Wednesday, July 15, 2009

Wednesday,

Overwhelming. That would be the best word to describe our day today as we spent all afternoon at the Karmanos Cancer Center learning about bone marrow transplants and what Bonnie is facing. A lot of questions were answered, but deciphering the volume of information that came at us created additional questions needing clarification.

Before going into detail on the road Bonnie is facing, we need to remind ourselves continually that God is faithful regardless of the incredible circumstances before us. He knows our needs as He is always with us. He knows our frailties and weaknesses. He is our strength and the nourishment we need to draw from as we feel overwhelmed. He is complete and His word is sufficient. Psalm 73:23-26 is a source of nourishment to our souls as we travel this difficult road:

Nevertheless, I am continually with you;
you hold my right hand.
You guide me with your counsel,
and afterward you will receive me to glory.
Whom have I in heaven but you?
And there is nothing on earth that I desire besides you.
My flesh and my heart may fail,
but God is the strength of my heart and my portion forever.


Please pray for wisdom and discernment as well as a calming peace as we learn more about the bone marrow transplant (BMT) process. First off, the type of leukemia Bonnie is dealing with has a 70-80% chance of resurfacing within the first year if we chose not to do the BMT at this time. Waiting doesn’t appear to be an option.

The process is starts with Karmanos identifying a donor. They will start with Bonnie’s siblings first to see if there is a full match. There are 8 different genes they look to match, but could go with a donor that only matches 7 genes. There is a 1 in 4 chance that a sibling will be a full match. If siblings don’t match then they access the national donor database. We have been asked by a number of people where they can go to do HLA (human leukocyte antigen) typing to see if they are a match with Bonnie. Karmanos will be emailing us information on where to go to do HLA typing. There is an 80% chance as a Caucasian that a match will be made and a donor identified.

Once the donor is identified the transplant is scheduled. This part appears to be the simplest part of the process. The transplant does not involve actual bone marrow. Instead, the donor’s peripheral blood is harvested and put through a process of capturing stem cells and then replaced back into the donor. Once the stem cells are captured and separated they are transfused to the host (Bonnie) like any other blood transfusion. The proteins of the stem cells know to penetrate the bones and reside in the bone marrow cavity where they begin to produce to new white blood cells. It is quite fascinating and just one more argument that we didn’t just happen by chance but were created by an incredible God.

Where things become overwhelming is the physical trials Bonnie will be required to endure and the multiple side effects of the transplant. She will have to go through chemo prior to the transplant to wipe out her immune system so her body won’t fight the foreign stem cells. Once her levels are back in a neutropenic state the transplant occurs. The doctors say she should tolerate this type of chemo better than what she just went through these past two months.

Once the transplant occurs, it will take approximately two weeks for the cells to begin to mature in the bone marrow. The key is how her body will handle the infusion of stem cells. Her WBC can recover or possibly the new WBC can be seen as foreign and reject the transplant. They will use steroids and immune suppression drugs as part of the process for her body to accept the transplant.

Even if her WBCs recover and accept the transplant, the issue of most concern that she will face is called Graft Versus Host Disease (GVHD). During the first 100 days, acute GVHD can develop in the gut, liver or skin and is treated with steroids. Because of the advancement in DNA typing, they don’t see acute GVHD as much as they used to. Only a 30% chance with a sibling donor.

After 100 days, there is a 60% chance for some form of chronic GVHD requiring long term treatment. This could be a simple as thicker skin with a rash or less moisture from the salivary glands or tear ducts.

There is an 80 to 90% surviving the first year with a perfect sibling match and the leukemia relapse rate for someone receiving a transplant is 20%.

Facing the prospects of working hard over the next two months to get stronger only to be put back into a physical condition similar to Bonnie’s stay at Sparrow is overwhelming. Being told that you will most likely experience diarrhea, sores in the mouth, rashes, nausea, etc., sounds too familiar and close to home.

Add to that the time estimates for this to occur. Once the donor has been identified and the transplant occurs, the hospital portion of the stay is 4 to 6 weeks. Following that is the first 60 to 100 days where the Center wants Bonnie to stay nearby for monitoring and ongoing treatments. When you start to think of 4 to 5 months away from home, family, and the kid’s education it becomes overwhelming.

