Now that a donor has been recruited, Dr. Rossetti thinks that we will be able to “have stem cells by mid December”. No dates are firm yet, but we should be able to have a firm schedule in place by the end of next week.
Beth’s blood counts continue to be critically low – her white blood cells yesterday fell below 1.0 (“.94”) for the first time since I’ve been watching the numbers. And as I noted, her hemoglobin was 7.2, and her platelets were only 18 (again, lowest I’ve seen them). So today, Tuesday, she’ll go to Jefferson Hospital for her (7th of 7) injections of Vidaza, for two or more units of blood, and also, for platelets.
Beth’s bone marrow is defective, and every stem cell she produces is defective, and so the goal over the next few weeks (including the “intensive chemotherapy” and radiation) will be to bring her “as close to zero bone marrow” as she can get. The Vidaza, while not enabling her to produce good blood cells as promised, has at least gotten her most of the way there already. And that’s a good thing. [Also a “God” thing, as I had written at first.] The reason you want all of it gone is to reduce the chances of relapse down the road. And in addition to the “intensive chemotherapy”, the full body irradiation “cuts relapse rates 20%”, according to Dr. Rossetti. Every little bit helps.
Once the new stem cells are transplanted, then Beth’s numbers should begin to go in the right direction. Her white cells should begin to recover within 2-3 weeks. Engraftment should occur on or before day 30. Hemoglobin production should start in about three months. Anti-rejection drugs will be administered between days 35 and 90 – more or less to either to control or enable some “graft-vs-host” (GVH) effect. To some degree, the GVH has a “mopping up” effect – the immunity of the new stem cells will target and destroy any remaining defective bone marrow, or any remaining defective stem cells.
Too much, to be sure, can cause problems. But this is what the donor search has been all about: matching on precisely the right DNA characteristics, to give just enough, but not too much, GVH.
Yesterday Beth and I spent much of the day down at the VA office in Oakland, before heading out to Dr. Jalil’s for a consultation and to begin her sixth cycle of Vidaza. We honestly didn’t know what to expect – it was her first “doctor’s visit” there. Her primary care physician is a young female doctor who has a great deal of respect for veterans, and she did a pretty thorough “history” on Beth. I appreciated her concern.
We also filed a claim for disability benefits through the VA. We heard from another individual who was standing in line that it can take up to a year simply to process the application. The actual VA benefits counselor we spoke with told us it would be six or seven months – within two months, we should receive acknowledgement that they have received it.
Beth also began her 6th Vidaza cycle. Dr. Jalil was generally encouraged by how she was doing. Note that her white blood cells were at their lowest point that I’ve seen them (1.1) – but also that her hemoglobin, which was raised into the nine-point-something range with four transfusions, actually increased a bit last week (to 9.5). That was a very rare “increase” in her hemoglobin level.
White Cells (4.4)
(Numbers in parentheses represent the minimum “normal” figure. For previous blood counts, see this chart.)
Finally, I’ve put up a new theological blog post, which I’ve entitled “The Roman Catholic Hermeneutic”. When Catholics and Protestants approach a given topic in Scripture or in history, they approach it in different ways. And it’s this difference, often unspoken, that often renders the subsequent discussions so difficult, if not maddening. You’ll hear things like “You have your interpretation, I have mine”. But what are these “interpretations” based upon? I briefly cite a Protestant scholar and a number of Roman Catholic scholars, and some popes, on how Roman Catholics use the Scriptures. It’s eye opening.
We got a call today from the Transplant Coordinator, telling us that the donor has been selected. They actually select the third of the three donors we had been undergoing testing — the last one to come in. This is good news — when we saw Dr. Rossetti, he had liked that second one a lot. And he likes this one better. This first choice is a young female, not from the U.S., same blood type as Bethany. She will be contacted with the news, and if she agrees to do it, she will be scheduled for a complete physical exam. She will also be given a list of tentative dates for the procedure; the earliest of these will be about three weeks after the physical exam.
The donor goes through a five-day regimen of injections to (a) increase her production of stem cells and (b) force the stem cells out of the marrow and into the bloodstream. On the day of the transplant, the donor will be hooked up to a machine like a dialysis machine: blood will flow out of one arm, through the machine, which will “harvest” the stem cells, and the remaining blood will be put back into the other arm. This is about a 6-8 hour process for the donor. The stem cells will be stored in a bag very much like a regular unit of blood. Since the donor is outside of the US, they will be put on an international flight to Pittsburgh, and transported to the hospital.
By that time, Beth, also, will have undergone an 8-day regimen of intensive chemotherapy and full body radiation. The intention, again, is to destroy all of her damaged bone marrow. The hope is that the new stem cells will “engraft”, or set up shop, within 30 days, and begin to form new bone marrow within Beth’s bones. About that point, Beth will begin to face “rejection” issues — “graft vs host”. Some of this effect is good — the immunity effect of the new “graft” will, it is hoped, destroy any remaining damaged bone marrow and leukemia cells. This is vital, in fact, in preventing relapse. The unfortunate side is that the “graft vs host” also can have side effects that can be very serious, and can even lead to death (i.e., pneumonia and other infections become a very real danger.). And this danger lasts about a year.
Needless to say, Beth is very apprehensive about this. But at least we are moving forward now.
I spoke with the Transplant Coordinator at West Penn yesterday, and the testing from all three donors is in now. All three of these match on 10 of 10 HLA (DNA) categories. All are three are female; two are younger, one is older (described as “under 50” still); two are international, one is domestic. Their blood type and age will be considered in the decision. Doctors should decide soon now. And it could be 3-6 weeks till Beth starts her conditioning regimen.
