HSCT – Day 12 – The chemo is coming

Today is the day I have been looking forward to, it’s time to start getting rid of those bad immune cells. If I am able to remove all immune cells that have been “programmed to attack my own body”, I will effectively have been cured of multiple sclerosis.

Yes I said it, CURED.

Obviously, a medical professional can’t use this word, understandably. Because the word entails some guarantee and hope of regained functionality, you can’t guarantee to be able to kill off all the bad immune cells, and you can’t guarantee one of these cells won’t be created by mistake again and allowed to replicate. I will try to explain how these autoimmune diseases “work” in a future blog post.


Simply put, there are no guarantees in this game.

But you’re chances of success are high.

However, if I am successful with destroying all of the immune cells, so I can rebuild a new immune system from scratch based on healthy cells. It makes sense to me that this would stop the disease. Because there are no “bad cells” that can reproduce, and cause further damage to my central nervous system.

The day begins

I wake up at around 6 am, I’m too excited about whats going to happen today so I’m unable to get back in bed to get a few more hours of sleep. Which probably would have been a good idea.

Instead I decide to make a cup of tea, which I have never done before in my entire life.

It’s not too bad.

It turns out drinking a cup of tea in the morning isn’t too bad. It gives you a soothing relaxed feeling, which is nice.

Before I’m allowed to eat breakfast they come in and measure my bodyweight, to be able to calculate today’s dose of Cyclophosphamide (chemotherapy).

A common chemo protocol for aHSCT treatment internationally is 200mg Cyclophosphamide per kg body weight, it’s the same protocol that is being used in Sweden, Norway, Denmark, Canada, US, Singapore, Mexico, and several other places.

Since I’m a smart guy, I made sure to add 10 more kg’s to my body weight before I went to Russia. To make sure I get the most chemo for the money. Brilliant, ey?

Breakfast

9 am is breakfast time, and today they served porridge and bread. I’m not sure if they are used to eating porridge with bread in Russia or what. But I prefer to eat that bread with some tuna instead. Honestly, King Oscar’s tuna “Hot Thai Chili” spread on a slice of bread is amazing!

Porridge, Tuna and Coffee

Time for infusions

At 11 am it’s time to start with the infusions.

Picture of chemo bags ready for infusion

In this rack, you can see 5 bags of fluid, these contain:

  • Bag 1 – 9 grams of Cyclophosphamide, mixed in a saline solution
  • Bag 2 – 9 grams of Cyclophosphamide, mixed in a saline solution
  • Bag 3 – 500 ml saline solution (0,9% NaCl)
  • Bag 4 – 500 ml saline solution (0,9% NaCl)
  • Bag 5 – 500 ml saline solution (0,9% NaCl)

Basically, they have watered out the chemo-drug with 2 liters of saline water. They first give you 1-1,5 liter of pure saline water to make sure you are hydrated. Before continuing to give you the chemotherapy drug, that is mixed with 2 liters of saline water.

All these bags will be hooked up to my external jugular vein through the new central venous catheter I have put in. This type of catheter is called a triple lumen catheter. As you might have guessed this means it has 3 individual chambers inside the same tube.

Looks nice, doesn’t it?

This catheter can be used in the following useful ways:

  • Infuse different types of medications at the same time, for example, methylprednisolone and sodium chloride (water with salt) at the same time.
  • Double down on the same drug, for example, chemotherapy. Flow-rate can also be controlled by a machine.
  • The most interesting feature, in my opinion, is the ability to measure the right atrial pressure. This reflects the amount of blood returning to the heart and the heart’s ability to pump the blood into the arterial system.

This will probably be a useful metric for the Doctors to have when I’m going to get infused with my brand new baby stem cells in a couple of days. To make sure my heart is functioning properly.

Time to get started

Dr. Denis Fedorenko explains what’s about to go down

After the chemo drug, Cyclophosphamide has been infused. I still have 2 more infusions coming that day, a couple of hours later. Both containing supportive drugs to protect my organs and for my well being. The drugs are commonly called mesna and aprepitant.

Mesna is used to protect against hemorrhagic cystitis, which is an inflammation in the bladder. It goes without saying that avoiding any type of inflammation is a good thing considering you’re trying to eliminate your immune system.

Aprepitant, or what I suspect is actually called Fosaprepitant, is an anti-nausea and vomiting drug.

You also take these oral drugs:

  • Ciprofloxacin 1000mg/day
  • Fluconazole 200mg/day
  • Aciclovire 1200mg/day
  • Co-Trimoxazole 960 mg/EOD
Supportive medication

I will cover what these drugs do in a later blog post, detailing the drug protocol.

As you can see in the photo below, I’m already lovin it!

Me posing like Fabio Lanzoni doing chemo
Posing like Fabio Lanzoni while getting pumped on chemo

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