Editor's Note: Jeremiah Ray was diagnosed with advanced stage testicular cancer in 2016, only to face a recurrence of his cancer six months later. Jeremiah is starting high dose chemotherapy, and is sharing his HDC journey with us.
To me, a stem cell transplant is still a mystery. I understand it on the theoretical level, but it still seems like some sort of sorcery.
When I spoke briefly via phone with the doctor in charge of bone marrow/stem cell transplants at Mass General Hospital (MGH) prior to my appointment (April 20), it sounded as if he wanted me to start the procedure the following day. There was this sense of urgency. I was, and am, ready. In fact, I needed the time (since being told of the recurrence) to accept and come to terms with it and thus prepare myself (on every level) for the next steps. Being “ready”, on a purely medical level, is acceptance of what is, of the facts. Being "ready", on every other level, is only acknowledgement of the work and tasks that lay ahead. When initially diagnosed I didn't have time to think about everything, seek out other opinions, talk to survivors and current patients in treatment. It was: seizure, hospitalization, surgery, treatment. I have come to understand that a part of me was in denial when informed of the recurrence. Naturally. I also knew, from the crash courses I had given myself in oncology & cancer treatment (etc.) that, this time around, I did in fact have some time. As aggressive as my cancer may be, I knew I sort of owed it to myself (and my body/mind!) to seek advice. Since all signs keep pointing back to this route, that of high dose chemo with tandem stem cell transplants, I feel a sense of readiness. Also, and most importantly, I needed the time since my meeting with my oncologist (Feb 2) until my meeting with Dr. Einhorn (April 5) to not only research and explore, but also cry, scream, walk in circles in the woods (literally), as a way of grasping it. In doing so, I unblocked and addressed some of which I didn't have time to deal with initially, when I was first diagnosed. Looking back I am thankful for this time. Not only did I get to explore and look into the vast world of alternative therapies (clinical trials, studies, etc.). But I also had the pleasure of meeting (by phone, e-mail, or in person) some very wonderful folks. On top of this, and perhaps most importantly, I was able to get a better look at some of the emotions I "didn't have time" to address before.
Anyways... those next steps, the preparatory stages, are even more complex than the (stem cell transplant) procedure itself, or so it seems. I suppose this makes sense, being that the very nature of a stem cell transplant (2 transplants in all) is so involved and brutal on the body, there needs to be adequate preparation. It’s not just relatively basic and seemingly simple stuff, like having my dentist sign off stating that any routine work has been done and in their professional opinion my teeth are fine and ready, etc.. It’s more timing and lining everything up so that it all is so methodically prepped and in place that, like clockwork, it follows a pre-determined, pre-planned, pre-mediated, schedule with such exactitude.
I’ll break it down by posting updates as things move along.
Right now the plan is to receive a single infusion of Etoposide on May 5th. Etoposide is a chemotherapy drug. I received it before in various regimens during my initial treatment. The idea behind just one, single, stand-alone dose is to push the body into generating white blood cells, to initiate a sort of overdrive in production. This is the body’s natural response under normal conditions while undergoing "conventional" chemo. To maintain health and immune support it, the body, instinctually generates white blood cells. Even though etoposide has cancer treatment and maintenance “benefits”, we’re using it to jump start white blood cell production. After a two day pause, just after the etoposide has flushed from my system and right when my body is in (white blood) cell production, I will start giving myself daily injections of a white blood cell booster. (Right now they’re deciding on which drug to utilize, but they all work similarly.) I had these before, however this was after the week of cisplatin-based therapy when my white blood cell was very low & dangerously so. After 10 days of forcing my marrow into overdrive production, I’ll go in for harvesting. Prior to high dose chemo, which destroys my marrow, harvesting is done so there is adequate platelets to replenish that which is killed off by the high dose chemotherapy.
As of right now, all of these procedures will be done at MGH. I won’t be inpatient until I start high dose chemo as this will require a sterile, germ proof environment. Yes, totally exhausting, I know!
More updates to follow.