80/20

                      The latest bone marrow biopsy results are good. There is no sign of leukemia. In the bone marrow, 80% of the cells are Sam’s and 20% are David’s. The hope is that David’s blood cells will continue to age and die and Sam’s blood will take over. As I said before, David will have Sam’s blood type. Modern medicine can be amazing.

David is doing well. Patient waiting is the order of the day. So far there is no sign of graft versus host disease, so Sam’s cells apparently aren’t attacking David’s organs. The skin and digestive tract are most at risk.

Jim and I are flying home tomorrow, after a 10 day trip to Fort Benton, Montana (a Hazen/Holms reunion with my 91 year old dad and 80 year old uncle and aunt), Yellowstone (three different days in the park), and Island Park, Idaho (a reunion with Jim’s mom and siblings). Sam, Peter, Xiomara, and 15 month old Andrew were able to attend the Montana festivities, meet a lot of Western relatives, and see the old ranch house, which has been abandoned for several years and is now in the middle of a wheat field. They also attended part of the Johnston reunion and toured Yellowstone.

It’s been a good trip and we are grateful David is doing well enough to be on his own. Thank you to our friends in Massachusetts for visiting him, taking the sacrament on Sundays, and driving him to doctors’ appointments.

And thank you to all our Western family who have expressed their love and support, and have kept us in their prayers.

Day Twenty-four

            David’s checkup on Tuesday, 8 Jul, showed his white blood cell count back down to 1.9 (reference range: 4.5 to 11). Jess Driscoll, the nurse practitioner, said fluctuations are expected. He received an injection of Neupogen (filgrastim), which stimulates the bone marrow to produce white blood cells. It’s the same drug Sam received before the transplant, to increase his stem cell production. We have a supply of syringes pre-filled with Neupogen, which David can use at home, but for this week Dr. Chen judged that one dose will suffice. David’s hematocrit (HCT), the percentage of blood volume that is taken up by red blood cells, has remained fairly steady at about 30. At 208, his platelets (PLT) are in the reference range (150-400). Platelets are blood cells that stop bleeding by forming clots. They have no nucleus and are 1/5 the diameter of red blood cells.

            Jess also performed a bone marrow aspiration and biopsy, David’s fifth. The fourth was pretty rough, but this one went smoothly. His iliac crest (hipbone) is thick and strong, so it takes strength and perseverance to puncture it.

            The initial results of the aspiration and biopsy should be in next Tuesday. They will show whether or not there is leukemia and whether or not Sam’s stem cells are thriving. It’s not expected that his stem cells will have taken over at this point; we just hope it’s moving in that direction. Additional molecular testing will determine whether the mutation, FLT-3, is still present.

Day Sixteen

We saw Dr. Chen yesterday. It was all good news: David’s white blood cell counts are 9.9, well within the reference range of 4.5 to 11. His red cell counts remain a bit low, but steady. Next Tuesday David will see Jess Driscoll, the nurse practitioner, which is a good sign that he is doing well and doesn’t require Dr. Chen’s constant attention. He will have a bone marrow biopsy on Tuesday to determine whether or not the leukemia is in remission and also whether or not the bone marrow is being populated by Sam’s stem cells.

David moves slowly and gets tired easily, but he is able to move around the house, make himself a sandwich, go for short walks, and be home alone. In fact, Dr. Chen advised us to take our two week vacation, which we had planned months ago. On July 17^th we’ll fly to Salt Lake City, drive to Fort Benton, Montana, for a Hazen/Holmes family reunion. (It’s the 80^th birthday and 60^th wedding anniversary of both my Uncle Herb and his wife, Aunt Judy.) My 91 year-old father will attend, along with my sister, Maggie, and her husband, John, and my brother Timothy. A few of our kids will probably attend as well.

Then we’ll spend a few days at Yellowstone National Park and a week in Island Park, Idaho, with Jim’s mom and siblings. We’d love to have David go, but he can’t travel by plane for a few months.