Friday, July 16, 2010

Mmmm ... mediciney

This morning I went to the pathology facility where I will ultimately be making my donation of stem cells for the NMDP. The donation (or “collection”, as they call it) is scheduled for this coming Tuesday but I had to go in today to start a five-day course of a drug called Filgrastim. Two subcutaneous injections before 8 am, that’ll wake you up in the morning, boyo.

Standard I-am-not-a-doctor disclaimers aside, this is my understanding of the whole deal. The reason why cancer patients need bone marrow donation is that chemo/radiation compromises, weakens or kills most of their own marrow and leaves them dangerously (even fatally) vulnerable to infection because without the marrow to produce white blood cells, their immune system is essentially nullified. So it used to be they would sink a gigantic (and excruciatingly painful) needle into a healthy person’s hipbone and extract a mass of marrow and turn around and inject that into the person who had chemo, and let the healthy marrow make white blood cells in its new location. Fortunately for me, they have come up with another way to achieve the same basic results, which is to dose the donor with Filgrastim, which triggers the body to do two things it doesn’t normally do: produce excess bone marrow stem cells, and dump those excess cells into the bloodstream. After five days of that, there’s a substantial mass of stem cells floating free in the donor’s blood stream and the donor can be hooked up to a non-nightmare-sized needle (depending on the relative nightmarishness associated with a person’s innate trypanophobia, I suppose) in a vein. So its equivalent to giving blood, except that it takes four or five hours as all of your blood goes out through the tube connected to the needle (though not all at once, obviously), and circulates through a machine that centrifuges out the stem cells, and then gets pumped back into your body along with a little extra to make up some of the unavoidably lost volume. OK, so it’s nothing like popping into the Bloodmobile but at least it’s a point of reference.

Anyway, the appointment this morning was more or less a non-event, as they took my temperature (normal) and blood pressure (normal) and asked how I was feeling (as a pre-injection baseline) and then shot me up, once in the back of each arm. The needles were actually an incredibly fine gauge, which was a pleasant surprise, and then the nurse said “There’s going to be a little bit of burning as it goes in but that fades pretty quickly,” and son of a GOAT she was right about that, happily so on the second half. Then they gave me a bottle of Tylenol and told me to take 2 every 6 hours whether I felt like I needed it or not, because I was definitely going to need it eventually and if I waited too long then I would wish I had started sooner.

The whole scenario is pretty conceptually strange. I’m a big fan of modern science and its capacity to fix things; it may not be a cure-all and certainly needs certain reasonable constraints, but I’d rather live with it than without it. But there’s something fundamentally … I hesitate to say “perverse”, but twisted at least, that in order to fix someone else who is broken, science is going to break them even more (chemo) and then break me a little bit, too. Because I generally think of medical science as being concerned with getting things back to normal: you have too much cholesterol, so we’ll give you drugs to bring you in line, with “too much” and “in line” being judged against the average of everyone else which delimits “normal”. Now I find myself willingly going along with a plan to make myself temporarily abnormal, pushing one of my bodily processes beyond the range of average. And hey, I’m not regretting the decision in any way, I’d say I’m past willing and well into committed, but I’ve also read enough sci-fi in my day to know what happens when scientists have the hubris to try to push the boundaries and remake nature’s handiwork to conform with their own visions. I know how that can escalate out of control …

OK, maybe I’m not really anxious about biomorphing into some kind of uncontrollable living engine of destruction. I am not exactly, in point of fact, an experiment, either, since this technique has been in use for quite a while. I am a little apprehensive about known side-effects, though, I must admit. It all boils down to “it’s not gonna kill you, but it may make you feel like crap.” All the usual fineprint type of stuff, of course, like nausea and dizziness and skin rashes and such. Plus a deep ache in the bones as the marrow gets worked into unpaid overtime, hence the admonition to start sucking down Tylenols sooner than later. My plan is to just tough it all out, have a normal weekend, come in to work on Monday, and then take Tuesday off to let them do the collection in the morning and then just chill in the afternoon. But in reading over the info sheet they gave me today, I’m less than 100% confident in that plan. It’s still my intention, but the info sheet made various unsettling allusions to the availability of prescription narcotics if the pain got so bad I couldn’t sleep (WHAT THE WHAT.) and also a number for 24 on-call physician, you know, “just in case”. (Uh … huh …)

So yeah, we shall see. Every deviation from the norm is an opportunity for adventure, though. And assuming I can keep myself from freaking out every time I feel a slight twinge anywhere in my body, I’m sure everything will work out fine.

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