol Hill, got another round of antibiotics at the SCCA, went for sushi and noodles at Blowfish, then met up with a friend for coffee at Cafe Vita. Afterwards, I walked downtown, caught the bus home, then met up with Johanna and had dinner with my parents to help send me off to the hospital. Admittance time is 8 am tomorrow morning, so Johanna and I are just finishing up some light packing before we head off to bed.

I've enjoyed seeing all my friends and catching up recently, and look forward to seeing everyone when I get back out again. I should be able to have visitors almost any time during the next 4 weeks, but to make things easier I think Johanna and I will put together a simple sign-up sheet for visitors so that no one has to worry about when might or might not be a good time to come by. You may be given a gown and mask to wear, but as long as you don't have a cold or scratchy throat, it should be ok. Though I may not look very healthy to look at some of the time :)

My friend, Josh, joked that my marrow transplant should be called a "camaro transplant", and my mom remembered that and decorated this miniature Camaro with a bunch of cool decals! For example, the license plate says "platelet" and there are decals like NMDP for National Marrow Donor Program, and HGB for Hemoglobin. The car is yellow since I'm on the yellow team. See if you can figure out all the decals :)

9 days until transplant

Today we switched to an IV version of anti-fungal antibiotic, since the voriconazole can cause problems during the upcoming chemotherapy. The infusion took place at the SCCA, and they also taught us how to change the dressing on the Hickman and prepare the dressing for taking a shower. With the PICC, I needed to wrap the arm in saran wrap and carefully tape the ends to make the whole thing waterproof, which was hard to do by yourself. It was also painful since your arm moves around a lot and the tape pulls at your arm hair. The Hickman dressing is waterproof by itself, so all that needs to be done is to cover the ends of the Hickman tubes with a special wax paper called parafilm. A few seconds preparation time and that was it. The nurse set I could even go in the hot tub with it, as long as it's not submerged. Not bad!

After the infusion I met my boss for coffee, then met up with some coworkers later that evening for some Rock Band. Tomorrow is another hour-long infusion and marks the last day of freedom before I go into the hospital. Can't wait to get things rolling.

Hickman surgery successful, still sedated and recovering

I probably won't remember parts of what happened this afternoon, so I'll try to write as much as I can before the amnesiac effects of the sedation wipe it all away :)

The surgery went well. Last night and this morning I showered using a special antiseptic soap on my chest that they require patients to use before surgery. They'll actually postpone the surgery if you don't do this. The way the Hutch works, the pre-soap ritual was probably the result of someone's research that found that patients using a surgical soap in advance of this surgery decreased their risk of infection by some percentage. Anyway, I did the soap, wore freshly laundered clothes to the surgery room (also required), and it was on.

The procedure involves 2 incisions, one at the jugular vein in your neck, and the other in your chest above your nipple. Rather than having an unsightly catheter sticking out of your neck, they tunnel the tube under your skin between the 2 incision points. This way, the catheter enters the vein at your neck, but comes out of your body lower down on your chest. With your fingers, you can actually feel the catheter under the skin. This layout makes it much more convenient since the ends of the tube can rest in the natural chest cavity pocket there. I have a necklace with a clip on the end to keep it from dangling around too much.


The illustration shows a single-lumen Hickman. Mine is a double-lumen Hickman, which means it has 2 tubes coming out, and the tube itself is split into separate chambers all the way to the heart. This allows them to do things like an infusion on one line, while drawing blood from the other. With a single lumen they would need to interrupt the infusion.

Apparently Dr. Hickman, who invented the device, retired just a few months ago at the ripe old age of 83 and was the sole person doing these surgeries until the day he retired. I'm not sure if that's a good thing, or a bad thing :) The doctor who performed mine studied under Dr. Hickman for years, and was great. The surgery went perfectly.

The procedure itself wasn't too bad, though I'd read up on it so I knew pretty much what to expect. The doctor and nurse also did a great job of explaining, and did a show-and-tell on the ultrasound so that Johanna and I could see the actual jugular and where exactly in the jugular he would insert the catheter. It pulsed with my heartbeat, and you could see it squish and move around as he pushed down with the ultrasound tool.

