We Know More Now

In brief:
Jon was admitted to the hospital last night because they found staph in a blood culture. Started him on IV vancomycin. This afternoon we got to talk to Dr. Borello in person (he is now the top transplant doctor here, he was Jon's doctor 11 years ago) and he decided that Jon will have enough stem cells tomorrow and he will be collected tomorrow. He is confident that it will go well.

In more detail:
When he was admitted to the hospital last night, he was assured by the attending, Dr. Swinnen, that he would be back out this morning after his dose of antibiotics.  Of course that ended up being optimistic.  They did do another CD34 (the one that looks for stem cells) and the results showed a slight increase, but not much. For many days it has been stuck at 0.02, today it is 0.03. This feels discouraging, but we don't know very much and information is given out in small batches. When Dr. Swinnen came through on rounds at about noon -- with a silent entourage of medical students and other doctors and nurses -- he said that the decision about how to proceed would be Dr. Borello's to make.  With the increase in white blood cells, his numbers are borderline.  Dr. Swinnen said, Dr. B will decide whether to persist.  This caught our ear. And then Dr. S noted that and said we should not second guess. We should wait for Dr. B to make the decision.

So then Jon told the nurse (who has been in hem/onc for 28 years, working in the IPOP and on this floor) that he wanted to see Dr. Borello. He wants to be part of the decision-making. The nurse said she would send that message.

At 2:10, Dr. Ivan Borello walked in the door. We haven't seen him since 2012. He remembered us because Jon was part of one of his studies, and they do about 129 transplants a year, so it's not that hard to remember people, I guess.  He answered all Jon's questions and he explained how they do the calculations about whether there are enough stem cells (he got out his phone and showed the multiplication of white blood cells times CD34). He says the minimum number to collect is 10 and Jon is at 12, so we could have done it today. But they have a policy/goal of collecting only once, which is different from other transplant centers. They calculate to try to find the best possible day for the one collection. He decided while he was here that tomorrow is the day, and Jon will continue with another round of both types of bone marrow stimulants. He said that the reason Jon is not generating stem cells  at the desired rate is probably that he has an infection somewhere and and this is affecting his stem cell making somehow. He pondered whether the regular chemo had been stopped early enough, and he decided it had. He said that he is certain that a second transplant is not the problem -- they don't see many of them, but this is not a factor.

Anyway, we feel MUCH better. It was great to be able to talk to the person who knows the most, who knows Jon, who is making the decisions. He spent 20 minutes here reassuring us that this will work, he rarely sees a patient who cannot go through collection (sent one home recently, coincidentally) and he is sure that this will go fine. As our friend HG said, he is an old fashioned healer. And he is really nice.

Because Jon is now a Medicare patient, there are bureaucratic issues to work out with getting the antibiotic as a home-administered drug. It will take a while to get the meds from Kaiser, have them delivered here, have someone remind us how to do this (we did it last time, but we need a refresher). When she heard about this hurdle, Alissa said she had never discharged a patient on the same day as the orders went through for drugs to go home. So we were forewarned. Jon will be here one more night.

I personally had a wonderful day yesterday, being outside, doing everyday normal things, helping to push the season along. There was one task that ended up being too complicated for me to do alone, and Benjamin and Stephen both were nearby and came to solve the problems (three pallets of potatoes at the front end of a 40 foot tractor trailer, each weighing 2000 pounds, no pallet jack) and they got the potatoes unloaded without disaster. Since I am supposed to be a reliable caregiver, I cannot take risks that will keep me from my most important job, so I was glad to be rescued.  And then Carrie and I laid the first plastic of the year and it went perfectly -- that is so unusual. And at the end of the day I got to babysit Mika, which brings me nothing but joy. I will miss her very much during the rest of this exile, but I am glad to have had this month of delicious Mika time.

So, tomorrow we will be where we hoped to be a week ago. We don't know the rest of the schedule but that will become clear eventually. It feels good to be reassured that this will work.