Season’s Greetings to All

What a year! For those who are counting, Dec. 31, 2008 will be day 315 since my transplant. There have been several set-backs including returns to the hospital, and at this writing I am suffering from graft vs. host disease that has caused mouth sores, gut problems and a nasty rash over most of my torso. But at this writing I am in better condition than others I know who are also recovering. I am able to eat anything I want, and I can leave the house (with my mask), we even traveled to Baltimore for Tori am Sean’s “Blessing of the wedding", and to Portland to see my aging parents, so you see I feel I have my liberty.

We had a wonderful Christmas around here. Sumptuous meals, terrific company; Emily, Michael and his mom were here Christmas Eve. The others spent the night here. Christmas Day we opened gifts, stopped to make and eat breakfast (Thanks Emily and Michael), then we finished the gifts around noon. The kids stayed until 2PM at which time I took a nap and Beck puttered around. A great day by any measure.

I’m also thankful for the hope I have for the future. Despite political and economical upheaval, unemployment numbers that boggle the mind, I believe we have the right guy at the top, and he has surrounded himself with the right people. I expect there will be lots of volunteers emerge to help with whatever. I sense the hope in others too.

So as my journey to wellness continues, I continue to work at my physical therapy, support others as I can and encourage you to contact the American Red Cross and talk to them about the ease of becoming a Blood Stem Cell Donor. It’s not the horror story it once was, and you may save a life. That’s a Random Act of Kindness that will never be forgotten.

In closing, a few photos for your viewing pleasure.

Christmas Eve

Christmas Eve Dinner

Michael and Emily Christmas Eve

PS: Click on any picture to enlarge

Happy Thanksgiving

All,
A year ago today, I went to UCSF for a routine clinic visit and ended up in the hospital. In the days that followed, I underwent too many tests to mention, then my first chemo. In the months that followed I discovered friends I didn’t realize I had. And the amount of love and support was nothing short of miraculous.

Since then, I have recovered to the point that I have to remember that I’m still years from well. My stamina has returned as well as my mobility. I am actively involved in physical therapy and I continue to improve. I have begun to play golf (infrequently) and am riding the heck out of stationary bikes. I have learned a lot about the fragility of life and am amazed at the people I know who are affected with similar life threatening diseases. All of this has taught me to appreciate the small things like sitting in the shade on a gorgeous day or dinner and a movie. Many such things are still outside the scope of my recovery, but I am constantly reminded of those less fortunate than I. At this writing, my only real discomfort is the return of mouth sores, but they are very manageable (just say no to hard crust bread!).

Today is day 277 since the transplant and we wonder if this is as good as it gets. Personally I expect it to improve. Currently I am down to 10mg of steroids. Any future reduction of immunosuppressant s will be watched very carefully as my sister’s marrow continues to learn that I am not the enemy. That process likely will take years, but I remain hopeful.

Although we have traveled a very rough rode in the last year, many are still traveling that road. Every day I am thankful for where I am and hopeful that others will recover completely. This Thanksgiving, please keep a good thought for all those less fortunate than we are. We hope your holiday is full of cheer and good will. Love to you all.

Me with two of my dearest friends doing what we love to do.

Dad's Birthday

All,
Once again I have allowed way too much time to pass since my last update. Since then, I’ve seen my new doctor (Dr. Linker retired you may recall), had a couple of bad days, flew to Portland for my dad’s 87th birthday and bought a cord a wood. I’ve walked about 10 miles and ridden twice that on a stationary bike. In no particular order:

The bad days present themselves with incredible fatigue. No matter how much sleep I get, I’m still exhausted. It has happened twice and it usually lasts 2-3 days. I may be awake for 10 minutes or a few hours at a time, but there is no energy and sleep usually comes easily (even if sleep patterns are screwed up). This is often accompanied by:

Lower GI distress which prohibits me from going anywhere unless I know where the restrooms are and I am not too far from them. This problem occurs daily and can last all morning. Not much fun at all. Both of these problems are symptoms of Graft versus Host (GVH) disease. We try to control it with various drugs and we have varying amounts of success. Fortunately there have been only 2 such outbreaks since our last conversation.