Really, the most uncomfortable part of the whole procedure was the lidocaine injection into the neck for the incision, since it burned a bit, and when they used the tunneling tool to open a passage under the skin for the catheter. Everything else was relatively easy. The amazing part was that once they got everything sterilized and set up, the procedure itself took only 10 minutes. But it took a 45 minutes to properly prepare and sterilize the room. What I mean is, I was covered from head to toe with a sterile tarp and a piece of metal near my head to suspend it from my face. A window was cut out of the side so that I could breathe and talk to the nurse that was applying the IV sedatives and pain-killers. Around the surgery site, the tarp was taped down and the site of the surgery was sterilized with antiseptic soap. The doctors, technicians, and nurses were fully gowned and had face masks and hair nets. It was nice to see the amount of care taken to keep the place sterile, since infection is the leading source of problems with these central lines

A combination of ultrasound and x-rays were used to position the guide wire into the proper position in the superior vena cava above the heart, and to make the appropriately-sized hole in the jugular vein for the catheter. I was on a flat table beneath a large x-ray machine, and the table was tilted back with my feet above my head. So the experience was like being in a narrow tent, lying backwards downhill. I'm glad I wasn't claustrophobic! But like all my previous procedures, once the sedative started flowing, everything felt great :) I was relaxed and calm and just enjoying the fact that the procedure was happening and would soon be over.

Recovery was fairly quick, and after some string cheese, Oreo cookies, and apple juice (I wasn't allowed to eat all morning and was starved), we were done! We headed to Taco Time to satisfy my taco craving, and then stopped by my old office to see coworkers I won't see for a while. It's been a few hours since the surgery, and I'm hardly noticing the Hickman at all, except for some soreness in my neck, which is expected since there are a lot of small muscles up there which they had to cut through. I think it may prove to be less of a hassle than the PICC line.

Tomorrow we take a class on caring for the Hickman, such as changing the dressing and how to protect it when taking showers, and I'll have an hour-long IV infusion after that and again on Sunday. Then Monday I'm admitted into UW Hospital. It's sort of a relief to have this week over with, since there were a lot of unknowns, like what the results of the CT scan and data review would be, and how I would feel after getting the Hickman line. It all feels pretty good, so I'm excited about moving on to the next stage.

Ciao for now! Thanks for all the comments :) I love reading them all, they really make my day!

10 mile walk

By the way, here's a route of the 10 mile walk I did yesterday. It was a nice walk, not too much traffic except around the Montlake bridge and the 520 overpass. I hit the Burke-Gilman trail for part of the way back after leaving the University.  The zig-zag walk through Capitol Hill was great. It's one of my favorite areas and offers lots of inspiring view of the Space Needle and Puget Sound, especially refreshing after the hill-climb from Montlake.

On the way, I listened to a great episode of This American Life about inmates at a high-security prison as they rehearsed and staged a production of Hamlet. It was fascinating listening to murderers acting out a play about murder, and one critic said it was the best version of Hamlet he'd ever seen. Here's a link to the episode.


I parked the scooter in the neighborhood at the top right and walked clockwise. At the bottom left is where I hung out at Starbucks for a bit to fuel up and play on the internet.

"Go" for transplant!

We got the good news today that the CT scan showed "reduced inflammation in line with recovery from infection", which was good enough for Dr. Doney, the attending physician in charge of my transplant. She gave me the good housekeeping seal of approval and after the necessary consent forms were signed, gave the green light for the transplant! The whole meeting was relatively uneventful, though she did a mock drum roll when announcing the pulmonologist's report. :) The donor is also ready to go, and passed her physical exam with flying colors. She'll start taking drugs on the 22nd to release her stem cells into her peripheral blood, and then on the 26th will go in to have her stem cells drawn. I'll be ready on the receiving end and they'll fly the stem cells over and infuse me as soon as they get here. It's getting exciting!

So tomorrow I'll have surgery to get the hickman line installed, Monday I'll be admitted to UW Hosptal to start 6 days of chemotherapy, and the Monday after will be the transplant.

We are at dinner with my sister, Brian and my family to celebrate the "go" decision, even though it's kind of weird to be celebrating something like undergoing a transplant. But we're celebrating the chance at a new life, so that's pretty cool :)

12 days until transplant

Tonight I am blogging from the huge Starbucks on Capitol Hill. I walked here from Ravenna, an exact 5.0 mile walk, according to Google Maps. I've been wanting to do a full 10 miles before I go into the hospital and there aren't many days left to go, so today was the day. I rode my scooter and parked it on a quiet street near Ravenna, and am looking forward to riding it when I get back to it. Hopefully I can still find it :)

Yesterday Johanna and I finished the Health Safety class and the IV Pump class at the SCCA, which were pretty informative. Actually we ducked out of the Health Safety class a quarter way through since they were running out of chairs. We had already taken the 2nd half of it earlier, but I had been under sedation earlier that day from a bone marrow biopsy and spinal tap and pretty much forgot everything that happened that afternoon, so we decided to take it again. I even went to the dentist and had fillings filled that day, and it's the first time that I can't point out which teeth were worked on, since the sedation causes a bit of amnesia. Johanna and I were the only participants in the IV pump class, and we each had pumps and a pretend Hickman line to practice on. The nurse showed us how to load the backpack with the IV bag and pump so that you could carry it around, and how to program the pump. We felt like old pros, since we had figured out a similar IV pump when I was on IV nutrition after being in the hospital for my induction chemo. We won't pick up the pump and backpack until after I go home from the transplant, and then every other day we'll visit the clinic for supplies such as saline syringes, sterile wipes, and my medications.

