A Few Hours of Testing Turns Into Fourteen

Mark and Dianna went to the hospital yesterday in anticipation of a few hours of testing. They arrived at 7:00 am for a MUGA scan at the Huntsman Center. A MUGA scan is an evaluation of the function of the heart ventricles. It provides a movie-like image of the beating heart and allows doctors to determine the health of the heart’s major pumping chambers.

Right after the MUGA, Mark and Dianna rushed to the University for a pulmonary function test. Everything went great and they were off for a break. They spent the time checking out their new digs for the next several weeks while Mark undergoes high-dose chemo.

At 3:00 pm, they arrived for the CT scan and chest/sinus x-rays, and were ready for their next appointment at Research Park -- the MRI. Mark and Dianna were surprised to find out that the MRI would take about 3.5 hours. The purpose of the MRI would be to look at each lesion at extremely deep views. Unforunately for Mark, there would be no music, no movement, and no cool air.

During the CT scan, the technicians found free air in Mark's stomach. BAD NEWS!!! They were worried that the air could be the result of leaks in his bowels, so Mark spent the next few hours drinking dye WHILE continuing his MRI session.

After the MRI, Mark and Dianna arrived back at the Huntsman Center around 7:00 pm for another CT scan on his stomach. They were told that there was a possibility that Mark would be ending his day in EMERGENCY SURGERY.

After some difficulty getting in contact with the PA to get directions on what to do next, they were finally able to reach Dr. Zangari. Apparently free air could be caused from the chemo or steroids that Mark had taken earlier, and that as long as no symptons were apparent, such as fever and tenderness, that they should go home. Mark was more than thrilled to hear that after spending what seemed like an eternity thinking that he would be getting his abdomen cut open.

Apparently chemotherapy can produce pin-size air bubbles. The bubbles can feel like the size of baseballs and can cause major pain and discomfort. Once the bubble pops, it will cause free air. In certain circumstances, free air is an indication that something is very wrong.

Mark is scheduled for another CT scan on Monday, along with lab work, an echocardiogram, and a bone marrow biopsy.

The GREAT news is that Mark is feeling really good despite the fact that their quick day of lab work turned into 14 hours!!!

Mark is scheduled to see Dr. Zangari on February 5th. The plan is to start high-dose I.V. chemo on the 6th, pill-form chemo over the weekend, more high-dose on the 9th. After that, they will begin the stem cell transplant.

Your thoughts and prayers are so appreciated.

Thanks for the support, David! It's not too late for anyone else to join the "Strapper 'Bald Head' Support Club".

Really Good News!!

Hallelujah! Mark's tandem stem cell transplant has been approved by Altius. Apparently approval of BOTH transplants is a first for this particular insurance company so this piece of good news was a bit unexpected.

Over the next couple of weeks, Mark will have to redo all the tests that he had done in the beginning (bone biopsy, CT, MRI, pulmonary function, and all the lab work). Then on February 5th, Mark will meet with Dr. Zangari to get the okay for starting the transplant process. If all goes as planned, that will happen on Monday, February 12th. The process will include high-dose chemotherapy, then two days of pills and labs, more chemo on the 4th day, then the transplant, which will take one to two days. Once the stem cells enter his bloodstream, circulation will deliver them to the bone marrow. This is called engraftment and will take up to 15 days.

Engraftment occurs when the bone marrow makes new blood cells after the stem cell transplant. After the stem cells are infused, the bloodstream carries them to the blood marrow. The body’s own chemical signals direct the stem cells to stay there, where they start to produce new stem cells and blood cells. In about 10 to 14 days, the marrow produces enough white blood cells to achieve an absolute neutrophil count of 500 or more for three consecutive days, when the transplant is considered engrafted. Red blood cell and platelet counts may take another one to two weeks to stabilize.

Mark's treatment so far has gone extraordinarily well and he is way ahead of most patients in the process. Hopefully he will be just as successful in this next step.

Dianna will need to find another place to stay in SLC prior to the 6th as The Chase Suites was not the most ideal place to live.

Number Six

Meet Kim Peterson. Kim is a Myeloma patient with Mark and wanted to join the "Strapper Support Group." Thanks for the picture, Denese!

