TBI

I was at the hospital yesterday for a long planning session with the folks of the BMT, the Blood and Marrow Transplant program (BMT, not just a Subway sandwich anymore).

They seem to be a kind, dedicated and committed bunch, which is encouraging, and the meeting was informative, if slightly horrifying. I'll be back there next week to meet the radiation oncologist and to do some dry runs of the actual irradiation process, partly to get some measurements and partly to keep me from freaking the hell out when they drop me into the microwave for the real thing.

Our euphemistic initialism of the day was TBI -- total body irradiation. I will get a lot of TBI. GFY, TBI.

I'm frequently asked why I would be given both chemotherapy AND radiation for this -- it seems like overkill. Yes, but I suppose overkill is the idea. The reason for this conditioning regimen is twofold: to kill any remaining cancer, and to suppress my immune system to let the new one take hold. The radiation, a high-energy x-ray, is on occasion very effective against lymphoma and gets into the darker nooks and crannies of the human system that chemotherapy sometimes does not reach. Like your brain. Or your nuts. Of course, THE EXACT TWO PLACES I DON'T WANT RADIATION. I'll get six blasts over the three days preceding the transplant.

I might have mentioned this before, and forgive me for dwelling, but it comes with some charming possible side-effects: nausea, mouth sores, diarrhea, swollen and painful salivary glands, rashes, itching, cataracts, fatigue, hair loss, sterility, mild burns inside and out, secondary cancers, etc. Not so different from the chemo, or living in Chernobyl.

As a bonus, though, I might also actually pick up a tan from this, which is always a positive in Ottawa in November.

I also got the details on the cocktail of immunosuppressants I'll be receiving to keep my new immune system from waking up too quickly and rejecting the various vital organs I rather rely on: methotrexate and antithymocyte globulin.

I'll get the standard package of antinauseants (zofran) and steroids (decadron, or trimspa as I've come to know it), plus an assortment of other meds that could include neulasta (to stimulate white blood cells), ativan and maxeran (to chill me out if I need, I guess), eprex (to encourage red blood cells), hydromorphone (drugstore heroin for pain), benadryl (for the various allergic reactions to various things), stemetil and haldol (apparently in case I get twitchy...is that really a risk?), antibiotics (trimethoprim/sulfamethoxazole), antivirals (acyclovir), and antifungals (fluconazole, nystatin). Yes, antifungals. It's a thing. I am singlehandedly supporting an entire sector of the economy. Between the whole pharmacy I'll be eating every day and the radiation, something is bound to give me superpowers. I just hope they're useful, and not like Aquaman's.

I'll take part in some research along the way, because why not. I'll be a test subject to help assess when it's most advantageous to provide blood transfusions to address low hemoglobin levels (a side effect of the chemo and radiation). I'll also be wearing a heartrate and breathing monitor to see if there are earlier ways to identify the onset of infection. Because apart from the cancer itself coming back, infection remains the biggest risk in this process. Identifying infection early and treating it quickly with antibiotics is key.

Oddly enough, the biggest risk of infection comes from, of all places, me. Since the gut lining gets thinned out and damaged by the preconditioning, there's a chance the nasty bacteria in my gut gets into my blood stream.

Infection risk also means that after October 26th there will be no takeout for a while, no delivery, no restaurants, no fresh fruit, no raw vegetables, no unpasteurized or moldy cheeses, no unpasteurized honey, no more questionable basement charcuterie, no rare meats, and sadly, still no sushi. Fuck you, cancer.