Re-induction Update

So I've been back in the hospital for two weeks now, I finished the last dose of chemotherapy a week before last Friday, and have been waiting for my numbers to drop and rebound. Right now my ANC (immune system cells) are practically zero, white blood cell count is at 0.1; hemoglobin and platelets have dropped and I've had some transfusions, a couple red blood transfusions and a platelet transfusion.

I've been walking a lot, usually a two or three miles a day, often without supervision, which is nice, because I haven't had issues passing out in months, and have been feeling pretty good. 

Because today was day 14 since beginning the “re-induction”, they did another bone marrow biopsy. When I came in this time my doctor told me how the first time they did a bone marrow biopsy back in February, my marrow was 100% leukemia cells, and after that first induction it was down to 5%, and after the first re-induction it was clean, which is considered remission. This time the bone marrow was 5% leukemia cells, and we used a different pair of chemotherapy drugs, because it is assumed that the leukemia cells which survived the previous drugs are most likely ones that have adaptations that protect them from the previous drugs. So I'm not worrying much about whether this one worked or not, though I didn't really ask the doctor about odds specficially, so I guess I'm a little uncertain in that sense.

Assuming the biopsy they did today is clear, and I'm again in remission, the plan will be for me to wait here until my ANC recovers, and then probably head straight to Boston to begin the transplant process. If I'm weak they might send me home to regain strength first, but I think I'm pretty well in that respect, probably mostly due to the daily walking. I feel quite well, though I think my hair is beginning to fall out again, which is expected, and my taste may be getting weird, which may be an indication of my tastebuds dying off, which is also expected, and also tended to happen with each of the consolidation chemotherapies.

Meanwhile my app broke when Apple updated their operating system to iOS 10 recently, so I scrambled to update it, and today it got approved and updated in the App Store, which is a relief. It also served as a refresher course in programming, which is good because I have some ideas I want to explore, to get more comfortable with what I'm doing. So I'm excited about that.

Other than that I've got a lot of waiting and time to kill. I'll update again when I know something about the results of the biopsy!

Reinduction

So I was re-admitted to the hospital on Monday for another round of induction chemotherapy, it consisted of two new (to me) drugs, each administered once a day for five days, so last night was my last dose of each. Now I'll be hanging around for the next three weeks, waiting for my counts to drop down and then rebound, after which I'll head to Boston for the transplant process.

So far it's been pretty easy going, I've been walking a lot, which is both good for my health, and allows me to avoid painful shots in the stomach that they give to most patients to help avoid clots from forming in the calves. Today they disconnected me entirely so I can walk around without pushing the pole of fluids with me, which is nice too. It could be a little rough over the next two weeks, I'll probably need some transfusions as my blood and platelets die off temporarily, though it shouldn't really be anything I haven't already seen in the past.

I have a lot to work on, and plenty of distractions. I should make more of an effort to try out some things, and I also have to delete photos to make room on my computer and my phone. That's all for now!

Less than Ideal News

So somewhat bad news, they called me back yesterday because the cytogenetic analysis of my bone marrow indicates the leukemia is still there, so Monday I'll be readmitted at Dartmouth Hitchcock for another round of induction chemotherpy — it'll be a lot like the first two rounds I went through, but not the exact same since whenever something survives one treatment they try to come at it from a different angle. I don't know the details exactly but my guess is it'll be about a week, and after that they'll try to go right into the transplant process, so I'll be moved down to Mass General.

It's scary, which I'm sure is natural. Though I feel somewhat prepared, since the original cytogenetic analysis indicated it was likely to come back anyway, and also because I figure the next step was to knock out my immune system entirely to prepare it for the donated immune cells, so it seems like another round of induction fits in well with the planned process anyway. That's just speculation though, I'll ask the doctor Monday and get a better idea of what I'm facing, and try to keep this up to date.

Labor Day Weekend

Another few weeks have passed, mostly without anything significant happening, except they asked me to go in for another blood count like a week ago and my white blood cell count had dropped pretty dramatically, down below 500, meaning I was neutropenic again. I found it concerning and so did the doctors, so they did another bone marrow biopsy on Wednesday, and on Friday told me they weren't seeing signs of the leukemia (which was sort of the only possibility I really thought about it; seemed likely it had grown back and was crowding out healthy cells again). It's weird reading back through all that, it seems like it was going much slower. If it had been the leukemia returning, I would have done another round of induction chemotherapy and then they would have moved me into the transplant process right afterwards.