One More For The Cause

Number FIVE and counting ...

A Show of Support

It didn't take long for Shane to jump on the bald head band wagon! You're awesome, Shane!! What a great way to support your Dad.

Mark is doing really well. So well, in fact, that he took the Peterbilt out for a drive the first day he was home. He told Dianna that he was just going to start it up for awhile. The next thing she knew, their house was nothing more than a reflection in his rear view mirror and he was on his way to Grantsville. Dianna called Timmy and told him to watch out for a masked bald man in a runaway truck. Like a good boy, Mark turned right around and came back home. Afterall, he is supposed to be using this time to REST at home!

Mark and Dianna would like to send out a special thank you to Dianna's co-workers for their thoughts and prayers, and the generous donation they sent. All your support is very much appreciated. It's great to know that Mark and Dianna have such wonderful and caring friends.

Here are some pics of Shane's noggin, along with one from Mark's brother, Justin. Okay, so who's next? Send pics to stefany[at]tigerjake[dotcom]. (You all know the correct email method -- I'm listing it this way in the blog to try to avoid spammers. I know, I'm a bit paranoid!).

It's Good To Be Home!

Mark is feeling great and really glad to be home with Shane. We'll know more about what the next several weeks will be like after his appointment with Dr. Zangari on Monday.

I've heard that several of you are still having trouble figuring out how to leave a comment. At the bottom of each post, you'll see the word "Comments". Just click on the word and it will take you to a screen where you can enter your note. There is a word verification step that you will need to complete (the purpose is to help reduce comment spam). You do not need to be a registered user. You can enter your comment as an anonymous user, but please be sure to enter your name in your comment so Mark and Dianna will know who it's from.

One last thing ... not all of you know Richie so I figured I need to rat him out. He's not really as heroic as he may have seemed in the last couple of postings. He's already bald -- lost his hair before he reached his 30's! Just thought I should be clear on that as he was feeling really guilty after getting kuddos for showing his support. That doesn't mean that all the rest of you should shy away from going cojack!

Mark's New Do

Home Sweet Home

Mark and Dianna finally made it home this afternoon.

For the past few days, Dianna has been finding Mark's hair all over the place. Shane is planning on giving him a little help with the assistance of some hair clippers. Stay tuned for pictures.

As mentioned earlier, Richie is sticking to his word of shaving his head in support. Wes, Kurt, Justin, Joe, Billy, Tim ... it's your turn!

Jackpot!!

YAHOO! They were finally able to collect all the stem cell's they need, plus more (25 million). Mark and Dianna will go to the hospital tomorrow for lab work and then they will be on their way home for a few weeks. They will, however, need to make a trip back to the hospital about every other day to be monitored and do lab work.

Mark has an appointment with Dr. Zangari on Monday, Jan. 26th. That is when they will set the start date for the stem cell transplant.

NOTE TO MARK: In anticipation of your hair loss, Richie would like you to know that he plans on shaving his head to show support.

Stem Cell Update

Today's stem cell collection only produced 6.0 so Mark will need to go back tomorrow for one more try.

Mark and Dianna will be able to go home after the collection is complete but will need to come back at some point to see Dr. Zangari.

The collection process is really draining on Mark, which is normal. The past several weeks have been draining on Dianna. Hopefully they'll both get to relax a bit once they're home for a few weeks.

Another Good Collection Day

Mark went to the hospital today for another collection appointment. He gave 6.5 today for a total of 12.1. Only 8.0 more! He received another Neulasta shot today so the tech anticipates that tomorrow will be the last of it.

Fortunately the bone pain is subsiding, however, he could hurt some in the next few days due to the shot. Dianna is making sure that Mark is taking the pain medications as needed to help with his discomfort.

More Collecting

Stem cell collection yesterday went very well. It took about 4 1/2 hours and they were able to collect more than they thought, however Mark is there again this morning for more. Mark said it was painless, although a bit daunting at first after noticing all the equipment in the room. It made him very tired though and he slept through most of it. Mark has had some serious bone pain that was keeping him from getting a good night of sleep so being able to sleep through the collection process was a treat.

Mark is one of the very few that have started collection before day #15 (he started on day #12). His white blood cell count never dropped all the way to zero before it started going back up. What this means is that he never lost his immune system completely.