My father celebrated his 87th birthday. The whole family was there. It was a real treat to see my brother Steve and my sisters Diane and Linda. Steve is the hardest to get together with, followed by Diane then Linda. As the distance increases, the visits decrease. It was great to have everyone in the same place at the same time. We had a great time and for the first time I can remember, dad was showered with gifts as he sat at the head of the table nearly hidden by presents. Great.

The physical therapy continues. There are lots of exercises we’re doing. There are several goals; we want to increase my balance, strengthen core muscles, and strengthen arms and legs. It’s working as I am able to walk much greater distances (1.5 miles) with much greater ease. My legs don’t bother me at all. You may remember it was not so long ago that my calves quit working after about .5 miles at most. I am enjoying my new found freedom. I remain handicapped, but I sure don’t feel like an invalid. In fact, I'm feeling so good now that I'm not home much, running errands, getting tires balanced etc. Haven't had a nap in several days! Still walking, but haven't cycled as much. We did have a weather turn yesterday, it's colder now so it's easy to be outside in long sleeves and long pants. That likely means there will be golf in my immediate future, cycling too.

And finally, I broke down and bought a cord of wood. Since I still am not supposed to be handling cordwood, I paid an out of work buddy to pick it up, drive it here, and stack it. Just didn’t seem right at all!

I hope you guys feel as good as I do. Love to you all...
Rick

Day In and Day Out

So it’s been a month since my last update. It’s been an interesting month. As I left you, I had just been released from the hospital where I spent several days being tested as to why my liver counts had suddenly gone through the roof. The counts returned to normal, and all tests were inconclusive. The docs suspended the use of one anti-fungal drug that’s critical to my health as it fights fungal infections I may get. My immune system is being suppressed still so I am unable to fight those battles without medical assistance. That drug was replaced with another that has all the same good capabilities but it doesn’t affect the liver. The down side is it’s a liquid. I take a spoonful 3 times a day, so it’s a little inconvenient as compared to a pill, but since we made the switch, the liver counts have been normal for 4 weeks now. I guess I’ll stop complaining.
Fatigue has been a factor recently. I’ve been doing some research on the matter and it seems the fatigue I’m dealing with is not your basic tired. Chemo or drug induced fatigue is very common and can last for years. It is not necessarily alleviated by sleep. In other words, I can be very tired, take a nap and wake up tired. Other times, I can’t get to sleep or stay asleep. Recently I’ve been sleeping poorly at night and been tired all day. I listen to my body and sleep when I need to. The doctor gave me a sleeping pill that helps me sleep at night, but sometimes it’s hard to wake up in the morning. It may take 2 hours to become functional. Other times I wake up ready to go. I started physical therapy 3 weeks ago and that has helped.
My physical therapy sessions take 2 hours. We are working the major muscle groups while focusing on the legs and back. As a result, I routinely walk 1.25 miles without pain. More importantly, before the physical therapy, my calves would become so tired at .25 to .5 mile that I could not lift my feet properly. My walking was at a 30 minute per mile pace. Yesterday I walked 1.25 miles with no pain, and calves working properly at an 18 minute per mile pace. My goal is to walk 50 miles this year since I was released from the hospital in March. The other goal is to ride STP in July 2009. Incidentally, I’ve been riding 2.5 miles daily on a stationary bike. The real bike is out and ready and gives me about 2 miles each time. It’s now a lot easier to do that 2 miles and I expect to increase it next week.
My steroids have been reduced several times. When I left the hospital last month, I was at 30mg daily. I am now at 15mg, having reduced it yesterday from 20mg. That pleases me on several levels; I’ve been taking it for a long time and it has some negative effects not the least of which is beer belly and fat face! It also acts as an immune suppressant which is good, but we’d rather use it for that as needed rather than on a daily basis. The immune suppression is more easily controlled if we do it with one drug, rather than two. Then we could use the Prednisone as a stop gap if needed. I look forward to the day I am off it or requiring a dosage less than 5mg daily.
Dave Albertine visited for a week. The first two days we did nothing. He asked me if this is what a vacation feels like. Poor guy hasn’t stopped since the third grade! The rest did him good. On day three I put him to work. He moved 21 forty pound bags of potassium 3 times as we moved them out of the way, then we build a shelf under which they could be stored, then he filled the garbage containers purchased for the purpose, then he put the containers under the shelf. It took a good part of the day, and he did ALL the heavy lifting. Thank you David, I could not have done it myself. The next day, I removed the screens from the downstairs windows then took a nap. While I slept, David cleaned the outside of all the windows. Another project checked off. Another day we went to San Francisco for my clinic visit after which we went to China Town, then to the Wharf where we had lunch at Scoma’s. A great day in the city. He got a pretty good glimpse into what goes on around here on a regular basis.
This morning, Beck’s sister Martha left for home. She visited for a week. Her stay wasn’t as fun filled, but we did get to San Francisco for a clinic visit followed by (wait for it) lunch at Scoma’s. She did clean out a couple of closets (check off another item on the to-do list). Thanks to you Mart for all your help around here.
Today is day 196, Sunday will be 200. No special significance, just a nice round number. I am in communication with a friend of a friend who also had a transplant. His disease is different than mine, but his therapies are similar. He is responding differently, but we are kindred souls none the less. It’s nice to talk to someone who knows what it’s like. Keep a good thought for Gordon.
That’s it for now. Thanks again for the calls, emails and letters. As life settles down to a somewhat mundane existence, I feel good and look forward to continued improvement in the coming months. Love to all.