So it was good it wasn't the leukemia, though it still isn't clear what is going on. The doctor said it could be a virus or other infection, and when my body overcomes it the ANC would bounce back, so they're going to track me for a couple weeks and do another bone marrow biopsy if I don't get better in that time. By Wednesday my ANC had dropped further, so I'm back to taking an antibotic and antifungal, and avoiding public, and crowds, and kids. In some ways it didn't concern me much because it seems like wiping out my immune system entirely is the next step anyway, and this would sort of be a head start. 

They started scheduling appointments for a transplant in Boston, but that'll probably be pushed back some dependingo on whether I return to normal soon or not. My red blood cell count ticked up slightly, so that's also good news. But it's still really low, and I get light headed a lot standing up. 

So I think it'll be an uneventful Labor Day Weekend for me. But so far it's been really nice out. And Stefan and Justine both visited which was nice. 

I started playing with twisty puzzles again, a few my cousin Kirsten sent me that I did solve but tend to mess up while soving a lot of the time. Or can't reliably solve particular problems on them. I'm actually messing something up right now where I can't quite solve it. And normally I figure these things out on a normal Rubik's cube, which I have somewhere still, but seemed to have misplaced. Which is mostly annoying because there aren't really a whole lot of places to look. Seems like I should have seen it by now.

Anyway, the transplant process is still moving forward, I should know in another week or two when exactly. I'll try to keep this a bit more up to date as things are happening, if I can.

Summer Update

So without even realizing it I neglected to post for almost an entire month!

The third round of consolidation went well, much like the second round — I walked a lot, I felt okay.

But a few weeks afterwards, around my immune system's nadir, I woke up with a fever, which put me back in the hospital for eight days or so. I also passed out twice, once the morning I had the fever and once the morning before that. I knew my hemoglobin was really low and I should have gone to get a transfusion, but it didn't seem like that big a deal at the time. Luckily all that worked out fine, but it was a miserable time in the hospital, I had fevers most of the time I was there, which made them reluctant to give me a blood transfusion, since if my temperature went up a degree during a blood transfusion they'd have to stop and write it up as a potential reaction, even though it would probably just be due to the fevers I was already having. So that first night they would pack ice under my armpits and behind my head to keep my temperature down. My hemoglobin was really low for a while, as low as 5.6, which I think is far lower than it has ever been before. (Normally in the hospital they would give me a transfusion when it was below 7.)

All ended more than a week ago. Then I got to spend a day with Allison & her family that Friday, which was really nice. 

Sometime in the last month I had another appointment in Boston with the doctor and team of people who are going to do the transplant. The plan right now is to have one more appointment to go over everything in late August, and aim for the transplant process to start early in September. It'll probably be about a month in the hospital, I'll get another dose of chemotherapy drugs that is more intense, like the first two treatements, with the intention of destroying my immune system completely. Then they'll take bone marrow or possibly just stem cells from the bone marrow of a donor, and give them to me much like a blood transfusion, through a vein. Then ideally the donated cells will embed themselves in my bone marrow and begin to grow as my own immune system. 

One of the bigger concerns is that the donated immune system might see me as a foreign invader, and attack me, which is called graft-vs-host-disease (GvHD). So they'll be watching my skin, lungs, and liver, for signs that the new immune system is attacking those organs. This will be a risk for the rest of my life, but I think it is immediately afterward that will most likely be the biggest risk. From what I've read and watched videos of people who've gone through this, a little bit of GvHD is actually a good thing, as it indicates the new immune system is growing and functioning, and there is even a graft-vs-tumor-effect, where the new immune system actually sees my old immune system, in particular the cancerous immature blast cells, as invaders, and actively seeks them out and kills them. If I do have problems with it, they may treat me with steroids, though I don't actually understand the mechanism there. The doctor also mentioned that there has been some recent success with partial match donations being treated with some chemotherapy after receiving the donation, which is counterintuitive, as that is when you would expect the donated immune system to be most vulnerable, but apparently it can help with the process. (Whenever I hear “graft-vs-host-disease” I think of David Cross's character Tobias in the show Arrest Development, and how he developed GvHD because of his hair plugs, so they threw a fundraiser for him and then everyone revolted when they found out it was just his hair plugs causing the problem.)