After the stem cell collection is complete, Mark and Dianna should be able to go home for a couple of weeks. Their daughter, Brittany, is getting close to having a baby so hopefully the timing will work out and they will be home for that.

Collecting Stem Cells

Mark got the call this morning around 10:00 am to come to the hospital for stem cell collection. Hopefully they'll get what they need in one session. We'll update you on his progress soon.

No Stem Cell Collection Today

As of this morning, Mark's white blood cell count still had not hit zero. Once that happens, his count will begin to rise as he recovers from the chemo.

During the four days of chemo, Mark received a combination of chemotherapy plus growth factor. The process is called Mobilization and the purpose is to stimulate the bone marrow to release stem cells into the peripheral blood. Stem cell collection will begin when testing shows the desired number of stem cells in the blood.

Stems cells are collected through a method which allows the removal of only the desired part of the blood. An instrument called a blood cell separator draws blood from the vein through a tube to a centrifuge that separates the blood into red cells, white cells, and plasma layers. The portion of the white cell layer that includes the stem cells plus a small amount of plasma and red cells are collected. The rest of the blood will go back into Mark's body immediately, usually through the second lumen of the catheter, all in a continuous process. The volume of the collected stem cells may range from about ¼ to 1 ¼ cup.

Stem cell collection usually takes 4 to 6 hours, depending on the volume of blood the instrument processes, however it could take up to 5 days. Factors that influence the amount of blood processed will include Mark's blood cell counts, the stem cell count, cell dose needed, and Mark's size and weight.

After collection, the stem cells will be frozen in liquid nitrogen and then taken to the stem cell lab for storage until the day of transplant. Mark will then be ready to receive high-dose chemotherapy which is designed to destroy myeloma cells.

Mark's mom is staying with him today while Dianna takes care of some things at home. Dixie was excited to be able to spend more time with him.

Blood Counts

Mark has been feeling great the last few days. He has been taking about three or four walks a day around the hotel. His appetite is coming back with a vengeance. Last night he said that he talked Dianna into making him some goulash. He ended up eating two big bowls of it and then more later!

Speaking of Dianna, it sounds like Mark is taking full advantage of her willingness to help nurse him back to health. Remember what they say about paybacks, Mark (just kidding). Dianna has definitely been Mark's rock through all of this.

Mark's white blood cell count has dropped low enough (to 2.66) that he will no longer be able to leave the apartment except for visits to the hospital. He is at an extremely high risk for contracting infections. He will go to the hospital on Friday to see if it has dropped to zero. If so, they may be able to start stem cell collection a few days early.

Below are a few of his blood counts (as of yesterday) that they are watching closely right now:

2.66 - White Blood Cell Count (should be 0 by Friday)
3.85 - Red Blood Cell Count (normal is 4.5-6.0 m/uL)
13.2 - Hemoglobin g/dl (normal is 12-16 g/dl)
238 - Platelets (should be less than 30)

The following link will take you to a document that explains the counts in detail: Blood Counts

Oh, and one other thing -- NO HAIR LOSS YET!!!

Finished With Chemo

Mark was disconnected from chemo on Saturday, which had been the worst day for him so far as he was very sick and struggling with eating.

Mark's mom stayed with him on Saturday afternoon while Dianna went home to take care of some things. She brought Mark a new little remote control car to chase Dianna around with, and you know that kept him entertained for awhile! Shane came back with Dianna on Saturday night and stayed through Sunday. Shane and his dad played games and watched a movie.

Dianna took Mark to the hospital yesterday to get his Neulasta shot. His blood pressure was low and they were going to give him some fluids, but determined that the blood pressure drop along with some hot flashes that he was having were probably just caused by his fear of needles. He has been fine since then and Dianna is finally getting him to eat something.

While he is Neutropenic, Mark will have to wear a mask whenever he is outside of the apartment.

Mark is feeling pretty good today and has been able to keep food down for two days now. He will go to the Blood & Marrow Transplant Unit for lab work this afternoon and then tomorrow will be a rest day.