48 Hours? Piece of Cake.

All,
As you know, I went for a routine visit at the clinic last Tuesday. Peggy Albertine accompanied Beck and I. The plan was to see the doctor, have a nice lunch, wander around a little bit then beat the traffic home. The best laid plans… I ended up in the hospital due to abnormally high liver counts. A normal high for this particular test is 80, they worry when it reaches 240, mine was 880! A good reason for precaution.

There were no beds available until late afternoon, so we had that nice lunch, (Beck had a drink) and then we wandered around. Instead of beating traffic, we went back to the hospital. I was checked in and the girls hung out for awhile, then they went home. That was Tuesday evening. I was released on Thursday evening, this comes to you on Friday afternoon.

The purpose of the hospitalization was to run some tests. On Wednesday, I underwent a bronchoscopy, a sigmoidoscopy and an abdominal ultrasound (no I didn’t drink lots of water, and no I’m not pregnant!) I provided biopsies from both of the scope tests although visually everything appears normal. I also provided various other samples from which numerous other tests are being conducted. Thursday was spent restlessly waiting for lab results. I felt great as I had when I was admitted. A few of the results came back, all negative. We then had the choice of spending another night waiting results, or go home and get ALL the results at once on Tuesday at my next scheduled visit. I called Beck at 4:45 PM to say I still hadn’t seen the doctor. I called again 45 minutes later and said “Come and get me.” She and Peg dropped what they were doing to drive to San Francisco. We took the opportunity to have a very nice meal…thanks Dave Albertine!

We don’t have any concrete conclusions as to why the numbers went so high so quickly. We thought it was GVH attacking my liver, but the numbers came down as fast as they went up and were normal when I left the hospital. We think the spike was caused by one of my meds, specifically the anti fungal required to protect me while my immune system is suppressed. There is no substitute for this drug, so we’re hoping for another explanation. In the mean time, we have been tutored as to what to watch for if it happens again even if I continue to feel good. The steroids were increased from 15 mg daily to 60, then reduced to my current regimen of 20mg twice a day. The upside is my energy has returned and my legs feel stronger. I will start physical therapy next week here in Manteca. I will be walking and riding more as my body allows. Might as well make hay while the sun shines!

