D+17 - Almost home

Christmas Eve and Christmas night were finally fever free nights, and on the 26th, Courtney was feeling so well that the doctors actually told her she could probably go home on Friday, December 28th. Needless to say, that didn’t happen. Here it is Saturday night and she’s still here in the hospital.

Early Wednesday morning Courtney’s fevers came back. Though the fevers didn’t spike as high as before, they lasted about 48 hours and delayed her discharge. The doctors wanted her fever free for at least 48 hours before sending her home. In the meantime they ran more tests to try to determine the source of her fever and rule out an infection of any kind. As of now all tests have come back negative and her fevers have since subsided and we still don’t know what was causing them.

The only reason Courtney is still in the hospital now is because of something that crept up earlier this week. Prior to the transplant Courtney tested positive for having “been exposed” to cytomegalovirus (CMV). Apparently this is a fact held true by about 80% of the adult population. This virus lays dormant in most people until their immune system is suppressed for whatever reason. Without treatment in can be life threatening, which is why the test for it in the first place. After the transplant they check her blood every 72 hours to see if the CMV is reactivating. Their tests can show that the virus is active before it begins to have any effects on the body. So, Courtney’s tests showed that the virus indeed had started to multiply and they began the IV administration of Foscarnet.

The regimen for Foscarnet is infusion of saline for 1 to 2 hours, infusion of Foscarnet for two hours and more saline for 1 to 2 hours. So, it’s about a six hour process and needs to be done twice a day until the CMV tests come back negative. After a negative test they continue to give her Foscarnet once a day until she completes three weeks of receiving the drug. While all of this can be done at home with the help of an IV pump, they wanted to wait until her latest CMV tests came back, hoping they could send her home with a once-a-day dose. This would make managing routine trips to the clinic a lot easier. I’m not sure how well IV pumps and poles travel. It would be cumbersome to say the least.

So, all continues to go relatively well with the transplant. The stems cells have done their thing wonderfully. And Courtney has fought through some crummy side effects valiantly. Fortunately, most of the unpleasantries have subsided including fever, rash, headaches, nausea and painful tingling. She's still fighting through a lack of appetite, some occasional nausea and fatigue. Nevertheless, she's ready to go home, spend time with the children and sleep in her own bed, uninterrupted through the night.

As it stands now, the plan is for Courtney to go home Monday, December 31st. That would be a tremendous moral victory for Courtney – to keep the hospital stays confined to 2007.

D + 12 - Christmas Eve gifts

Today, on Christmas Eve, we received news about as good as we could have hoped for. No, Courtney is not going home yet, but she is one step closer. Her neutrophil count went for around 50 on Saturday to 500 on Sunday and then to 1000 today. It’s a sure sign that the transplanted stem cells have engrafted and her bone marrow is beginning to function as it’s supposed to. Hooray for Tracy’s cells!!

So, now we just have to wait for Courtney to be fever free and GVHD (Graft Versus Host Diesease) free so she can go home. She’s been battling fevers for the past four days. They come and go fairly quickly and get almost as high as 104. Thankfully, the doctors have found no detectable signs of infection or GVHD. They do everything they can to rule out infection, including testing her blood for bacteria and doing chest x-rays. They aren’t exactly sure what’s causing the fevers, but believe it may be part of the engraftment.

Other than the fevers and occasional digestive discomfort, Courtney is feeling pretty well. In fact, tonight she’s gone the longest without a fever since Saturday. So, hopefully, that’s an indication that they’re going away. We need them to be gone completely for her to be able to go home. But, if Courtney continues to progress the way she’s been, we should have her home by the beginning of next week.

The best Christmas Eve gift was being able to reunite Courtney with the kids after being apart for more than two weeks. It was a short but sweet visit. We were all able to open Christmas pajamas that Courtney’s mom buys every year. It was cute seeing the kids put them on and wear them home from the hospital. It was awesome to be able to have some time together as a complete family at such a special time. Prayers were definitely fulfilled on our behalf today making for wonderful Christmas Eve gifts.

D + 9 - Hanging tough

It’s hard to believe that it’s already been nine days since the transplant. And it’s been three months since the diagnosis! They’ve obviously been the three worst months of our lives, and yet we have many great memories that we will one day cherish…when this is all over. Time is an interesting phenomenon – on the one hand is seems to go by excruciatingly slow, but when it’s in the past you wonder where it’s gone.

During the past five days Courtney has been coping with medication, side effects and neurtropenia (lack of white blood cells, specifically neutrophils). The rash finally subsided after about five days and some disagreement with the doctors as to which medication actually caused the rash. This is important to know, as Courtney would like to do everything possible to avoid it in the future. Sometimes, however, it’s difficult to determine which medication is causing which side effect when they give her five or more at a time. And when ALL the medications list many of the same side effects: headache, nausea, fatigue, rash, dizziness, etc.

Besides having to deal with all of the aforementioned side effects during the past week, Courtney has also head to cope with a sore throat, fevers, and painful tingling in her extremities. The biggest concern for the doctors is the fever. Whenever Courtney’s temperature is above 100.7, they take precautions to rule out infection. These precautions include blood culture (checking for yeast or bacteria), chest x-ray (checking for fluid build up) and changing her antibiotics. So far, everything has tested negative (that’s good). Idiopathic fevers during neutropenia are somewhat common and not too threatening. Things become more disconcerting when the doctors can actually find a source of a fever. Still, we’d rather that Courtney not have fevers at all.

So, after a few weeks with relatively few unpleasantries, Courtney is back to facing the ugly side of cancer and treatment. So far, thankfully, things have not gotten nearly as bad as they did during her first round of chemotherapy in October. We’re still holding out hope that that was the worst of it. Now she’s just fighting through this phase and waiting for her bone marrow to come back from vacation and go back to work. Doctor V said we shouldn’t really expect to see any activity until the 26th or later.

So, ten more days. That’s our goal for Courtney – to be well enough to go home by the 31st. What better way to ring in the new year!

D + 4 - A Friendly Visit

So far, everything is going as planned, with the exception of a horrible rash caused by one of Courtney’s antibacterial medication. She’s been dealing with it since Thursday, and if not for that, would probably be feeling quite well. She is, in fact, feeling pretty good. They’ve been doing a good job of staying ahead of the nausea and she has yet to suffer any bad side effects from the chemotherapy.

