What is a Bone Marrow Transplant?

You know, the reality is, we spend so much of our time talking about Brad's BMT, that sometimes we forget others haven't been planning for this event like we have for the past 4+ years.  If you haven't followed our blog from the beginning when Brad was diagnosed in 2009, he had extensive cancer throughout his body, similar to what we're seeing now.  Dr. Fintel was pretty confident we would see the cancer in his bone marrow and that we would likely be moving forward with a transplant (which we soon discovered other treatment options would be tried first).  In preparation for a possible transplant, Brad's 3 brothers were tested to see if they were a match.  It turns out that Brad's fraternal twin brother Chad was (is) a match, which wasn't a guarantee since they're not identical twins.  It has been a HUGE blessing for us that we have known for the past several years, that when God's timing was right, we had a donor on the sidelines, unlike so many others who have to agonize whether a match exists for their loved one.

Brad will be having what's called a myeloablative allogeneic transplant.  The "myeloablative" word refers to the hospitalized chemotherapy and/or radiation combination Brad will receive when he first arrives to Duke, completely eliminating his body's ability to make any blood cells.  The "allogeneic" word is the type of transplant, which in this case indicates that Brad has a donor and is not using his own harvested cells in hopes of becoming cancer free.  I keep telling Brad he needs to send Chad a big roll of bubble wrap to protect himself up until transplant!!

For Chad, the donation process, while time intensive for him, is an outpatient procedure.  A couple weeks prior to transplant, Chad will travel to Duke for a day of tests and blood donation.  Two weeks later, he'll return for a one week stay and he'll have daily visits to the transplant center where they'll be harvesting his blood cells in preparation for Brad to receive them.  We need to think of a really phenomenal way to say thank you to Chad and his family!  Really, how many times can somebody say they've saved a life??  Chad, you have NO idea how thankful we are to you and Lisa and this truly wonderful gift you are providing.

For Brad on the other hand, this is where many of his/our life changes begin.  At the point Brad is hospitalized to begin the intense chemo and radiation, he'll be hospitalized in an ICU environment for approximately 30 days.  Because the chemo is so intense and as indicated above, completely wipes out Brad's ability to make its own blood cells, Brad will have zero immune system. The slightest cough, germs, anything of the sort, can be deadly to him, which is why his environment and his visitors will be so restricted.  It's strange to think about, but Brad's immune system will be likened to that of a newborn baby.  Brad will even have to have his childhood vaccinations all over again, once his transplant oncologist indicates it's time to do so.  The actual bone marrow transplant and the placement of cells into Brad is a quite simple process.  Once Chad's cells are placed into Brad's body, they'll get settled into the marrow areas (where the good and bad cells were killed from the chemo) and begin to regenerate themselves.  Is the transplant a guarantee that Brad's cancer will be gone?  No, there's no guarantee, but this is the only hope we have that it could be and we're banking on that to pull us through!

Once Brad is released from in patient care, we'll continue to live at Duke for a couple of months so Brad can have tests and blood drawn daily.  Brad has to be within 5 miles of the hospital for any potential emergency that could arise, which can happen easily since his immune system will be severely weakened. Although the first full year after a transplant is challenging for most, the first 100 days are the most critical for transplant patients and Brad will be monitored closely and tested often.

We know that there are lots of tests and procedures coming before we continue to move forward and we couldn't be more blessed with our cheering section of family and friends lifting us up.  You know, the reality of all of this is that right now, as I sit here today and in this moment, I'm more excited for this process, than afraid.  I'm excited about the opportunity for a new beginning.  I'm excited about the potential for our family to live cancer free.  I'm excited for my husband to start his life "over" and for us to move beyond cancer.  Lately, it seems like everywhere I turn I'm seeing the exact same bible verse (no less than 5 times this past week - it's like it's hitting me in the head!) and I want to share it with you:

Isaiah 41:10
Do not fear, for I am with you; do not be dismayed, for I am your God.  I will strengthen you and help you; I will uphold you with my righteous right hand.

It's amazing how the right words, can make an impact at the right time.  Here's hoping you hear the words you're looking for this week!!

Love,
Sandy

Happy New Fear...