We had an uneventful weekend. Of course, my Facebook friends who pay attention here know that I fixed the toilet over the weekend. Those kinds of small household chores scare the daylights out of me.
Speaking of “fear”, I fully expect that we’ll hear from the doctor this week to say that they’ve selected a donor (from among the three 10/10 matches we’ve found) and there is a schedule for the transplant. Almost any way you put it, it looks now like we’ll be tied up with hospitals for Christmas. (Unless they decide to hold off the transplant until after Christmas, but I can’t see them doing that.) If they do select a donor this week, our 3-6 week “window” falls right in December.
Beth had a restful weekend. Going to church has become her big event for the week. Getting up and showering, then going to Sunday School and the worship service is a major effort. But she loves the church, she loves the people there, and she’s even made some good friends. But then she has to come home and take a long nap.
The concept of “the righteousness of God” was at the heart and soul of the Reformation. Not only, “how is God righteous?” but “how can we, sinners, be righteous before a perfectly holy God?” That’s the question Martin Luther wrestled with. It’s the question that was at the heart and soul of the Reformation, and it’s the subject I discuss in my latest post:
Aside from the four legacies given here, I might add a fifth, and that is, “our society will feel the need to allow women to serve in the armed forces, and thus come home with deadly illnesses that may very well cut short their lives with their children.”
What follows here is a continuation of a message from the Theology of the Cross series, The Christian’s Most Precious Treasure. That article provides more background on the opus alienum and opus proprium of God, which are two “perspectives” on why God does the things he does, and why they don’t seem quite “God-like” to us.
God humiliates man, in order that he may justify him; he makes man a sinner, in order that he may make him righteous – and both aspects of this matter are increasingly seen by Luther as works of God. Although Luther initially appears to have believed that man humbled himself, there are clear indications in the later stages of [Luther’s 1513-1515 lectures on the Psalms] that he is moving towards a more theocentric understanding of the various aspects of justification. God induces in man a state of total humiliation – a term which Luther prefers to ‘humility’, on account of the latter’s associations with the monastic virtue of humility – and then he accepts this as the righteousness which he demands of man if he is to be justified. Once Luther has grasped the fact that it is God who takes the initiative in Justification, and that he must be regarded as active rather than passive at every stage of the process, he is increasingly obliged to recognize the problems which are raised by this assertion. It is not man who humbles himself – it is God who humbles him. Even in the earlier stages of [Luther’s 1513-1515 lectures on the Psalms], where Luther allows man a greater role in his own justification, God is still seen as instigating man’s humiliation, even if man himself must cooperate with God if this humiliation is to be properly effected.
How does God humiliate man? Through the experience of the wrath of God, the threat of hell and eternal damnation, through Anfechtung and suffering. It is through experiencing the wrath of God that man is humbled, and forced to concede that he cannot, by himself, stand in the presence of God – and thus he turns to God in his helplessness and hopelessness, and by doing so, is justified. Paradoxically, it is thus through God’s wrath that his mercy is able to operate, in that man would not seek that mercy unless he knew how much he needed it. It is considerations such as this which lead Luther to distinguish two aspects of the work of God in justification. Even at the earliest stages of [Luther’s 1513-1515 lectures on the Psalms], Luther may be found to employ the concepts of the opus alienum [“the work alien to God”] and opus proprium [“the proper work of God”] to deal with this paradox…. While the impenitent taste nothing but the severity of the wrath of God, the penitent recognize the merciful intention which lies behind it, in that they discern that it is intended to move them to repentance, humility and faith, and thus to receive the grace of God. God, having ordained that he will bestow grace upon the sole precondition of humility is obliged to stand by his primordial decision – and thus, if man is to receive grace, he must meet this condition. The intent underlying the opus alienum Dei is to enable man to fulfil this precondition, and thus to receive the grace of the merciful God who is hidden in his strange work. As we showed on the basis of our analysis of the soteriology of [Luther’s 1513-1515 lectures on the Psalms] in the previous chapter, Luther appears to interpret fides Christi as sibi iniustus esse ita coram Deo humilis [“unjust to him to be humble before God”], where fides Christi is the righteousness which God requires of man if he is to be justified.
If man is to recognize his own unrighteousness, and thus be moved to humility he must first be forced to concede his own utter unworthiness, and the futility of his situation, if left to his own devices. The merciful intention of the opus alienum thus becomes clear, although this may only be recognisable to faith…. The Word of God, by passing its severe judgement upon man, makes him a sinner, and thus executes the opus alienum – but in that this moves man to cry out to God for mercy and grace (which are immediately forthcoming!), it indirectly executes the opus proprium.
It is of considerable significance that Luther later illustrates the concepts of the opus alienum and opus proprium in the Heidelberg disputation with specific reference to the justification of the sinner: ‘thus an action which is alien to God’s nature results in an action which belongs to his very nature: God makes a person a sinner, in order to make him righteous.’ The fundamental insight, recognized by faith alone, is that God’s wrath is his penultimate, and not his final, word.
Bethany gets her blood tested at least twice a week, and yesterday she had another blood test. The doctor from the Lab called to tell us that the lab tests she had yesterday were more stable than the tests she had done in the hospital.
I don’t have access to yesterday’s numbers, but the last four columns in the chart below were all taken during her hospital stay last week. (Click on the chart for a bigger view, and click your “back” button to return to this article.)
The numbers in red represent “critical lows”. She’s down there in all three counts: hemoglobin, white blood cells, and platelets. It’s good that she’s “stabilized” from this. There’s another good thing: Her LDH level is down to 340. As recently as September, her LDH level was 621. As one nurse told us, “That’s the disease process”.