As for the chemotherapy, even though she finished the last dose a week ago, we’re still seeing the effects of it. Her red blood cells, white blood cells and platelets have been steadily dropping this week. Courtney is now what’s considered neutropenic and extremely vulnerable to infections. Now we wait two to four weeks for her counts to get back to a safe range before she can go home. However, it’s normally 6 to 12 months before all of her counts return to normal. In case you're interested, here are her lab results so far:

Day		WBC	Neutrophils	RBC	Platelets	Hematocrit	Comments
Normal Range		4.1 – 10.9	2000 – 5000	4.00 – 5.20	140 – 440	37.0 – 46.0
Dec 04	D - 8	7.6	5900		243	32.2
Dec 06	D - 6	9.5	7900	2.96	201	28.1
Dec 07	D - 5	10.4	8600	3.31	197	31.5
Dec 08	D - 4	8.9		3.40	190	32.6
Dec 09	D - 3	6.7	5200	3.16	172	30.1
Dec 10	D - 2	4.2	3300	3.35	158	31.9
Dec 11	D - 1	3.7		3.18	170	30.2
Dec 12	D - 0	2.8	2700	2.95	154	28.1	Transplant
Dec 13	D + 1	1.5	1400	2.52	132	24.0
Dec 14	D + 2	1.1	1000	2.26	92	21.2	Got blood.
Dec 15	D + 3	0.6	600	2.93	62	26.9
Dec 16	D + 4	0.3	200	3.12	48	28.5

Officially, she can’t see the kids until it’s just about time to go home. They don’t allow kids past a set of double doors to her hallway, and while neutropenic, they don’t allow Courtney to exit the double doors. It’s been over a week that she last saw the kids and it will likely be at least a couple of more weeks before she will get to see them again. : ( Unfortunately, they’ve all been fighting colds, so even if they were allowed, they couldn’t visit her anyway.

The best part of the weekend was that Courtney was visited by her best friend, Amber, from Utah who she hadn’t seen since we moved in 2002. Amber was able to stay with her Friday and Saturday night providing Courtney with much needed laughter and fun. Not quite the slumber parties of old, but I think they still had a good time considering where they were and why they were there. Thank you, Amber.

Though we aren’t quite sure how long Courtney will be in the hospital, we like to think that we’re just about halfway home. What we’re really hoping for is that her counts rebound quickly and she’s home before next year!

D 0 – Out with the old, in with the new

After a relatively good night of rest, Courtney woke just in time to greet the girl from Carter Blood bank who arrived just after 10:00 AM with a bag of stem cells. It basically looked like a bag of blood. The bag was hung from the IV pole with care, and a long tube connected to the bag was connected to Courtney’s Neostar catheter. At 10:30 AM the tube was unclamped and the stem cell transplant began with gravity doing the work.

There wasn’t much to it, however it was quite an emotional moment. These were the cells intended to help ensure a long life for Courtney.

Tracy arrived just a few minutes later, after having the straw removed from her neck. She and Courtney were able to share some time together, cherishing a new beginning.

Today marks the day that Courtney’s blood will gradually fade away as Tracy’s stem cells slowly take root in Courtney’s bone marrow and begin the process of making more blood – blood whose DNA matches Tracy’s blood. Blood that is leukemia free.

At 11:45 the bag was empty and the transplant was done. Just like that. And now we wait. We wait for Tracy’s stem cells to make their way to the bone marrow where they will mature, engraft and seed the process of producing her own cells. In case you were wondering just how the stems cells find their way to the marrow and do what they’re supposed to do, no one knows.

Currently, Courtney’s white and red blood cells are dropping just like they did during the last round of chemotherapy. This is due to the fact that her bone marrow, where the cells are produced, has essentially been shut down by last week’s chemo drugs. In about five days or so, we expect to see the last of her remaining white blood cells die and her counts hit zero. By this time her red blood cell and platelets will also be significantly depleted and she may need transfusions. We then will wait for another ten to fourteen days for the bone marrow to start making enough cells to be released into the blood stream and her counts to return to normal.

Courtney will go home once her white cell counts are back to normal and she isn’t experiencing complications such as graft versus host disease (GVHD). That’s something we don’t want. So now we pray that the stems cells do what they are supposed to do and kick start her bone marrow. Sometimes they don’t. And we pray that her recovery is quick and as painless as possible. And we pray that she doesn’t have to deal with GVHD or serious infections. And we pray that Courtney continues to have the courage and patience to endure these next few weeks and months.

Thank you for your thoughts and prayers. Each and everyone one of you is in ours!

D -1 Collection Day

2.1 million stems cells were needed from Tracy. The goal, however, was to collect 5 million. There’s a chance that the first round of cells don’t do what they’re supposed to, so they like to have a second dose to give. For Courtney, they’ll have almost four doses to give, as they were able to harvest 8 million stem cells from Tracy. Now that’s what you call generosity.

Needless to say, the day went quite well. Courtney experience a little more nausea, but other than that she had a good day. Tracy’s was a little rougher. She got two Neupogen shots to the gut, and then spent over five hours hooked up to the apheresis machine watching her blood leave her body out one tube and return through another, while leaving behind the valuable stem cells. It’s quite an amazing process. While not nearly as painful as the old way of extracting bone marrow, it’s not an altogether pleasant process either. The Neupogen causes a flu-like achiness, and, in Tracy’s case, caused considerable pain in bones. The other main discomfort that she experienced was numbness of her lips and fingers. This is caused by a reduction of calcium in her blood. They mix her blood with an anticoagulant as it leaves her body (for obvious reasons) and the anti-coagulant happens to bind to calcium. To offset that side-effect they gave her some calcium through her IV and instructed to try to consume foods high in calcium for the next couple of days.

How do you pay someone for the gift of life, especially when that life is as priceless as Courtney’s? I’m sure Tracy feels that she’s only doing what any good sister would do, but that doesn’t lessen the value of what she’s done. The truth is, there is no way to compensate Tracy enough for her gift to Courtney. Fortunately, that’s the value of love – it doesn’t demand payment.

Thank you Tracy.

"And above all these things put on charity, which is the bond of perfectness." - Col. 3: 14

D -2 End of the chemotherapy

D -2. That’s how they label the doors in the BMT unit of the hospital to signify where each patient is with regards to the transplant. D -1 tomorrow and then D 0, transplant day, on Wednesday. The day after will be D+1.

Today went much like yesterday for Courtney, but worse. She experienced quite a bit more nausea after being given her second and final dose of cytoxan. Fortunately one of the nurses found a drug combination that seems to have helped control the nausea and allow Courtney to actually eat a bit for dinner. When I arrived this evening, she was already quite relaxed and resting well. Right now it kinda seems like War of the Drugs. Cytoxan = bad vs. Morphine = good. Although, as much as Cytoxan is kicking Courtney’s butt, we sorta have to root for it, since it’s a key element to the transplant, and ultimately helping to cure Courtney.

As bad as Courtney’s day was, Tracy’s was seemingly worse. She went in this morning to have the Quinton catheter surgically placed in her neck, where it will stay for the next two days. This is basically like a large soda straw inserted into her jugular. Not a comfortable procedure by any means, but rather simple and routine. That is, until you have an allergic reaction to one of the drugs. Apparently, things got rather dicey in the OR, when one of the drugs sent her into antiphylactic shock and temporarily made breathing quite difficult. The doctors responded quickly and got things under control and were able to finish the procedure without further complications. Tracy’s day wasn’t over, as she still had to go back to the BMT clinic today for another round of Neupogen shots.

While tomorrow should be a quiet one for Courtney (they refer to it as her “day off”) because she’s not getting any heavy hitting drugs for the first day since admission, it’s the biggest day yet for Tracy. Tomorrow is “harvest” day. By a process called apheresis, Tracy’s stem cells, which the Nuepogen is causing to be produced in extra quantities, will be harvested. Apheresis is the process used to separate out a specific part of the blood such as stem cells for transplantation. Tracy will be connected to a machine via the Quinton catheter. The blood is removed through one branch of the catheter and run through the machine which separates the stem cells. The remaining parts of the blood are circulated back to Tracy through the other branch of the catheter. The process is expected to take 7 to 8 hours. If they don’t get enough stem cells, an amount predetermined by Courtney’s medical team, Tracy will have to go back for another day of harvesting. Otherwise she is done and they can remove the straw from her neck.

At the end of the day it’s still so hard to believe that we’re actually going through all of this. It’s still hard to say the word cancer and to accept that it’s directly affected our lives as it has so many others. And while it’s hard to believe that Courtney has had to endure chemotherapy three times in the past three months, it’s nice to know that that part of her life is now officially in the past.

D – 3 and counting until transplant

Sorry, I didn’t mean to let this much time pass before updating the blog. But here’s what’s happened the past five days.

As I mentioned, last Tuesday, Courtney was admitted to Zale-Lipshy hospital for the bone marrow, or more precisely, the stem cell transplant. They admit her 8 days prior to the actual transplant so the can administer the chemotherapy that prepares her body for the transplant. Tuesday night they started her on her first chemo called Busulfan. They gave it to her for four days, four times a day for a total of 16 doses. Each dose, that was administered through her neostar catheter, took two hours. During this time, she couldn’t leave the room, so she didn’t risk spreading the toxic chemicals around the hospital.

She tolerated Busulfan fairly well, with relative mild side effects. Her worst experience was an itchy rash that was most likely caused by a steroid they gave her along with the Busulfan. To counteract the rash, the gave her an antihistamine. They thought about giving her benedryll, but since it was the middle of the day and she didn’t want to feel too drowsy, they gave her something else. Ironically, she had an allergic reaction to the other drug and they ended up having to give her benedryl anyway. She also had some mild intestinal discomfort the past few days.

We were able to squeeze in a few visits with the kids Tuesday evening, Thursday evening and Saturday morning. They aren’t allowed to go back to her room, but when’s she feeling up to it and not hooked up to any toxic chemicals, Courtney can leave the confines of her room and hallway and visit with the kids in a “family room” on her floor. They’ve been coping extremely well with their mother being in the hospital so much these past couple of months. It’s amazing how resilient and level headed they all are. It continues to be a huge blessing to have them so well adjusted to such a difficult circumstance.

Courtney’s sister, Tracy, who had been staying with her at night up until Saturday night, received her first of four rounds of Neupogen injections Saturday morning. She got her second dose this morning and so far seems to be experiencing about what the doctors told her to expect – general achiness and discomfort that feels rather flu like. So she could get her rest, I stayed with Court last night and tonight, while my mom has held down the fort with the kids at home and Courtney's mom continues to stay with her during the day.

Courtney received her last dose of Busulfan last night at midnight. I know I’ve brought it up before, but they really don’t seem to value sleep very much in hospitals. For instance, last night Courtney got hooked up to her chemo at 12:00 and then unhooked at 2:00 AM. Three hours later, although it seemed like much less, at 5:00 AM a nurse came in to check her vitals. At 6:00 AM a Fellow came in to check her over. Then 30 minutes later he came back with Dr. V who did the same checks. Another mere 30 minuets passed before her nurse of the day came in to perform the same checks. And he was followed by the breakfast lady 20 minutes later. By now, you pretty much just throw in the towel and give up trying to sleep. It’s just too painful to keep waking up right after falling back to sleep.

At 10:00 AM this morning Courtney received her first of two doses of Cytoxan. Unfortunately this one hasn’t been as nice as the first chemo drug. Within 15 minutes, Courtney’s nose felt irritated, her sinus felt pressure and her head started hurting. Her headache has lasted all day and was ultimately accompanied by bouts of vomiting. This is always demoralizing for Courtney, but we’re reassuring her that this is quite normal and almost expected with this particular drug. Her second and last dose comes tomorrow (Monday) morning, and her nurse indicated that many people tolerate the second dose quite a bit better than the first, but it’s no guarantee. So, she may be in for another long day tomorrow. At least Tuesday will be a day of rest, with NO chemo drugs.

Actually, tomorrow’s dose of Cytoxan will be her last so called chemotherapy forever. I think it may be cause for celebration, but the festivities will have to wait. Maybe we’ll toast the IV bags, since that’s about the only fluid Courtney is able to take in when she’s so nauseous.

Courtney and Tracy continue to plug along doing what they have to do to prepare for the transplant on Wednesday. There’s no turning back now. No, really, legally they can’t. They both signed papers indicating that once the chemotherapy started, they couldn’t stop the procedure from moving forward. Although, I’m not sure what would happen if either tried. Fortunately, that won’t happen, as they both know how important this is and both are anxious to make this whole cancer episode a thing of the past.

T minus 8 days and counting to BMT

Officially it’s now 8 days before the bone marrow transplant (BMT). The BMT phase really began yesterday. Courtney went to have the PICC line removed from her arm and a new central line (Neostar) placed in her chest. It’s almost identical to the Hickman Catheter that she had during the first round of chemotherapy, except that it’s the right side of her chest and has three lumens (lines or tubes protruding from her chest). The worst part, besides the post-surgery pain, was the fact that a 45 minute procedure had us at the hospital for almost the entire day. We left the house at 9:00 AM, arrived at 9:30; they took her to surgery at 12:30; brought her back at 1:15; and let us leave at 3:00. Kind of a waste of a full day, especially when it’s supposed to be your last day at home before being admitted to the hospital for five weeks. Oh well, at least she had a private room with a TV to wait in, and the procedure went very smooth.

Today was check-in day. They wanted her to arrive by 9:00 AM for admission to the hospital. Unfortunately we had to stop by the BMT clinic (five minutes from the hospital) to sign some consent forms. Courtney had accidentally dated all the forms with 2008 the other day. Legally they needed them to be correct before they would move forward with the transplant. It was an honest mistake that you can blame on “chemobrain” (an actual known condition and not a name that I call Courtney these days – I promise) or blame on nervousness as Courtney was signing papers that say she consents to procedures that could cause adverse effects including death. I think that’s enough to make anyone forget what year it is.

So we arrived at 9:30, thinking that we had just thrown off the 5 week schedule, since they were somewhat adamant that we arrive at 9:00. However, upon checking in and getting comfortable, Courtney mostly hung out and enjoyed time with her sister, Tracy. They didn’t even hook her up to her IV until after 10:00 PM. So, by my estimation, we were more than 12 hours early. Another day that could have been spent at home.

The hardest part of the day was having to say good-bye to Tracy’s children, Alex and Paige. It’s been so much fun having them around. We don’t get to see the much since they’ve been in Italy, so it was really nice getting to spend time with them. Since Tracy will begin receiving her medication in a couple of days, Alex and Paige were escorted by their Aunt Maureen to her home in Pittsburgh. She flew in yesterday just to be able to fly back with them! While it was hard seeing them go with tears in their eyes, it’s so comforting knowing that Tracy’s kids will be well taken care of, or in Maureen’s words, “spoiled rotten” for the next couple of weeks. They deserve to be catered to while their mom is here helping save Courtney’s life. Once again, the love and support from family and friends has been amazing and continues to be so. Thank you, Maureen. It was very nice to finally meet you.