Today I went in for a blood draw and the much-anticipated CT scan, which will determine whether we go forward with the transplant or not. I can't imagine there would still be inflammation in the lungs after all this time and since I feel so great, but that's what I thought last time and there it was, so it's hard to know. We'll know the results of the scan tomorrow.

Well, it's time for the 5-mile walk back to my scooter. I'll report tomorrow on the result of the CT scan and the data review meeting where we'll make the go/no-go decision. Wish me luck!

13 days until transplant

I'm hanging out at Grand Central Bakery near the SCCA, nursing a cup of cafe vita coffee and eating a huge croissant. Not much to report. Yesterday I had a scheduled visit with my transplant team and met Dr. Doney, the attending physician that now heads my team. Each month they rotate attending physicians and other staff between the 12 different teams, so Dr. Doney will be in charge of my transplant. She's been at Fred Hutchinson for 30+ years, and she was well-informed about my case and funny too. We'll meet again on Thursday for a go/no-go meeting, and if all goes well with the upcoming CT scan tomorrow, I'll go in for surgery on Friday to have my Hickman central catheter put in. The Hickman is sort of like the PICC line that I had in my arm, except that this one is inserted into your chest directly above your heart, so there's less chance of the line moving around or the line getting blocked. It's good timing too, since I'll need to switch from the voriconizole antibiotic to an IV antibiotic 48 hours before the chemotherapy starts, so it'll be nice to have the Hickman line in since it's an hour-long infusion each day.

In transplant speak, I'm at day -13 now. Day 0 is the day of the transplant, and everything is measured in terms of days before or after that. There are checkups at day 50 and day 100 for example. And they've done so many transplants that they know when to expect side-effects like mucositis (day 3 - day 13) and hair re-growth (day 15) to occur. The chemotherapy to wipe out my existing stem cells is called conditioning, and starts on Day -7. Right now I'm in the preparation stage.

Friday will mark the end of my freedom for several months, since from then on I'll have the Hickman catheter and we'll have to change the dressing regularly until it's removed. I'll be tethered to it 24 hours a day for a month starting next Monday and could have the Hickman for a while after that. So Friday is sort of a psychological milestone. But I'm looking forward to it. I'm ready to get this transplant done. My last hospital stay is far enough behind me that it's starting to be a distant memory, rather than something that feels like it just happened yesterday.

In other news, I'm sad to say that Dawn, the fellow blogger I mentioned in my last post last week, passed away last Thursday. My heart goes out to her husband and family.

That's it for now. I'll report back with more soon. Last Friday we started off the weekend great with a stay at the Salish Lodge in Snoqualmie, courtesy of our friends Jenny and Greg. We were there while the falls had a tremendous amount of water going over them as a result of all the recent flooding, so it was something you don't normally see.

2.5 weeks to go

I'm sitting in a Starbucks on Queen Anne nursing a double short latte. It's raining buckets outside, and my rain jacket is soaked. I just walked up from Fremont while listening to the latest This American Life podcast. The wifi is free and I'm buying coffee with the Starbucks cards I got for Christmas, so it's a good deal. I don't have much to report, except that things are still on track, and I'm keeping busy with appointments at the SCCA and spending time with my family. Besides attending classes, my only job right now is to stay healthy and stay hydrated. My nurse wants me to drink 3 liters of water a day, which isn't really so hard since I end up drinking a lot while taking all the necessary drugs 4 times a day.

