On My Way...

It's on.

I'm getting a stem cell transplant.

I couldn't be happier. It's like being brought back from the dead.

I talked to the oncologist yesterday and she's all for it. I'm so excited I can hardly stand it.

The first step is to safe guard my fertility. On Monday, I'm going to see a reproductive endocrinologist that specializes in onco-fertility patients. I'm going to have two procedures done. The first will be a cycle that will stimulate my ovaries to mature a number of eggs that will then be retrieved transvaginally. After that, they'll be fertilized with BF's sperm and after a few days of maturation, they will be frozen with liquid nitrogen. All of this would normally be out of our price range, but with the help of an excellent non-profit called Fertile Hope we'll have to pay less than half of the usual price.

After the embryo freezing, I'm going to have one of my ovaries removed and 20% of the tissue will be donated to the University of Pennsylvania for research into the in vitro maturation of eggs. The other 80% will also be frozen and saved for my use in the future. The ovarian tissue cryopreservation will be done as part of a clinical trial and it won't cost me anything so I thought, "why not?" The technology to successfully mature eggs from frozen tissue hasn't been perfected, so I wouldn't rely on just that option for any future kids I'll want to have, but I'd like to help science move forward and it will serve as a possibility for a backup option if frozen embryo transfer fails for some reason. I'm also going to have a tubal ligation while they're removing the ovary. I figure that I'm never going to be able to get pregnant naturally anyway, but in case the chemo doesn't make me totally sterile I don't want to get pregnant accidentally. Even if all of the eggs aren't destroyed, there could be chromosomal damage and I wouldn't want to risk a baby with major birth defects.

So after all of that is done, which is dependent on a number of unpredictable hormonal factors, we'll go ahead with the stem cell transplant.

I'll be admitted to Thomas Jefferson University Hospital for four days. While in-patient I'll have a central venous catheter implanted into my subclavian vein and a PICC line implanted into one of the large veins in my right upper arm. The catheter will be used when they remove the stem cells from my blood during aphaeresis and the PICC line will be used to administer the chemotherapy and other IV drugs and fluids throughout the process. After placement of the lines, I will receive a dose of chemotherapy and an injection of G-CSF to stimulate my bone marrow to produce more cells and to release them into my bloodstream.

For a week after that my blood counts will drop, but then they will rise again and once they get to the right range, the doctors will bring me back in for a process called aphaeresis. The aphaeresis will last about four hours. I'll be hooked up to a machine similar to a dialysis machine, but instead of removing toxins from my blood it will remove the stem cells, which will then be packed and frozen for storage until they're needed.

After that they give me a while to rebuild my strength. Once I'm back to relative health they do what they call high dose immunosuppressive therapy. Cytoxan and lymphocyte immune globulin will be administered over several days and my immune system will be totally eradicated. At that point I will be highly susceptible to death from infection as I won't be able to fight anything off; I'll be held in complete isolation in order to minimize my exposure. This is the point where they transfuse me with my stored stem cells in a procedure referred to a stem cell rescue as they are literally rescuing you from certain death.

Once my stem cells have been transfused we wait. They have to engraft themselves in my bones and start creating new bone marrow. Then, over the next several weeks to months, my immune system will gradually rebuild itself. This period entails a lot of monitoring for infection, blood transfusions, and treatment with antibiotics and IV immunoglobulin.

And that's it. Worst case scenario is obviously that I would die. There could also be other serious complications that could prolong my recovery. In addition to that, there's also the possibility that it just won't work and my autoimmune diseases will just continue on their current course.

But I could be cured. My lungs could improve. And I found out yesterday that I might even be able to carry a child of my own, something I hadn't even dreamed of.

This could be everything I've been hoping and dreaming of. This could give me another chance at having a full uninhibited life.

I can't wait to get started!