Myeloma Dispatches: The Cancer Triathlon Continues

Fall 2015. I sit on my back porch, relaxing under trees brilliant with fall colors. I’m feeling good. I challenge myself to remember my myeloma past.
In January 2011, Colorado was experiencing a record cold spell, and I was not feeling good. I had survived two rounds of aggressive induction therapy, the first leg of my cancer triathlon. Lab values confirmed my blood was scrubbed clean of myeloma cells.
It was time to prepare for the next stage of the cancer triathlon, the stem cell collection. The induction therapy cleared my body of myeloma cells but had also suppressed my white blood cells and stem cells. Neupogen (filgrastim) injections were the answer. This drug stimulates the growth of blood cells and the release of stem cells into the blood. It’s an injection given in the layer between skin and muscle.
I was surprised to learn that, even though I’m an experienced nurse, I couldn’t stick myself. Yikes. My kind husband gave me Neupogen injections daily for 10 days. This part of training was relatively easy for me. Even though I was weak, I wasn’t in pain, and didn’t experience any side effects from the drug. I was in the safety of my home, with my husband and my pets by my side. I had a goal and a schedule. I was hopeful and moving closer to the big event, the transplant.
Stem cell collection, or apheresis, is an outpatient procedure at the University of Colorado Hospital, where I was being treated. I sat in a comfortable recliner in a large open room with other patients. A nurse connected two tubes to my port. One tube drew my blood into the cell separator machine, and the other returned it back into my body. Painless. This amazing machine separated the blood and removed my stem cells, while simultaneously returning the remaining blood back to me. I spent three days in that recliner, reading, working on my computer, and listening to music. When I became restless, I practiced visualization, abdominal breathing, and people watching.
At the end of the procedure, I received disappointing news: not enough stem cells were harvested. I felt like I had failed some test. I had rested, I had taken Neupogen, and I had trained. The doctor reassured me that I had not done anything wrong. He wanted a large volume of stem cells, enough for a potential second transplant in the future.
As a next step he prescribed Mozobil (plerixafor). This drug untethers stem cells from the bone marrow, freeing them to enter the bloodstream. So once again, my schedule dissolved. Like an athlete, I was benched. Go home. Rest. Come back.
My husband and I were both in a dark mood. It was once again time for Plan B. We traveled to Santa Fe, one of our favorite places, full of art, great food, and definitely not a hospital. Santa Fe would lift our spirits. It worked beautifully.
After two weeks back home with rest, Neupogen, and Mozobil, the second stem cell harvest was successful. Once I let go of my competitive spirit, I felt grateful that I could go forward. The transplant was scheduled four days later, February 9, 2011.
Back home, we packed and I prepared to leave our home for two to three months. My husband, my adult sons, and friends would be my support crew. I was excited and just a little afraid – similar to how I felt right before a big athletic event. My coach had taught me “When you feel the butterflies in your gut, remind them to fly in formation and be a source of strength for you.”
What happened the day before my hospitalization surprised everyone. I tripped over my dog and fell. It was a small fall, but I broke my upper arm. The myeloma cells were crowding out healthy bone cells, weakening my bones. In the ER, the orthopedic specialist and the transplant doctor consulted with me. We all agreed I would go forward with the transplant despite my broken arm. I had to be willing to use a splint and a sling until I was well enough to surgically repair the humerus. At the time, I didn’t realize that I would be in that sling until June.
The stem cell transplant was a great success. The new stem cells grafted to my bone marrow and transformed into white blood cells, platelets, and red blood cells in record time. I was discharged early from the hospital and moved into an apartment near the hospital. Every day, I traveled to the hospital for blood draws and supportive therapy such as platelet transfusions.
I was not allowed to be alone, so a crew of friends and family took turns staying with me. A daily walk in cold but sunny Colorado reminded me that I was still alive. I was allowed to go back to my home in Carbondale in March, much earlier than the transplant team had predicted. Finally, I was faster at something.
I had completed the cancer triathlon of induction therapy, stem cell harvest, and stem cell transplantation. I was alive and officially in remission. My cancer journey was truly a team effort involving skilled physicians, nurses, and the angels of family and friends.
In August 2011, I was back at the Cherry Creek Triathlon. I couldn’t swim on triathlon day because of the recent repair of my humerus. One of my tri sisters did the swim, and I completed the 12-mile bike and 3.1-mile run. My tri sisters were all waiting, cheering for me at the finish line. I was filled with joy to just be there. I don’t know my overall time; I didn’t care then and still don’t.
The lessons of that cancer triathlon remain with me even today. I continue to focus on daily goals and try to accept my powerlessness over outcomes. I have learned to adapt. I still experience joy in completing a triathlon, but focus more on completion rather than times. I still like crossing a finish line with cheers in my ears. I am still alive and kicking.
Maureen Nuckols is a multiple myeloma patient and columnist at The Myeloma Beacon. You can view a list of her previously published columns here.
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Well written Maureen! I could visualize every step of your cancer triathalon.
You mentioned that you broke your humerus. My myeloma is doing a number on my right humerus and my physicians are thinking of pinning it to prevent breakage. What was the final outcome for you?
Earl mcKenzie
Thanks for the column, Maureen! Your description of the stem cell harvesting and ASCT is very good! I have never even given myself an injection, and was too squeamish to have needles to the stomach, before the aphaeresis procedure. We asked the transplant team if I could have them in the underarm! Later, last year, I finally had injections in the stomach, of Lovenox, while travelling. I found I had to put ice on the injection place to avoid large bruises from forming.
Sorry it took so long to get the stem cells harvested though. Mine were harvested in a long day. I was the last person out of the clinic ... the nurses stayed late that day for me I think. And to have a fracture of the humerus and have your arm in a sling for months, while going through the stem cell transplant, doesn't sound very comfortable either! Glad to hear that your were strong enough to do the biking and running in your triathlon. That is amazing!
Earl - The orthopedic surgeon wired the humerus 4 months after stem cell transplant. Still, a section has remained cartilage, yet the wires have held, so I am able to swim well, which was my goal.
Nancy, thanks for your kind words. One reason the harvest took so long is that I had to get enough stem cells for two transplants. Not sure if I will be able to ever use the stored ones. Looking forward to enjoying your next column
Glad to hear from you, Ms. Nuckols! Acceptance does bring peace. Glad to know about your "alive and kicking" status and attitude. Wishing you health and happiness.
Thanks, Upasana Pannu, for your comments. Even though I'm still alive and kicking, I'm back to receiving treatment, but have now outlived my original prognosis. An upcoming column will describe how I cope with more current challenges.
Thanks Maureen for a wonderful article and a clear explanation of your experience. It is so heartwarming to hear that four years later you are well. That gives us hope. My husband is at D+68 from his stem cell transplant. We have no idea what the future holds for him but we are full of hope and stories like yours help. By the way, do you have any residual issues with your arm or did it heal well?
I wish you continued good health and tons of happiness in Colorado - one of our favorite places. We are just down the road in southern New Mexico.
Thanks, PattyB, for your comments. I have relapsed 2 years ago and continue a variety of treatments which are working. My arm healed fairly well – I swim, bike, and walk with no problem.
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