Johanna and I were a little down last night and this morning, since a fellow blogger who underwent a transplant has taken a turn for the worse in the last few days. She had a cord-blood transplant over a month ago, and has been in ICU for the last 4 weeks with small bits of good news, but generally steadily getting worse. It started with a kidney complication, which led to fluid accumulating in her lungs which they had to drain each day. Her lungs became damaged and she went on a ventilator soon after. Possibly because of all the medication and antibiotics, her heart started beating irregularly, and they had to restart it once. Her husband has been steadfastly blogging the whole time. And all the time I'm hoping for the best and have been assuming that, though things are bad, they will turn around eventually and they will all look back on it as just some really tough times. It's like watching a dramatic movie and thinking to yourself that surely the director won't end it with a tragedy. You just never really think that the worst could actually happen. So it has been sad to read the last few blog entries and realizing that it's possible she won't pull through. She's 19 (sorry, she's 28), and though her leukemia was worse than mine and she didn't go into her transplant in remission, reading about her struggle has really had an effect on us. And from her pictures you can see that she is a vivacious, young 28 year old with tons of energy and is smiling in basically every picture. Yesterday they got news that her leukemia had returned with a vengeance, and they don't plan to restart her heart if it stops again. She's been under chemical paralysis and heavy sedation, so they might not even get to say goodbye to her. It's all very sad and so I think it has made Johanna and I a little down the last few days. So cross your fingers and toes and pray that she does ok. Her name is Dawn and her blog is at http://www.goshdawnit.com/.


Captain Dawn

Yesterday I met with the transplant team and it was an uneventful meeting, which is great. Everything is still on schedule and we're just waiting to see what next Wednesday's CT scan shows. I'm getting anxious now and am ready to get this thing done with so that I can get back to work and a normal life. Assuming the CT scan looks good, the transplant schedule shouldn't change from the following:

1/12 Mon - Clinic visit with transplant team
1/13 Tue - Food safety class
1/13 Tue - Managing care at home class
1/13 Tue - IV pump class
1/14 Wed - Blood work
1/14 Wed - CT scan
1/15 Thu - Patient/caregiver support group
1/15 Thu - Data review (go/no go meeting)
1/16 Fri - Surgery for Hickman central catheter
1/17 Sat - Hickman care / teaching session
1/19 Mon - Admitted into UW Hospital
1/20 Tue - Start 5 days of intensive chemo
1/26 Mon - Transplant

That's about it for now. Check out these awesome turkey burgers our friends Nic and Rachael made for us the other night! That's Nic, with their cute but hyperactive pug, Lola. :)

Happy new year!

Hello from 2009! Our trip to Los Angeles was great. We basically spent the whole time in the beach cities, relaxing or shopping or eating, either in Manhattan Beach where Johanna's sister, Val, lives or in Hermosa Beach where our hotel was. Walking between the cities was simple - just a quick stroll up or down The Strand, a pedestrian and bike trail connecting most of the major beaches in LA. Both Val's house and our hotel were on the Strand, so we probably put in at least 10 miles of walking, and the scenery along the way was gorgeous. On one side was the blue ocean with people surfing or playing volleyball on the beach (even in December!). On the other were a wide variety of closely-packed and expensive beach houses. You'd see a spanish colonial next to a Victorian next to a small cottage next to an ultra-modern glass and steel behemoth. And almost all meticulously cared for by their owners. There was a lot to see. The beach community definitely has a sense of self-pride and belonging, and it wouldn't be hard to get accustomed to their lifestyle. Alas, after 5 days we headed back home to our cold, wet Seattle :)

It seems like half the people we met had colds while we were there, with phlegm all colors of the rainbow, but we did our best to avoid too much close contact and I seem to have managed to avoid it all. Though I did get a sunburn on my face and my doctors gave me a slap on the wrist about it the next day. After the transplant, I'll have to be more careful, since graft-versus-host disease (GVHD) can flare up as the result of a single sunburn, and could take months to get back under control.

The day after we got back, I was scheduled for a blood draw, a nutrition class, an EKG, and a checkpoint visit with the transplant team. Everything went well, I passed all my tests from the previous week with flying colors, and all my blood counts were normal. Super cool. They are also checking the Voriconazole (anti-fungal antibiotic) levels in my blood to see if the dose needs to be adjusted. The next day I went back in for another blood draw, as my donor's sample blood had just arrived at the lab. They've already determined that we match as closely as possible through our HLA typing, but continuous blood checks are needed to make sure that my blood doesn't develop antibodies against my donor's blood. New antibodies can be inherited by getting a transfusion, or sometimes they can occur out of the blue.

Nothing much is expected between now and next week. Next week I'll have another checkpoint visit with the transplant team and that's it. The week after, we'll do another CT scan to see if the lung infection has cleared up, and if so, we'll proceed with the transplant.

As of now, the schedule looks like this:

Jan 14 - CT scan to check lung infection
Jan 15 - Transplant team makes go/no-go decision on transplant
Jan 16 - Hickman line (like PICC line, but goes in your chest)
Jan 19 - 5 days of intensive chemotherapy to wipe out marrow
Jan 26 - Transplant

It's turning out to be a nice day so I think I'll head off to a coffee shop somewhere. Ciao! Here are some pictures from our trip: