The New New New New Plan

Once upon a time, the plan was induce remission, take a short break outside the hospital, and the return for a stem cell transplant. The break is good psychologically and physically. The physical part is that your own immune system can attack infections that may have taken advantage of its previously weakened state, providing a better starting point. The psychological advantages are obvious -- being in a hospital is inherently stressful, even when nothing is going wrong.

I got half of the remission right -- no detectable leukemia -- but it's not remission unless the blood counts build back up. So a new plan was floated. It might make sense to go straight to transplant. As part of this plan, there was a potential plan to postpone Mara's donation by a couple of days so that my conditioning chemotherapy would end as her donation was ending and I could get fresh stem cells, not frozen.

Then the many doctors discussing my case decided that my infections argued against going straight to transplant, at least on a schedule tight enough to make it reasonable to extend Mara's schedule by a couple of days. So she was put back on her original schedule, and we're back to seeing if my counts start coming back once the infections are being managed.

This past Monday, the plan was to give me Neupogen for four days and see if that boosts my counts to leave-the-hospital levels. If not, go straight to transplant. If so, take a break. Decision to be made on Thursday.

On Tuesday, the doctors determine that they didn't get quite as many stem cells from Mara as they had hoped. Her age is a factor, as is the fact that I outweigh her by as much as I do. There's only so much she can give, and she gave it all. It's enough to do a transplant safely, but it might stretch out my recovery a little. This adds some weight to the take-a-break side of the scale. A break opens up the possibility of bringing Mara back for another donation round, after she recovers. A break, assuming my immune system is up to it, also gives my body a chance to keep beating down any infections I have, known and unknown. Decision day is still Thursday.

On Wednesday, the plan is to extend the Neupogen injections a full week and make a decision next Monday.

Today, the plan is to go straight to transplant. My counts are not moving as much as they hoped. I appear to have the current infections in check -- several consecutive days without a fever, feeling good. Tomorrow, I start the conditioning round of chemotherapy. A week from Friday, transplant.

So that's The Plan. It is more firm than any previous plan, or choice of plans. It's basically back to Monday's plan, and we have arrived at Monday's plan's decision point.

I'm ready. I'm not worried about the psychological break I'm not going to get. I know what it's like to be at less than full psychological strength, and I'm far from there. I am strong right now. I'm a little concerned about the infections I'm clearing up, but I trust the doctors. Also, the longer we wait, especially in a hospital, the more likely I am to catch another infection. And, the sooner I get the transplant, the sooner I'm out of here.

Let's go!