A Duke Consult

It's Tuesday 6/10/2008, and today I have my first consult with the Duke docs at the Bone Marrow Transplant group. Due to insurance issues, my transplant has to be done at Duke instead of UNC where I was first diagnosed with leukemia. Bone Marrow Transplants cost upwards of $150,000 so the insurance company gets a big say in where that happens. I suspect they negotiate a price with a particular medical center and then require all of their enrollees to use that center.

I saw my leukemia doctor at UNC yesterday just to check in and get my blood counts redone. Fortunately, they were about the same as last week when I had them checked. Last week at the clinic, I also had a bone marrow biopsy done by a terrific PA named John Strader. He pre-medicates with a little IV morphine and ativan to make the procedure more comfortable. I've never had a bone marrow biopsy before, but I think it certainly helped me be more relaxed. I mean they do stick a big needle into your pelvis bone and suck out the marrow for testing.  I was a little anxious about it I have to admit. I've seen them done during residency and they looked painful. It left me a little bruised and sore at the puncture spot, but it wasn't bad overall.

My sister Beth is coming up today from Ga and Becky arrives by plane tomorrow. They are coming to be supportive and to be tested to see if their bone marrow matches mine for the transplant. There are 6-8 markers on our blood cells that help our bodies decide if something we encounter is foreign or part of us. I need to get bone marrow or stem cells that match mine so that my immune system doesn't reject the transplant. Since we inherit the antigen markers from both parents, the best match is most likely to come from one of my sisters. Each one of them has a 1 in 4 chance of being a match for me. (Makes you want to be from a big family-more options for a potential match.) If neither of them is a match, then my doctors will search the bone marrow registry/database for a donor who is a close match. Of course, it would be a lot simpler if one of my sisters is a match. They live nearby and are willing to help out. I can only imagine what it would feel like to donate life-giving cells to your sister. Altruism of the first degree. Fortunately they now use stem cells instead of actual bone marrow cells so the donor doesn't have to have a bone marrow biopsy or harvesting anymore. They sit in a chair as if they are giving blood and a large apheresis machine separates out the stem cells, returning the other blood cells to the donor. So I imagine it to be a little like giving blood, just a lot more complicated than filling a pint bag at the Red Cross.

Word of the day: Peace... brings to mind quietude, internal tranquility, forgiveness, self-soothing

Book I'm Reading: The Post-American World by Fareed Zakaria

Best Book I've Read Recently: the World is Flat by Thomas Friedman

Thing I'm Most Thankful for Today: The deep shade of a large tree. It has been 100 degrees in the Triangle the past few days, and I am struck anew at the pleasure of stopping below a big tree to cool off.