We continue to be amazed at the blessings this trial has brought to our family. While it’s a crummy way to bring them about, it’s given us the opportunity to meet some wonderful people – the staff at the hospitals and clinics have been awesome; it’s given us time to spend with family we wouldn’t normally have had – it’s hard traveling with kids overseas, or anywhere for that matter; it’s helped us to reconnect with old friends and it’s been so much fun catching up with some of them. While at first all of these were silver linings in a very dark cloud (borrowing from an old cliché), they’ve helped to brighten our lives, reducing the cancer to little wisps of clouds that cast the occasional shadow.

One of the hardest parts of moving forward with the transplant is sending Courtney towards something that we know will make her feel worse than she does today. It’s like turning around and heading back into a storm that you just drove out of. Courtney’s been doing so well, with each day literally getting better. You just don’t want to see that trend reversed in any way. Yet, we know that we have to do this to give her the best chance for a cure. And were fortunate to be able to do this now and get it over with, without having to drag it out for months or even years. This time next week we’ll be able to say that Courtney is done with chemotherapy…forever. And that will be the biggest blessing of all.

Gratitude

Family. This is what it’s all about – to live, learn and grow with one another. It’s what we’re most thankful for. It’s our reason for being. And each day we have together is a gift to cherish.

We really enjoyed the past week with the girls home from school and Courtney home from the hospital – especially since she’s doing so well. It was great being able to spend so much time together. Like all ‘vacations’, we only wish it could have lasted longer.

Last week my Mom left on Tuesday, so I stayed home Wednesday to help Courtney with the kids. I was able to take them to see the movie Enchanted. I have to admit that I was a little apprehensive, but we all loved it. It would have been a lot better if Courtney could have gone with us, but she still has to be cautious about being in public places. Movie theaters don’t seem like the most sanitary places. Anyway, as much as my masculine side hates to admit it, I highly recommend the movie – just not when the Cowboys are playing.

Courtney’s sister, Susan, arrived on Thursday, just in time to go over to our friends’ home for Thanksgiving dinner. After everything we’ve gone through, and after everything they’ve done for us, it was especially meaningful to celebrate Thanksgiving with the Perkins. They are some of the many people that we could never possibly thank enough for what they’ve done to help us during such a difficult time in our lives. We are truly blessed to not only know them, but to be friends with them.

Friday was when the rest of Courtney’s family arrived: her mom and dad, her sister Tracy and two kids, Alex and Paige, from Italy, her sister Kelley (Susan’s twin) with Jimmy, and her brother Chris with his wife Leticia and their precious girls, Lindsay and Christiana. All in all, we had 18 people in our house for three days. With all of Courtney’s family here, we celebrated Thanksgiving again on Saturday. (Isn’t that why the holiday starts on Thursday – so we can celebrate it for four days?) More great food and great company. It was so much fun to hang out and enjoy everyone’s company. It was awesome seeing Courtney doing so well and in such high spirits. Again, you just want times like these to last for more than just a day or two.

The family picture was taken on Friday morning at our friend Becky Eastman’s home. She has her own studio and always does such a great job with our kids. It was the first time since before Aidan was born that we had our family picture professionally taken. Thank you, Becky, for squeezing us in during such a busy time and for doing such a wonderful job! I told you all that Courtney had a beautiful head!!

Today (Monday), Courtney went to the clinic with Tracy after having to say goodbye to Susan. (Goodbye's are always difficult these days.) Courtney and Tracy both had their blood drawn and both received a clean bill of health. Of course, Courtney’s “clean bill” was relative to her post-chemo condition. She’s still slightly anemic, so she finally got her million dollar Procrit injection. All I can say is it better do something. Oh, and thank you insurance company.

So, despite the crappiness of cancer, we really do have a lot to be thankful for: the love and support of friends and family, remission, a bone marrow match in Tracy, relatively good health, our faith that has helped us through this and our children, who lift our spirits more than anything else and give us something great to wake up to each and every day.

Day 22 and final day of Consolidation

With yesterday’s CBC results it looks as if Courtney’s blood counts are finally starting to return to normal on their own. Her WBC’s are still slightly above normal, due to the lingering effects of the Neulasta. She never did receive Procrit, but with her RBC’s close to normal and her platelets well within normal on their own, she won’t be needing it. (Unfortunately, this validates the insurance company’s propensity to baulk at the approval of this drug. Oh, well).

	Wednesday	Thursday	Monday	Normal Range
WBC	5.1	15.3	17.9	4.1 – 11.1
RBC	2.70	2.62	3.52	4.01 – 5.31
HGB	8.2	8.2	10.8	12.1 – 16.1
Platelets	15	74	202	140 – 440
Neutrophils	3.5	13	NA*	2.0 – 7.5

*Neutrophils and other WBC differentials weren’t available at the time we left the clinic.

So, because her counts looked so good, Dr. V said Courtney didn’t have to return until the 26th. On that day, Tracy will also go to the clinic for her pre-evaluation. If all looks well on that day, the next trip to the medical center will be December 3rd, when Courtney will have the PICC line removed from her arm and a Neostar catheter (similar to the Hickman) placed in her chest. Then on December 4th she’ll be admitted to the hospital for the bone marrow transplant.

Physically and emotionally, Courtney is doing ‘OK’. For the most part, she sailed through this round of chemotherapy with relatively mild side effects. (“relatively” being the key word.) Her main issues are gastrointestinal. These are difficult, if not impossible, to relieve, due to the myriad of possible and likely causes. These are the three most likely culprits of Courtney’s current discomforts: 1) The gastrointestinal toxicity of the chemotherapy drugs. They affect not only the motility of the digestive process, but the taste of food as well. So, even if Courtney wasn’t feeling nauseous or crampy, food generally doesn’t taste or sound as good as usual. 2) The anti-bacterial medication she’s been taken can all have bad side effects relating to the stomach or intestines. At least she doesn’t have to receive the anti-fungal drug (Mycamine) any more. 3) Anxiety. I found the following passage in an old college textbook and have to quote it because it exactly applies to what Courtney’s been increasingly feeling the past few days.
“A substantial proportion of patients develop nausea and vomiting in anticipation of treatment, after one or more courses of chemotherapy have been given. Antiemetic agents do not provide complete protection from anticipatory nausea and vomiting.” - Krause’s Food Nutrition & Diet Therapy

In other words, Courtney is naturally nervous and anxious about the upcoming stem cell transplant and lengthy recovery. So please continue to keep her in your prayers. Pray that she has peace of mind and body, especially during these next couple of weeks as she prepares for the transplant. The better she feels going in, the better she’ll be coming out.