Beyond that the other major concern is probably infection, so they want me to brush my teeth four times a day, which I'm not used to but am sort of looking forward to I think. I've always had a poor opinion of my teeth — it seems like I've had cavities virtually every dentist visit of my life, and I've gone pretty regularly every six months for years. But one thing I've had a problem with for years is my habit of brushing in the morning, which for me didn't develop as something I do in the morning, but as something I do before I leave the house. So on the many days where I don't leave the house (especially as someone who worked from home before quitting and working for myself, (or trying to at least)), there are a lot of times where I brush either very late in the day, or just once before bed. But I have flossed regularly for most of my life, and used a rinse for most of my adult life. A lot of that has fallen apart during these long hospital stays. I wasn't allowed a tooth brush for much of my stays (they worry about bleeding with low platelets). So I think that's why I'm kind of looking forward to scheduled brushing four times a day.

After that first month they'll still keep a close eye on me, I think for at least the first 100 days. After that it'll sort of be the next five years of checking to see if anything grows back, if nothing shows up that would imply I've been cured, I think, is the idea. I know with some cancers it's never really clear whether you've been cured, there's always a risk of even a lone cancerous cell you missed growing back to overwhelm things again given enough time. 

I read an article a while back about research into giraffe evolution, which involved some gene sequencing to match it's closest living relatives, and then comparing the two genomes to find out what evolutionary changes occurred to make giraffes unique, and one of the interesting discoveries were genes that helped the heart be able to pump blood all the way up the neck, I think. And then the article ended by mentioning how because elephants are bigger than most animals, it was thought their rates of cancer would be higher because they have more cells in their body each with the same potential to go haywire. But they don't, and now it's thought they have some genetic mechanisms to help avoid cancer, and since giraffes are also very large, they expect giraffes to have similar adaptations. I found all that interesting, I had never considered it before. It made me wonder about whales too. And recently I saw a lot of headlines about research that shows a kind of shark that lives for several centuries, one headline said it doesn't reach sexual maturity until it is 150? But I didn't read any of the articles about it.

I think there are muscles or clams or something that live several (~4?) centuries, and are able to reproduce well into their second or third century. I think the next few centuries of human technological advancement will see us figure out how to incorporate many of those benefits into our medicine, and likely take complete control over our health, to a degree we can't really imagine yet, in much the same way people from a few centuries ago could hardly imagine the things we're able to do right now. Only the changs ahead are probably much bigger, because we're beginning to understand how we work on a fundamental level now. Though I'm skeptical of claims that we'll improve our lifespans dramatically. I'm sure we'll do that eventually, but in the foreseeable future it seems like the problems caused by aging will remain.

But I digress.

For now I'm just enjoying the summer weather and trying to advance the projects I find interesting. Also I need to hurry up and sell my car! And renew my drivers license! I bought a shiny copper plated colander to wear while getting my photo retaken, but I'm nervous about wearing it, I'm not really one to cause a scene typically.

Anyway, my cousins have mentioned a few times now that my comments seem to be broken, so they can't leave messages. I need to figure that out too!

Third Consolidation

So I'm back up at Dartmouth Hitchcock for a third round of consolidation chemotherapy. It started yesterday afternoon and if all goes to plan I should be heading home Monday evening after the last dose. The last two went well so I don't expect this to be too different, they let me walk a lot and that allows me avoid these painful shots in my stomach that they usually give daily to most patients to help prevent blood from pooling or clotting in the legs. The shot is usually painful, first with the pinch of the needle, and then with the stuff they inject, so the nurses don't like giving them either, so it's a win-win. Plus, walking is probably my best bet at keeping my health up for the next step, the bone marrow transplant, which is apparently going to be a much harsher and longer process than these consolidation chemotherapies (which really havent't been too bad, the complications in the weeks following have actually been worse, the nosebleed and the fever, but even they were relatively tolerable).

I got to see Allison a few times before coming back in, which was just great, hanging out with her really helped take my mind off things some. Not that I completely forgot whats going on and what lies ahead, but it stopped occupying my attention so much, which had started to happen for a while I think.

I forgot my phone cord so my phone is about to die, but I have my laptop and cord, so email or facebook are reasonable ways to contact me, or leaving a comment here (though my cousin said she couldn't? I haven't been able to figure out any problem with the commenting yet).