So… another bullet dodged. I’ll update again next week when the results are back. Love to you all. Thanks for your caring and concern…

And awaaaay we go...

Greetings,

We unexpectedly find Rick back in the hospital at UCSF this evening for some tests. We attended our regularly scheduled office visit today, only to find that his blood tests showed that 2 different Liver functions were “grossly abnormal”. This condition has developed in the last 2 weeks since our previous visit. The Physician’s Assistant stated numerous times that she was very concerned, and upon conferring with the doctors, it was decided to admit him to perform a liver biopsy and possible colonoscopy to see if they are able to understand what is going on and how to “get it under control”. It may be GVHD (Graft Versus Host Disease) or possibly a reaction to a medication that he is taking. Peggy Albertine, who is happens to be here on a visit, states that the irony is that Dad looks good, and walked around San Francisco today while waiting for a bed to become available.

It was originally thought that he would remain in the hospital until Saturday, however the team of physicians in the hospital need to review his case and tests and then a more “solid” release date will be provided. At this time we just don’t know….

We left home at 6am and only arrived back at 9pm tonight, minus one person. It has been a long and unexpectedly eventful day. What Mom has decided, and I whole heartedly agree, is that a change of clothes in all vehicles is essential! Be prepared shall become our new motto :o)

As always your thoughts and prayers are greatly appreciated, keep your fingers crossed.

Much Love,
Rick, Beck, Emily, Tori & Sean

Life Sets In

All,
It’s day 149, it’s been 49 days since our last post. Since that last post, life has sort of settled in. I’ve made my required trips to the clinic every two weeks; the numbers that we use to evaluate progress remain good, and I do what I have the energy to do. A typical day is breakfast, read the paper, computer time or sleep, lunch, computer, TV, errands and/or nap. Dinner, TV, bed. Fun huh?

Currently I am going through a bout of GVH. We think it is a result of the fact that we reduced the steroids to 7.5 mg daily on day 135. I began to experience lower than normal stamina. I also slept more than normal. McCarthy’s visited during that period. Boy was I a ball of fire! On day 145, the steroids were increased to 15 mg daily. Although it’s early yet, I seem to be more energetic. While McCarthy’s were here, I felt lousy all the time. Kerm completed all the items on my list but he said it wasn’t as much fun working alone and I know it was a real bummer lying down while he toiled in the hot sun. Thank you Kermit.


Take that, tree. Beck and Maria.

You may recall I told Dr. Linker that I would not authorize another bone marrow biopsy unless it was done while I was anesthetized. He said OK and began fighting for use of an operating room. He now says he will cancel the one scheduled for now and allow me to have it done at one year in Stockton by my oncologist there. Yeah! On a related note, my steroid induced diabetes has declined markedly. I have eliminated Novalog altogether and reduced Lantas to 5 units daily (from 10). Both drugs are injectable insulin.

I have had tingling and numbness in parts of my left hand and two fingers. We have assumed it’s a side effect of chemo, but in order to find out, an MRI was ordered for my spine. The results showed a compression fracture in my lower back. That has completely healed at this writing. It also revealed a bulging disk in my neck. A nerve test was done yesterday and proved that the tingling is a problem at my left elbow with my ulnar nerve. It can be surgically repaired, but we’ll not do that until much later. It may be treatable with braces and/or a sling which I am not opposed to. I’ll know more when I see the nerve doctor next week. Another issue has developed in the form of a spinal cord problem. When I move my head just right, I get a tingling feeling all the way to my knees. The doc at the Spinal Center is aware of it and will evaluate me on Monday when he receives the results of the nerve tests done yesterday.

Some good news, took my first bike ride on day 134. I only rode two miles and it felt great. When I got off the bike, my thighs were like rubber. A wonderful sort of inconvenience. There have only been a few rides since then. As you may have heard, there have been more than 900 fires in CA in the last few weeks. The smoke has cleared substantially, but it was pretty smoky for the better part of 3 weeks which kept me inside.