Days 19 - 21 Consolidation - Nice surprises

It’s been a nice few days off from clinic visits and blood tests – especially since the weather has been so nice. It would have been better if Courtney could actually go out and enjoy it more. We have to limit her exposure to outdoor dust and pollens to avoid allergies that could lead to sinus infections. But still it’s been a blessing to have such beautiful weather in the middle of November.

On Friday, Courtney received a package from Jen Flynn’s 3rd Grade class in Omaha, Nebraska. Jen married my cousin Tom this past August, and Emma, Miranda and Aidan were able to participate in their wedding. It was really cute. Anyway, the package contained precious cards from every kid in the class. So…Thank You to Mrs. Flynn’s 3rd grade class for all of the wonderful thoughts and well wishes. Courtney really enjoyed them and had a huge smile on her face as she read each and every one.

That same night, Courtney also received a call from Amber, her long lost best friend from Utah. They had a lot of catching up to do since it had been over 4 years since they last spoke. Amber always had a way of making Courtney laugh, so she got a big dose of the “best” medicine Friday night. All in all, it was a wonderful way to start the weekend.

Tomorrow morning we go back to the clinic for a check up. Courtney will have her blood tested, and, if needed, will receive blood and/or platelets. That’s pretty much all there is for now. We’re still waiting for her blood results to return to normal to consider this round of chemotherapy officially over. As it is, we have just a little over two weeks to go before Courtney is readmitted to the hospital for the big BMT.

Days 17 and 18 Consolidation – More long days at the BMT clinic

It’s amazing what a difference a day makes. Yesterday Courtney was feeling much better, with virtually no headaches or nausea. The day started off with a fairly quick and painless visit to a respiratory therapist who performed the PFT (pulmonary function test). Courtney didn’t rank up at the top, but we think she passed. Then, after a quick breakfast at Wendy’s, we headed to the BMT clinic. They were really nice and let us come in two hours before our scheduled appointment. She had her blood drawn and then we waited for about three hours. The wait was for the Procrit shot and platelets. The platelets eventually arrived, but the Procrit didn’t. Apparently it’s a somewhat complicated and potentially lengthy process for the insurance company to pre-approve the Procrit due to it’s expense. She didn’t get it today either.

CBC results for the past two days:

	Wednesday	Thursday	Normal Range
WBC	5.1	15.3	4.1 – 11.1
RBC	2.70	2.62	4.01 – 5.31
HGB	8.2	8.2	12.1 – 16.1
Platelets	15	74	140 – 440
Neutrophils	3.5	13	2.0 – 7.5

So, what do these results tell us? That Neulasta really works. On the 5th, Courtney received an injection of Neulasta that’s supposed to help increase her Neutrophils before her bone marrow is fully functioning again. This is to help avoid the potentially dangerous neutropenic fever. So, in a way, her WBC and neutrophil counts are artificial. The hope is that by the time they drop down, her bone marrow will be back to running normal and her counts will stabilize. Apparently this is the same thing Procrit is supposed to do, except for her RBC’s. At least she can have those infused. Which she did today.

The other thing we learned from the CBC today is that she received a really good dose of platelets yesterday. Usually we see an increase of about 15 to 20 when she receives a bag of platelets. After receiving a bag on Sunday, her count was only 4 on Tuesday (not so good). Then Tuesday’s bag increased her platelets from 4 to 15. And finally yesterday, she got her bag of super platelets and her count increased to 74! So, hopefully she’s good to go for a few days.

It seems like today we got twice as much done in half the amount of time compared to the previous two days. Courtney received two units of blood, had a nice long visit from the Social Worker, and had her bone marrow aspirated. All in a day’s work.

The social worker was nice and asked Courtney a lot of personal questions. Apparently social workers get paid to be nosy and pry. Courtney was very honest and open with him, and he really seemed impressed by her attitude and demeanor considering what she’s been through, is going through and is about to go through. It’s likely she’ll be getting a “go for transplant” from him.

Right after his visit, she was taken to another room where some nice people, including a nice man with a very good drug called versed, painfully extracted some more of Courtney’s bone marrow from her hip. While the versed didn’t knock her out or take all of the discomfort away, it did help her to relax and not care so much about what they were doing. She said she’s going to ask for a little more next time. The unfortunate part is there WILL be a next time and possibly MANY more next times. : (

So, after three fairly long days at the clinic, we aren’t scheduled to go back again until Monday, and that should only be for a blood check and maybe blood and/or platelets depending on the results. We’re looking forward to having a nice three day break from doctor stuff and to having a nice relaxing weekend at home. We have 19 more days to enjoy at home until Courtney’s admitted for the transplant. But who’s counting?

One more thing – I looked up Procrit at drugstore.com. They sell it for $5099.63 for 18 ml. It always cracks me up when they price it a few cents under an even hundred. As if $5099 looks so much more affordable than $5100. Just for comparison, a can of Coke is about 354 ml. At that price Procrit costs $1,072,206.39/gal. Although they would probably sell it to you for $1,072,199.63/gal. No wonder the insurance company is stalling!

Days 15 and 16 Consolidation - BMT tests

Another long day. Today's cancer related activities started at 8:30 and ended at 5:00 . It didn’t start out too well, as Courtney battled a head ache and nausea when she woke up. We arrived at the clinic where they drew her blood and gave her some medication to help with her discomforts. Then we went upstairs from the BMT clinic for Courtney’s chest x-ray. That didn’t take long, but by the time we were done it was 12:30 . Then Court rested until 1:30 at which time we went down the road to St. Paul for her MUGA (Multiple Gated Acquisition Scan) to assess Courtney's heart. That took a couple of hours. We then went back to the BMT clinic because she still needed to receive platelets. We finally headed home at 5:00 . Everything seemed to move in slow motion today. It doesn’t seem like a lot happened to justify so many hours. Fortunately it was mostly a lot of sitting and lying around. Not too exerting.

The good news is she got new medication to help keep the nausea away – phenergan. That’s always worked best for her. Plus, it’s likely that the zofran she had been taking for nausea was the source of her headache.

The better news is that her chest x-rays and MUGA were fine. She got the thumbs up from both of those. The technician who performed Courtney’s MUGA was bald. He got a kick out of the t-shirt she wore that Susan had sent – “Does this shirt make my head look bald?”

The best news is that her neutrophils are at 500!! That’s almost a week sooner than we were expecting. Tomorrow they are probably going to give her blood as well as Procrit. Procrit is like Neupogen, except to boost her RBC’s instead of WBC’s.

Today's CBC:

WBC = .8
RBC = 2.72
HGB = 8.5
HCT = 23 (Cut off is 22 for blood, so she will probably get some tomorrow.)
Neutrophils = .5 (Goal is 1)

Tomorrow may be another long day. She has her PFT (pulmonary function test) along with the possible blood. Then Thursday is her bone marrow biopsy. They’ve promised to give her versed, if that’s what she wants. And it is. A mostly unconscious Courtney during the biopsy is a mostly happy Courtney after the biopsy.