Day Four

Today hasn't been a good one. Mark is very nauseous and sick, and has started on an additional nausea pill. He is borderline neutropenic, so by tomorrow, his white blood cell count will be down to a level where he'll need to be very careful about everything he eats and does. Neutropenia is a hematological disorder characterized by an abnormally low number of white blood cells called a neutrophil. Neutrophils usually make up 50-70% of circulating white blood cells and serve as the primary defense against infections by destroying bacteria in the blood. Patients with neutropenia are more susceptible to bacterial infections.

It will take a couple of days for the nausea to go away once Mark is disconnected from the chemo, however the lethargy will continue for awhile. He will be disconnected tomorrow around noon and then will receive a white blood cell booster shot called Neulasta.

Dianna is hoping that things will be stable enough that she can run home tomorrow afternoon to do laundry and then bring Shane back with her to see his dad and stay for the night. Dixie will stay with Mark while Dianna is gone.

Chemo Day Three

It's day three and the chemo side effects are starting to rear their ugly heads. Mark woke up this morning not feeling well. He started taking one of the nausea pills -- once before they change out the chemo bag and then every four hours after that. As the nausea gets worse, he will add the other types of medications as needed.

For those of you that know Mark well, this next bit of news will come as a shock. He gave himself the shot last night -- right in the stomach!! He was a bit shaky but did it with no help.

Besides the nausea, Mark is a bit queasy, tired and beginning to lose his appetite.

Second Day of Chemo

Yesterday was Mark's second day of chemo. Mark's mom, Dixie, came by for a visit so that Dianna could show her how to take care of him at times when Dianna needs to be away to run errands, etc. Dixie will need to learn how to give Mark his shot, so she will be practicing on an orange. Mark seems to be doing well right now and his spirits are up. He has a great attitude and is staying as positive as possible.

First Day of Chemo

Today was Mark's first day of chemotherapy and everything hooked up fine. The chemo will flow from a bag intraveniously through the catheter in his chest. The medication will run for 24 hours a day for four days and will be changed out every morning. The tubing from the bag to his port is only about three feet long so it won't be leaving his side. Mark is doing okay so far but commented that he has two "Ole Bags" now.

He is taking a total of 13 pills a day, many of which are for the prevention of bacterial and viral infections. He also has three additional medications that he can take if needed for nausea. To top it all off, Mark was surprised by the fact that he will need a daily shot of a blood thinner medicine right in the stomach. NOT what he wanted to hear! He started that today and will need to continue the daily shot until the specific count they are watching goes from 292 to 30. Not sure how long that will be but it could last through the stem cell replacement phase.

By the way, I have changed the setting so you do not have to be a registered blogger in order to leave a comment. Anyone can leave comments without having to log in -- so please do.

When It Rains, It Pours!

Yesterday Mark had his central lines placed. Everything went well but Mark was definitely not happy about having it done. The central line is a catheter placed into a large vein in the chest used to administer chemotherapy, medications and fluids.

Regarding the move into the Chase Hotel and Suites, things certainly didn't go as smoothly as they should have. When Mark and Dianna arrived, they found that their room had been given away to someone else. The Chase gave them another room down the road but unfortunately this room was far from ideal (bugs, faulty toilet, etc.). Somehow they were able to get the person that took their original room to move out so they were able to move in. All issues resolved, right? NOT!! The person that had temporarily stayed in that room was a smoker (even though the room is designated as non-smoking). The housekeepers were very helpful though and put air purifiers in the room last night and wiped it down with bleach. They also helped Dianna carry their things into the room. Hopefully Mark and Dianna can settle in okay and be comfortable for the next several weeks.

If all that wasn't enough, as they were driving to the store last night, a small chip in their car windshield turned into a large crack from one side to the other. Can anything else go wrong??

Other than that, Mark is doing great. He was in pain quite a bit last night but is doing much better today. Home Health came by for a visit this morning and taught Dianna how to take care of the lines and change the dressing. Dianna said it won't be as bad as she thought. Mark was finally brave enough to look at the line placement this afternoon. Home Health will be back tomorrow to check on him.

By the way, they have internet connection so please leave Mark and Dianna comments here on the blog. They will be so pleased to hear from you all as your support and encouragement is needed and much appreciated.

Happy New Year!

p.s. Notice I put "2008" as the date on the pictures below. I'll be doing that for at least a month!