My first ride (Kerm escorts)


In addition to a visit from the McCarthy’s, our daughter Tori and her husband Sean visited for a week. I was still under the weather so it was a relaxing visit. It was great seeing them again. If you have any influence with them, encourage a move west. Also on the family front, Emily has decided to stay in California for now. She recently received a promotion and will be working with a different group of people in a different area (department) of Risk Operations/Fraud. We don’t see much of her as she spends much of her time with her boyfriend. Also, she and a long time friend of hers will be moving into a rental house on September 1. Congratulations to her as she takes the next steps into independence.

Beck is currently suffering from an unknown illness. Her doc thinks it may be Epstein Barr Virus. Blood tests show an elevated level for the disease. She is to wait and see how she feels in a day or two. She has been lethargic and tired, generally feeling crummy for two weeks now. We make a great pair!

And finally, Dr. Linker, the head honcho that everyone knows and admires, the one I am so fond of, is retiring effective the end of this month. He will continue to handle his national research and board activities, but is retiring from practicing medicine. I met his replacement this week. He seems to be as remarkable as Linker. We shall see. I look forward to exchanging pleasantries with Linker when our paths cross in the clinic as he seems to think they will.

That’s it from here. Again, life has set in. I’ll keep you posted as things change. Love to you all…

DAY 100

All,
Today is another milestone; Day 100. There have been many milestones and hurdles since the transplant. All have been chronicled here. The two I most looked forward to were release from the hospital and Day 100. Going home to Manteca was third on my list. Now, and for the foreseeable future, I will be coasting – determining what life will be like from here on out. How much of the lingering effects of what my body has endured will remain, and to what degree? I know I will be going to San Francisco every Tuesday for a clinic visit. At some point, the visits will become bi-monthly, then monthly. I don’t know if GVH will rear its ugly head, or how much medication I will require. I don’t know what the side effects of those will be. And since my last post, there is another issue. An MRI revealed a “bulging disk” in my back which causes a lot of localized pain if I move wrong. It is improving since muscle relaxers were prescribed last week and I’m mobile again. I have started walking, and while distances are still low (1.4 miles), commitment is high. I still can nap easily if I sit still too long. That’s likely a function of drugs I’m taking combined with not enough sleep at night at times.

The clinic visits continue to show progress. The numbers we use to evaluate levels of substances in the blood stream are good, liver and kidney functions remain strong. Immune system is still suppressed so exposure to sunlight is problematic, as is contact exposure to viruses. I still look like a hairless Ted Kaczynski when I leave the house. See the attached picture! The bone marrow biopsy is still in limbo, but I’m confident Dr. Linker will get it scheduled when he’s ready.



We have had several visitors recently; Laura and Chad visited just before we moved home as did Stephen. Michael and Haley were here last week. These are our “other children” and their friends. As always, it’s a boost to see you guys. Barrie Lane visited and we had a dinner out in San Francisco.

About that dinner with Barrie: Beck and I took him to a place we’ve been many times before. An inexpensive Italian place with friendly staff and big portions of good food. On this occasion, we were seated not five minutes when they seated two ladies next to us one of whom had a dog on a leash. When our waiter arrived, he was unaware and equally surprised when advised we were seated next to a dog. Management huddled, the ladies were talked to and they responded that this was a “service dog” (hogwash), it had its shots, and it was harmless. I thought all it had to do was lick its butt, then kiss me, and I’m dead. I kept my thoughts to myself.

Long story short, the restaurant wouldn’t ask them to leave and said they had no other tables so I put on my mask. Eventually, we were reseated in another part of the restaurant, and they didn’t charge us for the meal. Most importantly, I didn’t get sick. That lady was the single most insensitive, entitled ______ I’ve ever come across. That night I dreamt she was hit by a bus as her “service dog” sat placidly watching from the curb.