Days 11 - 14 Consolidation - Long Days at the BMT Clinic

Since Wednesday, Courtney’s only real complaint has been fatigue. This is likely due to the fact that her blood counts are all low and she’s considered anemic. On Friday, we had a long visit to the BMT clinic. We arrived at 9:45 in the morning. They checked her blood, gave her platelets, and a couple of hours later gave her a unit of blood. She actually needed two units, but another unit would have added a couple more hours to what was already a long day, and they said she would be fine receiving it Sunday morning. On the way to the clinic, we were able to pick up Courtney’s brother, Chris, who was in town for a conference. Having him there for a couple of hours really helped the time go by. The clinic has a TV with a DVD player in each room that also make long days there more tolerable. We were able to watch a couple of Courtney’s favorite movies: 50 First Dates and Bruce Almighty! We didn’t leave the clinic until 4:30. Like I said – long day.

Her counts on Friday:
WBC = 0.2 (Very Low)
HGB = 7.7 (Low)
Plt = 6 (Very Low)
Neutro = 0.0

So, Courtney is officially rock bottom. This means we can now start waiting for her WBC counts to go back up and have this round of treatment be officially over. It also means that we really have to be diligent these next few days in keeping Courtney as germ free as possible. This is technically challenging with four small children around, but they’ve been great in keeping their hands washed and staying out of our bedroom. It’s amazing how patient and understanding they have been these past few weeks. We know we have answered prayers to thank for this. So thank you all for your many prayers and amazing support.

We also had a good conversation with Dr V. She said that chances are Courtney is past the point when she should have adverse side effects from the chemo. That’s great, because this round Courtney has suffered relatively few side effects at all. That made Courtney really happy! We just have to make it through the next week or so while her WBC’s recover and pray that she doesn’t get a fever during this time.

Saturday was fairly uneventful and, since Courtney didn’t have to go anywhere, she was able to get much needed rest. The girls had a fun time playing with my sister, Molly, who was in town through today, helping out while my Mom went home for a few days.

Today the girls took part in a wonderful children’s program at our church. It was sad that Courtney didn’t get to be there for it. While they were each speaking their parts and singing songs, Courtney was back in the clinic receiving more blood. Some tradeoff. Hopefully, the blood will help keep her from feeling too crummy. You really don’t have a lot of choices for things you can do while being treated for cancer. I think that aspect is really taking a toll on Courtney. She can’t wait to get back to having a “normal” life. Fortunately, that day will come in the not too distant future. Unfortunately, that future day is still distant. We pray that the transplant will be successful and her recovery will be quick. We have a date to the Caribbean waiting for us!

Days 8, 9 & 10 Consolidation – It’s Gooood.

I’ve been afraid to update this blog, because everything has been going so good, and I don’t want to jinx it by pointing it out. But, I owe it to of you who cares enough to follow Courtney’s progress to keep you in the loop. And I owe it to all of you who have lent us your support and who have kept Courtney in your prayers to tell you how much they’ve helped. The bottom line is Courtney is doing remarkably well.

We’ve been waiting and somewhat expecting the chemo side effects to kick in, and although she has felt some nausea and has lost some of her sense of taste and smell, the side effects have pretty much been limited to just that. Her headaches are all but gone, and she’s gained strength and energy each day since she’s been home. She’s making it easy to forget that she’s in the midst of a course of chemotherapy. But we can’t forget because we still have to be diligent. Her WBC counts still have to drop to zero before they go back up and we can consider her done with this round. As of today, her blood counts are steadily dropping.

So far, we’ve been to the BMT clinic twice: Monday and today. Monday we went so she could get a shot of Neulasta. This drug is supposed to help prevent a nutropenic fever, a condition relating to a really low amount or altogether lack of neutrophils. That’s pretty much all they did. She didn’t even have a blood draw. They didn’t expect her counts to be so low, so they put of running blood analyses until today.

Today’s visit to the BMT was slightly more eventful and much more informative. While they did draw her blood, the counts indicated she didn’t need any blood products, but probably will on Friday. They’ve already ordered the platelets.
Her counts for today:
WBC = 3.0 (low)
HGB= 9.1 (low)
Plt = 44 (low)
Neutrophils = 2.9 (normal)

Dr. Vusirikala (Dr. V), Courtney’s oncologist for this round of chemo and for the transplant, came in to give us much more information regarding the bone marrow transplant and its timing. Speaking of the transplant, I just realized I never shared the fact that Tracy, Courtney’s sister in Italy, will be the donor. It turns out that she is the only match amongst her siblings. So, needless to say, she will be making another visit to our home in the near future.

The timing that Dr. V gave us could change depending on how Courtney feels during the coming weeks, but it’s still nice to have a plan. So, taken from Kelley’s notes and subsequent email sent the family, here’s the plan as it stands now:

Nov.12th: Courtney will start pre-work up testing which could last 3 days.
Nov. 26th: Tracy will go for pre-work up testing.
Nov. 30th: Anticipate all of Tracy's blood work and test result will be back for confirmation
Nov. 30th: Courtney goes to UT Southwestern (outpatient) for removal of PICC line and insertion of new line (neostar? Three tube line on opposite side of Hickman).
Dec. 3rd: Courtney is admitted to BMT unit; will receive dilantin as preventative for seizures
Dec 4th: Courtney starts Chemo – this is a 7 day course of Busulphan (4 doses every 6 hours on four days) and Cytoxan (two doses).
Dec 7th: Tracy will start injections for 3 days; she will not be admitted at any time
Dec 9th: Courtney will get Prograf (an anti-rejection drug). This is a drug that she will likely be on until for over three months after the transplant.
Dec 10th: Harvest Tracy's stem cells. This may not require a catheter but may be done through a regular IV. They will determine this prior depending on the size and strength of her veins.
Dec 11th: Bone Marrow Transplant

Discharge is contingent on: Resolution of toxicity of chemo effects, resolution of infection if one occurs, recovery of WBC counts and resolution of graft versus host disease (GVHD) should it occur (10-15% chance for acute GVHD).

Dr. V also shared with us the fact that while Courtney will probably feel pretty crummy during the BMT treatment, she probably won’t feel as bad as she did during her first round of chemotherapy. We hope and pray that this will be true. It would be nice if she never feels worse than she does right now . . . which is, in Courtney’s own words, “Goooood…considering cancer still sucks and chemotherapy is still crappy.”

Days 6 & 7 Consolidation – Home Again

Home sweet home. As nice as the hospital was this time, it’s still much nicer for Courtney to be at home and in her own bed. This is especially true when she’s not feeling ill or on mind altering drugs. Then it’s nice having nurses around. Nevertheless, Courtney is really happy to be with her kids again…and me she says. It’s also nice for me having her next to me as I update the blog.

So far this round of treatment has gone pretty well, aside from the spinal tap and horrible headaches which have greatly subsided thanks to the aforementioned blood patch procedure. It’s weird to think that she’s done actually receiving the chemotherapy but we’re still waiting for it to do it’s job and rear it’s ugly head. Hopefully it won’t be so ugly this time.

