During a routine follow-up at WPAFB, Doctor Berg noted a slightly enlarged lymph node in Tim's neck. He let it go for six weeks and when it was still there decided to have a surgical biopsy preformed. This was done at WPAFB. The results can back the next day as positive. The good part, if there is a good part about cancer, was it was the same Hodgkins. Sometime it comes back in a different form and this has less success in treatment.
Tim went through a series of tests to determine the extent of involvement. It was still class IV-A. Because the base hospital was phase out the specialty clinic, Tim was referred to Children's Hospital in Dayton. His primary doctor was Doctor Dole. The chief of the clinic, Doctor Broxson, is a retired Air Force doctor who worked in the AF specialty clinic at WPAFB. Doctor Dole did a search on Hodgkins and came up with a plan. Because this was a relapse, they decided to bring on the big guns. The plan was a series of chemotherapy followed by a stem cell transplant. Because of the cost involved, both of my insurance companies had to agree to the procedure, which they did.
Stem cells are the mother of all blood cells. The cells are part of the blood. While most people have heard of bone marrow transplants, stem cell transplant have a much higher rate of success. And since they would be coming from the donor, there isn't much chance of rejection. If you have a blood disorder like leukemia, you must have another source of stem cells or marrow.
The plan was for two to three sessions of chemotherapy followed by the transplant. The number of sessions would be determined by the reduction in activity in the involved nodes. The chemotherapy would be about twice as strong as that Tim received in round one. The treatment was strong enough that Tim would have to stay in the hospital during the sessions. Tim would continue to receive laboratory support and CAT and gallium scans at WPAFB.
Before he could go through the treatment sessions, Tim had to get a central line. This is catheter that is surgically inserted in the vein. This permits IV lines and fluids to be inserted without using IV needles in the arms. This reduces the chance for an infection when the blood counts are reduced because of the chemotherapy.
We reported to Children's Hospital and Tim was examined and admitted to start the procedure. The first thing that happen was the surgery for the placement of the central line. After recovering from this, the chemotherapy was started. As I remember this was the next day. The drugs are administered over a relatively short period and the rest of the time fluids are run through the system to remove them. The first session resulted in Tim being the hospital for five days. Once he showed no problems he was permitted to go home. Before we went home, I was instructed on how to change the dressing over the central line exit point. I also received instructions on giving Neprogen subq, or just under the skin.
As I remember, 10 days later he spiked a fever at home and I had to take him to the hospital. He went through the emergency room before being sent to a room. This first trip to the emergency took some time because of a police emergency. Cultures were taken from both central lines to determine what infection he had. He was in a room two hours after we arrived at the hospital. Nothing was found in the cultures. Tim was put on antibiotics but continue to spike temperatures. He ended up being in the hospital for six days before his temperature stayed normal.
Because Tim was going to go through a stem cell transplant, we had to go to the Hoxworth Blood Center in Cincinnati for the harvest. Tim and I went down on a Thursday as I remember for an initial check of his veins. The staff there said that the veins in his arms were not good enough and he would have to get another central line. Tim said no and we walked out. We then went over to Children's Hospital for a tour of the facility. Because our guide was late, we were within one minute of leaving when she showed up. We got a quick tour around the fifth floor and then went home. I remarked that we were probably wasting time because Tim would not get another central line. By the time we got home we where told the Tim could get the stem cell harvest through his veins, even though they said it would take twice as long.
The next week we went back to Hoxworth for the first of a projected three collection sessions. I had given Tim a double injection of Neprogen (GCSF) which is a white blood cell growth factor. This procedure involves inserting an IV needle in one arm from which blood is drawn and then run through a separator, which removes the stem cells, and then the blood is returned through the other arm. The technician was able to get a rate of 115. With the other central line, the rate would have been about 140. This first session lasted about three hours. The next day we were back for the second session. This one also lasted about three hours. The goal for the collection was 5 units of stem cells. They still didn't have the results of the first day so we were scheduled to come back the next day. As we were pulling out of the parking garage, the technician flagged us down and said that Tim already had enough. The first day draw was 13.4 units.
So it was time to return to Dayton's Children's Hospital for the second round of chemotherapy. This round fell just after Christmas. We were able to have a semi-normal Christmas including going to Cleveland. Because Tim had done so well with the first round of chemo, he was released after a four days.
Like the first round, Tim got another fever 10 days after being released from the hospital. Back to the emergency room and readmittance to the hospital. The emergency room was "normal" this time and from the time we walked in until Tim was in the room was 45 minutes. Again, Tim was given several antibiotics to fight the infection, which, like the first time, did not show up in the cultures. Tim was able to leave after five days but went home with antibiotics and IV pumps. I got to run two containers worth of antibiotics through him every six hours. No much sleep.
Because Tim was missing so much school, he had a lot of work that was sent home. Because of the chemotherapy and how he felt, he wasn't up to doing much of the work. This was Tim's senior year and he was missing most of classroom work. Tim had done very well on his SAT and ACT examines and had been accepted to the University of Illinois with a scholarship. Tim thought everything through and made the decision to withdraw from school because he was missing so much.
During tests conducted to determine the status of the Hodgkins nodes, it was determined that he need still one more session of chemotherapy. However, it was decided that this round would be the same type as he received during round one at WPAFB. This was an outpatient type. This decision was made by the transplant team in Cincinnati. This went without major problems.