Some personal messages: to Lisa Schnaidt for her letter received 2 weeks ago with the message “Do Not Open until May 30.” Thanks for remembering. To Maria, as always on top of everything with her cheermail of today. To sister Linda for the balloons honoring my “graduation.” And a huge thank you to Lenny, Cecil, Wayne and Steve Sr. for all those trips to my place to fix all those little things (and some not so little). We could not have done them ourselves. Thank you, thank you, thank you. Love you all.

To the rest of you, the count of cards is over 100, the calls and emails are countless. The support has been tremendous. Thanks to you too. Your energy and enthusiasm are contagious. We love you all.

And finally, Dr. Fye, the Rheumatology and Pain Specialist at UCSF to whom I was referred and who was instrumental in my diagnosis sent his patients a letter this week. He has been diagnosed with pancreatic cancer and is leaving his practice. Please add his name to your prayer list as we have.

Onward to the next milestone: ONE YEAR

Homeward Bound

Waiting and Waiting

All,
Beck and I spent more than 5 hours at the clinic today. It can be very frustrating when all but about 30-40 minutes of that time is waiting, waiting, and waiting some more. That’s the bad news. The good news is that I have passed another milestone. I am now on once a week visits which means WE CAN GO HOME!

Rick & Cecil after steaks

For the record, we went home last Friday for the weekend. That was the first time I’d been in Manteca since Feb. 4 and the first time Beck has spent more than 24 hours there in that time. As we drove up Main Street from the freeway to our house, we both were a little depressed. San Francisco it ain’t! It IS home however, and we adjusted quickly. Our neighbor Cecil came over for dinner and I BBQ’d for the first time since forever. Now it seems we will be back to Manteca and out of our apartment next week. So much to do, so little time.

Nothing about my driving please

Beck has let me start driving again. Another milestone I guess. I ran some errands in Manteca last weekend, then drove to San Francisco and have been driving around here since. Beck has learned her way around quite well. Me, not so much. I haven’t paid much attention all these weeks, so she has me on a crash course. Good luck with that one. I get my sense of direction from my mom (always refers to the directions), Beck got hers from her dad (was reading maps at an early age). I figure if Beck doesn’t know where we are, my GPS will!

The clinic visit was uneventful. The steroids are being reduced again from 30mg daily to 25. I am having some aches and pains that we are blaming on the adjustment. I also have some issues with age related problems with my back. I am slowed down a little, but not stopped and not deterred. We still are unsure of which of the issues I deal with daily will improve or go away completely, but I can live with it as long as I can keep pushing for more strength and stamina. Doctors are encouraging me to do so. I must admit my pleasant surprise at not having to be hospitalized again after the transplant. Not everyone is readmitted, but most are. I feel very lucky to have had the experience I’ve had and not something much worse. I’m convinced all of your caring loving thoughts and prayers are responsible. Keep it up.

A bone marrow biopsy looms sometime in the next few weeks. I’m told it will be done in the operating room under anesthesia. Scheduling is an issue I guess because those pesky surgeons don’t want to give up the OR. There will also be an MRI to check on my neck. Neither of these will prevent us from moving next week however. We leave here with mixed emotions. Two weeks ago I wasn’t ready. I am now. It’s good to reach this point and get on with life. My weekly visits will continue for a period as yet to be determined, then bi-monthly for awhile. It means the docs are comfortable with my progress and feel it’s safe to reduce the visits. Fine by me. For now, it appears our next blog will originate from Manteca. Barring any emergencies, ALL my medical work will be done at UCSF. In case of an emergency, UCSF will be involved and may even call the shots.