We’re still getting a ton of support from both family and friends, and can’t thank my mom or Courtney’s sister, Kelley, enough for everything they’ve done and continue to do to help us. And offers to help continue to pour in from our church, neighbors and community. We wish we could accept them all, and appreciate them all greatly, even if we have to turn them down.

Over the course of the next couple of weeks we will be going to the BMT center every other day. There they will draw her blood, check her blood counts, give her some IV medication, and give her blood products as needed. Some of these days could potentially be long ones. The days in between the clinic visits, we will have to give Courtney her IV medication here at home. A home health nurse came by today to show us how to do this. It’s fairly simple. And since she already has the lines in her arm, no needles are involved.

Courtney says she misses everybody! Don’t hesitate to send an email or call while she’s feeling good and at home. She really enjoys chatting with friends, even if it’s limited to a phone conversation. We wish we could have everyone come over and have a big party, but that’ll have to wait until next year, when we start 2008 – Cancer Free. In the meantime, we’re at least enjoying having Courtney at home. Her presence makes our sweet home so much sweeter.

Day 5 Consolidation - Blood Patch

After four days of a nearly debilitating headache, Courtney received what is called a blood patch. A neuroradiologist injected some of Courtney’s blood into the epidural space where they gave her a spinal tap. The makes sort of a patch to stave the leaking spinal fluid which was the likely cause of her severe headache. While this probably won’t completely make the pain go away, it should help significantly. Unfortunately, it wasn’t a pleasant experience for Courtney. Especially since they had to basically do it twice since the first time they determined they had approached from a bad angle. Everything was done with fluoroscopy so they could tell exactly where to put they patch. So, while she has a sore back and her head aches slightly, she feels better now than she has since Monday.

Today is also the last day of Courtney’s chemo during this consolidation therapy. She won’t need another dose of chemo until her bone marrow transplant, which should be in about four to five weeks.

Courtney will probably be coming home tomorrow. Over the next few days her WBC’s will be dropping just like they did during her last chemotherapy treatment. This means that we’ll have to take precautions, similar to the ones we had to take when she was in the hospital. It could likely be a very difficult two weeks ahead of us. We’re hoping and praying that things don’t go south for Courtney as bad as they did last time. Unfortunately there’s no way to know for sure how things are going to go. So, in the mean time our goal is to keep Courtney in a clean and comfortable environment. We’ll have to limit visitors, but feel free to call to see if Courtney is up for a chat!

Day 4 Consolidation

The past two days have been a battle with the spinal tap headache. I’ve read that it’s often described as “the headache of all headaches.” Courtney says, “that pretty much sums it up.” It’s really frustrating, because if it wasn’t for the nasty headaches, her stay at the hospital this time would be pretty much a piece of cake.

Yesterday was probably the worst day of the week. She was given chemotherapy to fight cancer, blood to fight anemia, morphine to fight the headache, benadryl to fight the itchiness from the morphine and phenergan to fight the nausea from the headache that caused her to throw up for the first time since this whole ordeal began.

Meanwhile, I got to leave the hospital to go to work and then spent the evening trick-or-treating with the kids (as if they needed more candy). I could dump out two thirds of the candy and they would never miss it – and I probably should – but won’t because I like candy and have a hard time throwing away perfectly good candy. Anyway, I can’t tell you how guilty I feel having so much fun with the kids while Courtney is so miserable in a hospital – even if it is a nice hospital.

And even though I know Courtney would tell me not to feel guilty and that I should just enjoy the time I have with the kids, I can’t help it. It doesn’t seem fair that I should go about doing ‘normal’ everyday activities, while she’s confined to a 10 by 10 room. I feel guilty every time I leave her in the hospital, and every time I sleep in our comfortable bed at home, and every moment that I have fun with the kids, and every meal that I can eat without feeling nauseous, and every time I go shopping, and I feel guilty every time she feels pain of any kind while I go about without so much as a sniffle. I know it’s a blessing that I can do all of this and do what I need to do to keep our family afloat, but I still feel guilty. I just wish I could trade places with her, even if was for just a few hours. Too bad we can’t tag team while fighting this disease.

So, after a rough day yesterday, Courtney followed it up with a slightly better day today. Today was an off day for chemotherapy and she didn’t need blood. So it was a quiet day from the IV pole. Her headache also subsided for awhile and she was able to get up and walk around a bit and eat some decent food. Unfortunately it came back pretty bad after dinner and she asked for some powerful meds to help her relax and sleep pain free. Hopefully the pain free afternoon was an indication that her spinal fluid is returning to normal and the headaches will be gone for good. Just in time for the side effects of the chemo to kick in. Life just isn’t fair sometimes.

Day 2 Consolidation

This is the Consolidation Chemotherapy plan:
Days 1, 3 and 5 Courtney will receive two doses of Ara-c (Cytarabine) separated by 12 hours. Days 2 and 4 she will sit around and do nothing – as far as chemotherapy is concerned. She will probably do a lot of talking. She’s always been easy to talk to, but lately she’s been especially chatty. It’s been a lot of fun just listening to her. I wish I didn’t have to work, so I could spend more time with her. But I’m grateful for the nights that I’ve been able to stay with her and grateful to my mom for helping taking care of the kids and the house so I can have this time with Courtney.

So, today was chemotherapy free once the 2nd dose finished early this morning. She had a really good day, with the exception of some headaches. Hopefully that will be the worst of her stay here, and hopefully they won’t last much longer. Her next dose of chemotherapy begins tomorrow at noon. Each dose takes about 3 hours to administer. So far, not so bad.

Day 1 Consolidation

New round of chemotherapy and new hospital. After meeting with Dr. V last Thursday and deciding that we would proceed with a bone marrow transplant, we also decided Courtney would undergo the recommended round of consolidation chemotherapy under her care at UT Southwestern. We figured that since she would be going there for the transplant, we might as well go there now, allowing ourselves a chance to get to know the doctors and facilities, and allowing the doctors the opportunity to become familiar with Courtney. This way they will have a few weeks of first hand knowledge or her condition and reactions to the chemotherapy and other medications before the transplant procedure begins.

The hardest part about switching facilities is leaving behind the awesome nurses, techs and doctors that became like family during our stay at Harris Methodist. However, so far, everyone here at Zales has been great. And we have to admit the room is quite a bit nicer than her room at Harris Methodist. Note to Harris Methodist, the onocology floor is well past time for a serious makeover. A simple fresh coat of paint would go a long way. And get rid of the bump at the entrance to the bathroom; it’s a pain trying to get the IV pole over that all the time. A couple of little extra perks include a small fridge and dvd player. These small things just help ease the burden of being away from home, especially during an extended period of time.

So, the first day of consolidation came and went fairly quickly. We checked in shortly before 8:00 AM. At around 9:00 AM Dr. V came in with her PA (Laura), and the PharmD who will be verifying her chemo treatment. They said they would put a PICC line in, but this time they would use flouroscopy to see the line as it went in. At 9:30, Laura said Radiology was booked for the day and that she couldn't get her PICC until tomorrow, but would have Dr. V call down and use her influence. At 10:15, Laura came back to tell us she was on the schedule for Noon. Five minutes later, her nurse came in and said they were on their way to get her. By 11:30 she was back in her room after a flawless PICC line installation in her left arm. She flew through it without a single sedating drug and only local anesthesia! Much better than last time!!