My plan was to go back to programming some, but without being able to test it on the phone it'll be hard to go to far. Stefan also left me with plenty of reading material, and I still have a book Jared lent me that I haven't finished, so I guess I should spend more time with paper and less time with liquid crystal displays.

Guess that about sums it up for now!

An Upcoming Third Round

My updates have been infrequent lately, I suppose because I don't think there has been much to report. 

I had a folllowup appointment yesterday, my platelets and ANC have recovered well, which is nice, but my hemoglobin remains low, which just means I tire easy, and get a little dizzy when I first stand up, or take too many deep breaths in a row.

On Friday, July 1st, I met with the transplant doctor and her team, in Boston, to begin learning about the entire transplant process. She figured it'd begin in about six weeks, after they've checked me out thoroughly and decided I'm ready. I need to get a dentist appointment to make sure my mouth is in good shape before we begin. And they don't really like going more than I think she said 8 weeks between consolidation chemotherapies and the transplant process, so I'll be back at Dartmouth Hitchcock next week, probably Thursday, maybe Wednesday, for another round of consolidation. Mostly the consolidation chemotherapies have been pretty tolerable, though the complications afterwards — the nosebleed the first time and the fever the second time — resulted in a lot of unpleasant experiences. It feels like each one is teaching me to be more cautious about some aspect following the chemotherapy. After the nosebleed we took some extra precautions to keep my nose clean and less likely to bleed, now I'm going to take further precautions in the weeks my ANC bottoms out, make sure to wear a mask anytime I'm in public and so on.

The transplant process is going to be much longer, and tougher, than what I've been doing for consolidation. The chemotherapy will be much more potent, as it's intention won't just be to keep my immune cells somewhat suppressed, but to actual wipe the immune cells out more completely, in preparation for a donor immune system to take hold. Typically this process requires three or four weeks of hospitalization, after they wipe out the immune system, receiving the donor immune system is basically like a blood transfusion. Then hopefully it grows into my bone marrow, and begins to provide me with a new immune system. There is some concern about the new donated immune system attacking me as if I were a foreign invader, that's called graft-vs-host-disease, or GvHD, it's similar to the kinds of rejection they worry about with organ transplants, only in that case it is the recipient's immune system attacking the donated organ, in my case it'd be the donated organ attacking other stuff. The main targets tend to be the skin, the lungs, and the liver, and the doctors will provide some treatments if I show signs of those problems. I saw a video a while back on bethematch.org where people who've gone through this said it's actually good to have some minor symptoms of GvHD, because it means the donated immune system is working and taking hold, and there is even an effect called graft-versus-tumor, where the new immune system attacks the old one and helps kill off any remaining cancerous blast cells. There is about a 10-15% chance that the process kills me, and about a 50-60% chance that it cures me. I didn't ask, but I think that remaining 25-40% chance that I survive the donation process but the leukemia returns, at that point we start discussing other treatment options, I suspect probably clinical trials because I think this is the only real standard way to treat aggressive leukemias at the moment. 

So that's where my adventures in health are at the moment. Mostly a high degree of uncertainty, some unpleasant future stuff, but I'm glad to be born at a time when we know at least somewhat how to deal with this problem, and not decades or centuries ago when it would have just killled me right away.

Other than that I've been skipping around between projects, trying to focus on some experimental camera app idea. I got a lot of photos of the Fourth of July fireworks with my app trippygram, which I've been sharing on Instagram. I also made a snowflake gallery, though it's terribly mismanaged, I need to delete about a hundred photos probably. At least the ones that are very similar to one another. I got tired of sorting through them trying to decide which was better. 

The Last Few Weeks

So I haven't updated in a while, sorry about that.

Two weeks ago, on Friday the 17th, I measured a fever taking my temperature before bed — I wanted to go to bed so bad, it was 1 in the morning and I had been up at 730 for doctors appointments, things were mostly okay but I kept needing blood transfusions, I had had one that Friday, along with both blood and plasma transfusions both previous Thursdays and that previous Monday. So I had been up pretty early (for me) for a few days, and really wanted to go to bed, but I measured my temperature multiple times and mostly got above 100.4 F, which is where they want me to call and go to the emergency room, in case I have an infection. (Because without an immune system an infection could grow out of control quickly, and without many white blood cells I probably won't even show many signs of infection, no inflammation really.)

