Chronicle of a Stem Cell Transplant (and on through to the other side)

Wednesday, October 15, 2008

I Wasn't Kidding About the Waffles...

Breakfast in Texas

We're back. It's taken me a while to write as I have had a pretty sore back after the bone marrow biopsies I had in Houston and couldn't sit down for long at the computer. Perhaps, if I would finally opt for a comfortable and ergonomically-correct desk chair instead of a nice-looking one, I would have been here sooner too.

Things went well down south. It was an exhausting trip as I had a full-work up of tests. My final scan was an "eyes to thighs" CT, which included the added surprise of having rectal barrium. I usually feign nausea when I have to drink this stuff; after all, it seems silly that everyone, regardless of body weight (including the 300+ pound man across from me in the waiting room), gets the same amount, so I figure I'm good to go if I can get a litre down (and that's about as much as my gag reflex will allow). Unfortunately, I fooled no one and soon found out I would be getting more of this thick, pasty sludge through another orifice. Horror of horrors. I didn't bother to ask what flavor it was this time.

In between testing, we tried to see as much of Houston as we could, starting first with a trip to Target, or Targ├ęt, as we like to call it in Canada.

Not just Target, but SUPER Target!

I was also lucky enough to see a wonderful friend, Baranna, who I met last year while I was in Connecticut, and it was so nice to connect again. We had quite an adventure west of the city to a quaint little town called Round Top on the weekend.

My lovely (and most hospitable) Texan friend

Throughout the week, our driving and lack of direction was somewhat mitigated by the fact that we had out-of-state plates on our rental car, so not every gesture was "the finger" when we turned into the wrong lane. We got a few thumbs up from fellow Oklahomans too.

The car also came with these two thugs

On the last day of our stay, we got the treatment recommendations from Dr. Younes. We had no idea what this would entail and whether we may, indeed, be staying in Houston to start a trial right away. However, that was not the case. The trial he considers most suitable for me at this time is SGN 35, a drug we are familiar with that belongs to a class of agents known as anti-CD 30 antibodies. The drug works by binding to receptors on target (cancer) cells then undergoes rapid "internalization" and releases active drug from the antibody carrier inside the cells.

What was unclear, however, was how quickly I could get on this trial if I wanted to do it in Houston. Getting started right away while I qualify and without the risk of delay was certainly an important consideration; however, we were unable to get a definitive start date. This is often the case with clinical trials, particularly when they are in stage I, as there can be limited access to the drug itself, more urgent cases and other administrative issues. So, we would have been staying with very little chance or guarantee of getting on the trial a few weeks later.

As all pre-screening needs to be within 30 days of the start of the trial, if I didn't get a place in that intake, I would have to have a full-work-up again, still with no guarantee of a spot in mid-November. As a Canadian receiving treatment in the U.S., I am basically in the same position as an uninsured American. All expenses are out-of-pocket and it would theoretically be possible for us to spend more than $50 000 doing all the pre-screening and still perhaps not get a spot in either of these two intakes.

It is not a pleasant feeling to have to make such decisions based on cost, and, really, I am not. I am very, very lucky to have an incredible family who assures me we will do whatever it takes, whatever I decide. Fortunately, we also found out in Texas that the SGN trial is expected to open in Vancouver in phase II in the new year.

So, as soon as we came back, we were on the phone to see if I could get access to the drug up here sooner through an Expanded or Compassionate Access Program. While it is not possible at this time, through due diligence (and holding him hostage in his office for an hour and a half), we seem to have precipitated a major shift in the doctor I have had so much difficulty with here in the past (the one who saw no point in my exploring clinical trials). Fingers crossed, he seems to now understand why I would like to take a stab at the whole survival thing.

While it is a little scary taking this leap of faith and going back to "maintenance" chemo to hopefully hold the disease until the Vancouver start date, I can't express how relieved I would be to be able to stay at home to do the trial. I don't want to be away from my family and friends anymore and we have so much support here; Ian would also be able to continue working. Plan B might be Seattle if they get the trial open faster, but for so many reasons, we'd rather stay here. Still, who knows, stranger things have happened.

So, that's the view from here on this fine fall day (despite Stephen Harper still being Prime Minister this morning).