Compounding this is Steve’s lymphoma and the pending treatments still ahead of him near term. Please pray that we will manage being overwhelmed and that God’s peace will be even greater than what we experienced with the first round at Sparrow Hospital, that God will rise up wise counsel for us to interact with, and that we will continue to strive to glorify Him with our attitudes and actions. Please pray that our children will rise to the occasion and for wisdom of what to do about Caleb and Callie’s education this fall and winter.

Thank you for your interest, cares, concerns and prayers.

God Bless,

Steve and Bonnie

6 comments:

  1. Last night in Bible study here at MasterWorks we talked about God showing His strength and power through our weaknesses. The main passage we were looking at was 2 Corinthians 12. Here is a portion:

    9But he said to me, "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me. 10That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties. For when I am weak, then I am strong.

    It amazes me how people who are suffering so much in the flesh have God's strength shining through them. You both have been an extreme encouragement to me as I see God's power coming through your physical ailments.

    I am continuing to pray for you all and always know that God is with you and His grace is sufficient for you. He will sustain you and be with you in this time of need.

    I love you all,

    ~McKenna

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  2. One hears about people going through bone marrow transplants and doesn't think much about it (just another medical procedure), until one reads your excellent description, Steve. "Overwhelming," seems like a pretty good word to me, other words come to mind, mostly depressing ones.

    It's frustrating that it isn't a burden that we can help you bear in a physical way. We are praying, but wish we could do more.

    Psalm 73 has taken on a deeper meaning for me through watching you guys go through this process, it is an excellent passage to cling to, and it is an encouragement to us (who watch and pray) to see you do so.

    "All who sail the sea of faith
    Find out before too long
    How quickly blue skies can grow dark
    And gentle winds grow strong
    Suddenly fear is like white water
    Pounding on the soul
    Still we sail on knowing
    That our Lord is in control

    Sometimes He calms the storm
    With a whispered peace be still
    He can settle any sea
    But it doesn't mean He will
    Sometimes He holds us close
    And lets the wind and waves go wild
    Sometimes He calms the storm
    And other times He calms His child

    Scotty Krippayne - "Sometimes He Calms the Storm"

    May he hold you guys close as the wind and waves go wild around you.

    John and Cherie Murphy

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  3. Oh My!!!!! I don't even know what to say....

    The road is long, but God and your friends will be with you- for the long haul.

    Whatever it takes!

    One day at a time....I'm praying that for you both! Praying the kids can do that too.

    I feel helpless-that there isn't something I can do. I know others probably feel that way too.

    If there is ANYTHING any of us can do, to make things better, easier, less of a burden for you...PLEASE will you ask?

    On my knees for you !
    Kelly

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  4. We are praying continually for you guys!!! I am so sorry you have to go thru this. I will pray for wisdom, peace, endurance, and God's strength!!

    Thank you for being so encouraging. I love you all!

    Stephanie

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  5. Greetings from Illinois. One of my dear blogger friends, Kim - Just a Southern Girl, told me about you. Having survived breast cancer, I can emphathize with your situation and the physical uncertainty you face. God is faithful! He is there every step of the way. There is a book my precious husband purchased for me I'd like to recommend to you. The title is "what cancer cannot do stories of hope and encouragement." It has a pink cover w/the breast cancer symbol on it. I will be praying for both of you and following your journey. Blessings, SusanD

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  6. Me and my family are praying for you guys! It was weird, I was watching a video of an Olympic runner named Derek Redmond running the 400 (it is on youtube if anybody would like to see it). Anyway in the middle of the race he was running in what seemed to be a excellent race, but all of a sudden he just crumpled to the ground. And as everyone else crossed the finish he just laid there with what was soon learned after was a torn hamstring. But soon after they other runners crossed the finish line he got up and tried to finish the race. As security tried to get him off the track, his father came on to the track and said "you don't have to do this" and Derek said, "Yes I do!" And with that, as the crowd leaped to their feet, clapping and cheering, he the finished the race. As reporters asked later, questioning Mr. Redmon (Derek's dad) Why he had gone on the field to help his son, he said, "We started his career together so I thought we should end it together!" I felt like telling you guys this because, in a way is like what you guys are doing. You're starting the race with God and you are ending it with God. And you're relying on him throughout all of these crazy days. I hope everything works out for you guys!!!!!

    Peace,
    Ben

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