So they put me on really strong antibiotics for a while, my fever went away after a few days, but they wanted to keep me until my ANC had returned to at least 400. On Sunday I calculated it to be 504, so they sent me home. I tried plotting all the measurements I could find for how my ANC had changed over previous weeks and treatments, and this one fit pretty well in those ones. Though some of the antibiotics I was on most of the week, I think they said they can actually have a supressive effect on my immune system, so we were kinda tugging in both directions. 

Anyway, I'm all better now. Out of the hospital. Platelets went from like 27 to 50 in the last couple days at the hospital, so I'm not worried about bleeding, but my hemoglobin was still pretty low and I can definitely feel myself getting easily winded by just a little moderate exercise. Because I was in the hospital all week I had to move my appointment in Boston, where I'll start to get to know the doctor doing the transplant. So I'll meet her this Friday instead. Which meant I also pushed back a bunch of appointments for this Friday in Lebanon to next Friday. Last time (two Fridays ago) I met with a doctor I didn't know well, who thought we might do a third round of consolidation chemotherapy in a few weeks. I wasn't expecting that but the previous two rounds have been fairly easy, to I'm not too concerned about it. Apparently the chemotherapy for the bone marrow transplant is more severe, and is more likely to be another month in the hospital, so I'm trying to mentally prepare for that I think.

Now I'm working on another toy I started designing a few years ago, one that will need a few test prints I think, which is what held me up before.

More Transfusions

Another transfusion appointment went well today in Manchester — my hemoglobin was 7.6, platelets were 6, and my ANC was 20, so I had transfusions of the first two, and won't be going out in public much this week, if it can be avoided. I'll find out again, either Wednesday, Thursday, or Friday. 

It has me wondering how much a platelet (or blood for that matter) boosts those measurements, since I think I was 16 for the platelets on last Thursday, when I had a transfusion last, but it still dropped to 6, just 4 days later. But we can only sample it so often — sampling before and after a transfusion seems wasteful and impractical. If I can remember I'll ask if the doctors know on Friday.

As far as work goes, I'm back to working on another old toy/jewelry design in Blender, this one based on hypocycloids. I got pretty far on it originally but it was never clear I could get it to stay aligned, and I wasn't looking forward to iteratively determining what was feasible, but since Collin has a 3D printer handy it seems more feasible to give it another try.

Another Nadir

So I had a checkup today, platelets and hemoglobin were pretty low (14 and 8.3 respectively) so they gave me transfusions for each of them. My ANC was low, 740, but not neutropenic, so probably I'm still on the way down, and gonna bottom out some time in the next several days. I'll be avoiding public for a while, again, which is all expected.

Programming-wise I've been learning how to incorporate Objective C code in with the Swift code I work in by using a bridging header. Expanding my understanding of how to program feels really good, and should pay off as better software in the end. This should make it easier for me to get permission from the user to use the camera, and store photos, and maybe resolve some of the issues I had originally with it not granting permission the first time — which I think I solved, but was told there were better solutions still. Also it should let me handle metadata finally, which I've been struggling with. I can get the original metadata when the photo is taken, but never figured out how to save it with the resulting photo. I'd also like to add a “made with” tag in the metadata, so maybe I can do that soon too. Then I may need to have an actual privacy policy...

I made a tips & tricks page a while back, because I know I've learned a lot over the years about what works best in certain situations, and it would help if I could share that with other people. I should probably try to streamline that page as much as possible, and then incorporate it into some kind of help/tutorial/introduction to the app. So any feedback on that page would be greatly appreciated!

I haven't worked on zeeify lately, and am going to shift it to spectrify, which will take a series of photos and use a cheap method of edge detection and then use the same kind of colorization schemes trippygram uses — mostly because this will all be easier to do and I'm curious what the results will look like. Plus if I'm going to colorize them, it won't matter so much that I've used a cheaper method to cut out the sharp stuff. 

And all that should keep me plenty occuppied for a while. I was thinking recently I should apply to be a substitute teacher, but I feel like I need to wait until my health situation is more stable, maybe after the transplant process, if that all goes well, maybe as I recover I'll be able to do something like substitute teaching. Guess I'll wait and see!