Less than two hours later, Dr. Rohm came in to give her a spinal tap. This was a precautionary procedure to check her spinal fluid for leukemia. There are some forms of AML that appear in the spinal fluid and have to be treated with specific drugs. While they didn’t think her type would have this, they just wanted to make sure. This was obviously not a pleasant experience for Courtney. The main side effect has been head aches, but she’s doing great.

Laura the PA gave us some for information about the chemo and the duration of her stay. It will be similar to induction, with side affects occuring a week to 10 days later and her counts dropping to zero and going back up at a similar rate to what we saw last time. If she has a fever over 100.6 at any time, she will probably stay in the hospital until her neutrophils are back to 1000. If she looks good after the treatment, she will probably be sent home with instructions to return every other day. If during that time she gets a fever, she will probably be readmitted. Just like the induction treatment, she will need blood and platelet transfusions as her bone marrow goes off line. If she's not in the hospital, they will do the transfusions in the clinic as needed. They plan to leave her PICC line in when she goes home and set up a home health nurse to flush the line as needed. So, while were planning to be able to go home at the end of the week, we’re prepared to stay for the next 3 to 4 weeks if necessary.

I would have to say, and Courtney is sitting here agreeing with me, that today is the best day she’s had, physically and emotionally, since September 15th, when she first started feeling sick. She was up and about quite a bit, as witnessed by many of our friends we were able to see at our church’s Trunk or Treat.

The Trunk or Treat has become somewhat of a tradition for us. Each year around Halloween, families gather and park in the church parking lot and hand out candy to trick or treaters as they walk from car to car. We really enjoy it as it’s a safe and easy way for kids to trick or treat. You don’t have to worry about crossing streets, about strangers, or about dark houses. And everybody is home. And with cars only separated by a foot or two, the kids can hit a lot more cars in an hour than they ever could houses. This year the Trunk or Treat was especially great, since it allowed Courtney the opportunity to see the kids in their costumes and be with them trick or treating before she has to go back to hospital where she will be when Halloween actually comes around.

So, here’s the revised plan:
• Monday, October 29th, Courtney will be admitted to the hospital for five days of consolidation chemotherapy. Her doctor expects her to be released from the hospital on Saturday if all goes well.
• Next Friday, November 2nd, we should find out if any of Courtney’s other siblings are matches for a stem cell transplant.
• About four weeks after her consolidation treatment, Courtney will go to the Bone Marrow Transplant clinic for a couple days of physical examination, where they will make sure she is physically and emotionally fit for the transplant.
• If she passes her physical, she gets to play ball, and about a week later she’ll be admitted to the hospital for hopefully the last time.
• Eight days after admission and after a few days of more chemotherapy, Courtney will actually receive the stem cell transplant, which is more or less a blood transfusion.
• After the actual transplant, she will experience a couple of weeks similar to what she experienced after receiving her first round of chemotherapy (the induction chemotherapy.)
• Two to three weeks after the transplant, when her bone marrow is back to working properly and her WBC’s are back to normal, Courtney will be discharged from the hospital for the last time!

So, if you look at your calendars and follow the above timing, she will likely be in the hospital through Christmas, but coming out sometime before or after New Year’s. Courtney keeps saying she’s looking forward to starting 2008 cancer free! What a great blessing that would be!

We know for a fact that prayers work and have been answered throughout this entire process. We are again so thankful for the countless blessings that have come to us by way of so many wonderful friends and family members. We truly couldn't have made it this far so easily without all of the prayers and support. Thank you again!

Here are some pics from tonight!

Day 34 - The BMT Visit

Courtney had a lot of ups and downs today – literally and figuratively. She started off with her best night’s rest in a long time (thank you, Barb), but woke up in the wee hours of the morning with more stomach aches. The pain and discomfort continued throughout the day until we left for the appointment at the Bone Marrow Transplant Center.

The BMT Center was very nice. Everyone, from the receptionist, to the Physicians Assistant, to the Doctor were very accommodating and extremely likeable. We received more information regarding Courtney’s condition and treatment in less than an hour than we have since she was first diagnosed. They laid out the plan for more chemotherapy and ultimately the bone marrow transplant. It was a lot of good information to digest, bringing with it some big decisions to make.

By the end of the visit, Courtney was feeling much better. We had a nice dinner, courtesy of Courtney’s mom, who actually flew in for the day to attend the appointment and help us to gather information and ask the right questions. Courtney was feeling so well when we got home that she was actually able to walk up and down the stairs in our house for the first time since returning home. This was great as she was able to tuck the kids into bed for the first time in over a month. It’s funny how the seemingly small things become cherished moments when you’re not able to do them for such a long time.

Day 33 - A Donor!

This morning Courtney received a call from her sister, Tracy, who is now back in Italy. Tracy found out today that she is a match for a bone marrow transplant for Courtney! So far she is the only one to be tested. Courtney has two other sisters and a brother who are all planning to be tested as well. It's nice to be 1 for 1.

We’re not sure how having a donor will affect the chemotherapy treatment schedule, or how soon the transplant would take place. We have an appointment with the UT Southwestern Transplant Clinic tomorrow afternoon. Hopefully we’ll find out exactly what to expect in the coming weeks.

Courtney continues to see physical improvements daily. Today was by far her best feeling to date. She was up and about quite a bit and even got out of the house for awhile. Her biggest issues continue to be abdominal pain, tiredness and muscle fatigue. These are more than likely due to a combination of the lingering effects of the chemotherapy, the lengthy hospital stay, and the medications she’s taking. All of these will hopefully subside before her next round of treatment. In the meantime, she continues to eat fairly well and does what exercises she can. She was shown some great little exercises by the physical therapist at the hospital.

Her spirits are lifted daily as she’s able to visit with more friends and reconnect with her “normal” life that was suddenly and drastically put on hold more than five weeks ago. She’s also lifted up by the many small and not so small acts of kindness by friends and family near and far. This evening we received a surprise visit from the Young Women of our church. Unfortunately their visit had to remain on the doorstep and free of much wanted hugs as Courtney still has to be vigilant is staying away from germs. The wonderful young ladies brought over cute blankets they had tied and stuffed animals for each of our four children!! Thank you!!!

Also this evening, Courtney received a much needed professional massage that she described as “awesome” from a friend from church. I honestly haven’t seen her smiling so big and looking so content in a long time. After so many nights in a hospital bed, her back has been quite achy. It’s amazing what good rub down can accomplish. I think she’s really going to sleep much better tonight.

So, despite the horrendousness of cancer and all the pains that come with it, we continue to count our blessings and are constantly amazed by the plentitude that continue to come our way. It is our firm belief that God’s love is expressed through the kind actions and generosity of those around us. We are so very thankful to all of those who have given their time, talents, energy, money, and prayers (so very many of which have been answered), helping us to feel an overwhelming amount of God’s love at a time when we most need it. We hope and pray that your lives are blessed tenfold in return.