Wow and we're sorry is really all we can say. We've been slackers since our last post in 2012 while we were keeping everybody up to date about Brad's radiation therapy that took place during the week of Thanksgiving 2012.

Unfortunately, the return of our blogging does not bring us with the most enthusiastic of posts, but since we anticipate the need to continue sharing Brad's story, it's important we share the back story. In November, Brad had a CT scan (his PET scan was denied because it wasn't "medically necessary"). The results showed that Brad's cancer was active again, resulting in his Oncologist requesting a PET scan to obtain additional information about the activity. Sadly, it was denied AGAIN. I won't elaborate on my thoughts about Obamacare. After having to submit a special request, Dr. Fintel was able to obtain approval for the PET scan in December.

The information from the scan showed pretty significant activity all throughout Brad's body again, which was such a surprise given that both Dr. Fintel and Brad's Radiation Oncologist were predicting several years without activity. Needless to say, the option immediately presented was a return visit to Duke University to determine if now is the time for his bone marrow transplant (BMT) or stem cell transplant (SCT). That visit took place this past Monday on January 6th.

What we found out was both frightening and a relief all at the same time. Brad's cancer has progressed to a point that the chemo is no longer working the way that it should be. As a result, we were given 2 options:

1. Continue taking chemo, knowing that there would be shorter remission periods that would continue to diminish over time or

2. Have the bone marrow transplant

Particularly after hearing that if Brad continues to have chemo, his life expectancy is 2-5 years based on progression, we clearly are choosing the most aggressive treatment option available and Brad will be having a bone marrow transplant. Although it’s easy to think in your mind, well, doctors don’t really know when somebody’s body can’t fight any longer against this horrible disease, when your loved one is being told 2 years, it’s like a horrible lifeline that you can’t help but think about and cling to as a clock that’s ticking.

Beginning next Monday, January 13th, Brad will once again undergo chemo here in Roanoke as pre-transplant preparation. He will have 2-4 cycles, each cycle taking place every 21 days. Once he has completed his chemo he will have a PET scan to determine whether the cancer has gone into a temporary remission. Once that occurs, a very grueling transplant process will begin and we will "move" to Duke for a minimum of 90 days. During that time, Brad will spend the first 30 days in the transplant center in an ICU environment. Once he is given the opportunity to leave the transplant center, Brad/we will move to approved medical housing "off-site" that is within a 5 mile radius of the hospital, for daily appointments of blood work and other tests to make sure he is staying healthy.

Dr. Rizzieri, Brad's Oncologist, has said it will be a year before Brad is able to return to work on any full time schedule. Brad may be begging at the 6 month mark for some medical clearance for part time status and if he's lucky he may get it, although right now, he's been told no work for one year due to the risk of illness and the general stress imposed in the work environment. The recommendation is that he allows a full year for recovery.

I'm not gonna lie. This upcoming year will be a true test of faith and spirit for us. Although this process is so frightening and comes with some serious risks, we have so many pieces that have already come together that show us this is God's plan and that his presence is here. Brad's corporate offices for East Coast Metal Distributors are located in Durham, so he has a ton of employer support. We were told today when meeting with the President, that Brad needed to take his year or however long it took to recover and that his branch and his position would be waiting for him when he's able to come back to work. Another huge blessing is my recent change in positions with the American Cancer Society, which gives me significant flexibility to work remotely, with access to one of my offices in Raleigh, NC, only about 20 minutes from Duke. This flexibility means we won't also have to worry about my loss of income and will allow me the opportunity to continue working and being fully available and present for Brad while he's in Durham.

We ask that you continue to pray for a healthy spring leading up to Brad’s transplant in March or April (to be determined once he has a clean PET scan). It is really critical we keep Brad illness free since his immune system is so compromised right now. So, if any of our friends making visits have any of the yucky bugs going around, we ask that you give us a call instead of a visit. We love you, but not your germs!! Please also keep Avery in your thoughts and prayers. This is going to be a REALLY tough year for a 15 year old that has such a great relationship with his dad and their contact will be minimal while we are at Duke. Pray that he has strength to allow his concerns, feelings and questions to be met with an honest and open heart and that he and Brad can maximize their time together before Brad heads off.

There’s lots more to share, but this is certainly enough for one post. Thank you for all your love and support.

Love,

Sandy