Thursday, May 30, 2013

Go Donate! Part Three - You Are the Chosen One

So hopefully you've decided to join the bone marrow registry and you have completed Step One and Step Two. Now what? Well, hopefully you'll be chosen to save a life. As the Chosen One, you will undergo a procedure to harvest your bone marrow/stem cells (see this post for more on types of harvesting transplant material.) 

The procedure depends on the patients needs, so I can't really tell you exactly what will happen. However, I can share with you my sister's donation experience. The procedure she underwent is the most common procedure employed these days because it is safer and less invasive for both recipients and donors.  

Below is an account written by my sister. I've added pictures and diagrams to help. My comments are in red. 

Enjoy, Chosen One! 


I am so grateful that I was a 10/10 match for Wendy.  I had no idea what donating method she was going to need, from something as extreme as a bone graft to a peripheral blood stem cell (PBSCT), but of course I didn’t care. After we found out I was a match, I knew I had the easy part. It was Wendy who had the hardest job.

Check out some of what I had to endure here and here and here.

Wendy’s BMT doctor recommended a PBSCT, where stem cells are collected by a process called apheresis (explained below). The whole process was pretty simple for me: there were only 3 steps I had to take after finding out we matched (see more on HLA-matching here).

Step 1: Get some blood tests!

About a month before collection I did some blood tests to make sure I wouldn’t give Wendy any additional diseases like Hepatitis, (yea that is not a great way to treat cancer.)

Step 2: Get some shots!
For 5 days prior to collection I went to the apheresis room at Cancer Clinic and got a little shot in my stomach. They like you to do it around the same time each day, but I didn’t even need to make an appointment. 

The needle is the same size needle as insulin needles that diabetics use. 

The injection is a drug called Neupogen which boosts the number of stem cells in my bloodstream (see this post for more info on where you can harvest bone marrow/stem cells). For example, normal white cell count is 4,250-10,000 cells per millimeter cubed and on the day of collection, my white cell count was 66,000!! I felt like a super hero. (My counts returned to normal levels in a few weeks and I was once again just a regular person.)

Neupogen is the shot I would get to help boost my white count when I had fevers in the hospital!

The only side effect I experienced was slight soreness in my bones. I just took Ibuprofen and that was enough for me. I know they would have prescribed me something stronger if I said I needed it, but I didn’t. The soreness was in my lower back, but it was similar to achiness I would get when I was on my period. Sorry men, this comparison probably doesn’t make sense to you.

Step 3:  Apheresis/Collection day! 

Apheresis is the process (described further below) through which stem cells are harvested from the donor's blood stream.

The machine working away:

My Collection Day was Wendy’s transplant day. That seemed amazingly fast to me. Every PBSC donor collects about 4 cups of fluid (took about 4 hours for me which is average) and the goal is to collect at least 1-2 million stem cells per kilogram of the recipient’s weight. 

I arrived at the apheresis room early in the morning on May 29th, 2012. (My transplant was scheduled for 4 PM that same day.) The room was nice and private-ish because it was a small room with just 6 patient chairs and a staff of 3-4 specialized nurses. They gave me a medi-bracelet, and I went to the restroom (a very important step) before they hooked me up.

The nurse hooked me up to the apheresis machine by putting one needle in each arm. I asked her put the needle in my forearm after she started feeling around my wrist for a juicy vein (personal preference). So the way it works is that the blood from one arm goes into the machine where it removes the stem cells (along with a small amount of plasma and red blood cells) and returns the remaining blood and plasma back to me through my other arm. It’s sort of like a dialysis machine. I never felt any different because I think there was only a half pint of blood outside my body at a given time. The entire process was painless for me, minus the small pinpricks when they hooked me up to the machine.  The nurses were so nice to keep me comfortable; I think I was under 5 blankets! (hospital blankets are kind of thin….)

My chair was a very comfy, electronic recliner with a personal TV hooked up to it. There were a few other donors in the room (donating various blood fluids) who were reading, napping, watching TV, or on their computer. I knew I was going to be there for about 4 hours so I brought some home videos to watch on my laptop to help focus my energy on what and why I was going through this process.

Aw! All cozy! I was already in my hospital room, awaiting my new stems cells, so I didn't get to see any of this. (She's not a morning person and was really tired when this picture was taken.)  

While I was donating, my parents were in the main hospital in Wendy’s room, but they each came to visit me for maybe 20 minutes each. They just visited for a just short time each because I had told them I preferred to mostly be alone so that I could just focus. And that is what I did for the most part of 4 hours. No TV. No reading. I tried to focus on what I was doing. I would try to visualize in my mind and I would say things like "ok cells, you are just going to a new home”, “we are the same, we are the same", "Heal her, heal her", and just tried to focus on positivity and just love. I just wanted to do my best to donate and also focus on healing and tell my cells to not attack her. (Stay tuned for my post about graft versus host disease.)
I won't say the hours flew by quick, but I was surprised when I realized it was almost over. I was comfortable almost the entire time. It was only about the last 45 minutes that I felt uncomfortable from not being able to move my arms. During that time I had to put more energy into not thinking about it and not let the time and stiffness bother me (I did not want any negative feelings to attach to my collection).

Then it was over. 

They unhooked me, I had some juice, I went back to our rented condo to take a nap, and then returned to the hospital to wait with my family for the stem cells to get delivered.

Wendy needed at least 3-5 million stem cells for transplant. I collected 18 million! (The power of positive thinking!) The whole transplant thing was so simple to me. I came in the morning for my collection, then my stem cells got sent to the lab to count/estimate the number of stem cells in the collection, and then late afternoon the bag of fluids with my stem cells was transplanted into Wendy! It’s weird man, but I am so happy and grateful that this was possible.

Overall Time Investment: 

I really wasn’t concerned with with these details as you can imagine. But if you are curious, here is some info about how long each step took:

- Getting my blood tested: I probably did this on a weekend day or after work and it took 5 minutes maybe.

- The 5 Neupogen shots: I would say this took 15 minutes out of my day for 5 days. I know of a person who signed up for the bone marrow registry through their work and when that person got matched to a recipient, a nurse came to his work to give the shots! That is cool.

- The day of the collection: I woke up extra early and spent 4 and a half hours in the chair. I took a nap afterwards because I didn’t start my job yet, but if I had chosen to work that day I would have been able to. So I would assume the average person would be able to do this and only have to take half a day off of work if they needed to. I think my work even lists this as an official absence: ‘Organ donor/bone marrow’. Pretty cool.

Also the majority of insurance covers all donation procedures. My insurance covered my sister's donation process.

Please contact me through the comment section if you have any questions for me!  I can also email you personally if you prefer to ask privately.

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