I’m told I look good. I know I feel good. My quality of life is pretty good. I am, however, a long way from well. It will be a minimum of another year before we have a handle on my requirements for the immunosuppressant . Sunshine is not my friend in that period. I have to cover up and/or slather sunscreen all over me as a very small amount of sun can do a great deal of damage. I’m told 10 minutes a day of unprotected sun is MAX. If I do that, eventually I will begin to tan and I will begin to develop some natural protection. It is critical that I don’t burn as GVH will attack with a vengeance if I do. I learned that when I covered everything but my hands. They got pretty red and required some topical steroid ointment to rein it in. Lesson learned. I now wear gloves to go with my hat, long pants, long sleeves and dark glasses. With a hoody I look just like DB Cooper, the hijacker who bailed out somewhere between Seattle and Portland some 30 years ago and was never found.

So from San Francisco with love, we bid you adieu.

UCSF from Conservatory of Flowers

Sunset in The City

All the Latest From Funston Ave.

Pictures have been taken throughout our jaunts around The City. This was taken in The Castro District…unfortunately we are not registered voters in SF county or our names would have been added to the petition!

All,
The last two weeks have been somewhat eventful, although events seem to unfold slowly. I mentioned I was in a study to determine the efficacy of injecting manufactured stem cells to fight non specific inflammation. In my case, the new stem cells would migrate to the point of GVH and fight back. It’s a double blind study meaning that none of my medical team knows whether I’m getting a placebo or the stem cells. However, independently of each other, both the Physician’s Assistant and Dr. Linker said they think I am getting the REAL thing. They base that assumption on the fact that my GVH has responded in a fashion inconsistent with expected results given normal procedures they have provided. Either I am a wunderkind or I’m getting the good stuff. In any case, they told me today that my GVH is in complete remission. They also told me that my GVH started earlier than anyone expected and was worse than they thought. Coulda fooled me. It wasn’t much fun, but it was nothing like I expected. At any rate, I had the final infusion today. Now they will follow my case for another year. Most of that will be simple blood tests that are being taken regularly anyway. There will be another CT scan and an EKG, both of which are non-invasive. I do need another bone marrow biopsy in the near future. I told the medical team that I would not sign an authorization unless I was knocked out. They promised to schedule an operating room. Yeah!

We’ve been getting out and walking on a regular basis, doctor’s orders. That generally means long pants, long sleeves, hat and mask. We totally neglected my hands. Last Friday, they appeared burned and GVH was apparent to the doctor. I immediately started using sunscreen which I should have done earlier. Yesterday Beck and I went to REI and bought 2 new better-covering hats and 3 pairs of gloves. I really look like something from who-knows-where as I wander around with next to no skin showing and with no ability to leave a finger or handprint. One has to VERY careful when entering a bank in that get up! It will be interesting living in an area of the country where the sun shines and summer temps hover around 100 degrees.

McCarthy’s and Beck at Pacific Ocean

Who are those masked people?! (Nufer’s)

The McCarthy’s visited last weekend. We had a wonderful time. Saturday we walked Farmers Market at the Ferry Building, on the beach at the Pacific, down the Marina to Fort Point , and finally thru Chinatown; a total of 6 miles. I was done at the end. It was great to spend time with our good friends. By the way, apologies to the Nufers, who visited the end of March and were omitted from the list of visitors on the last blog. It was terrific seeing them too. Thanks to all of you who have made the trek.

Beck and walking buddy in GG Park

In Chinatown shop trying on wares

As for me, I feel good. The steroids have been reduced from 90mg to 60mg to 40mg daily currently. I expect them to come down again next week. The TAC (immunosuppressant) has not been tapered as yet and may remain where it is for more than a year. I may never be off it, but only time will tell. As long as I keep taking it, my immune system is being held in check. The more I take, the more vulnerable I am. The hope is that I will be able to get it down to a low dose or none at all. The variable is how hard Diane’s system wants to fight my organs. At every turn so far I have surprised the docs, maybe this will be another favorable surprise for them.
The steroids have created glucose issues. I monitor it 4 times a day and administer insulin as needed. It’s not a big deal for me to do it, but I’m hoping it will be controllable with diet as time progresses. By the way, I’m eating like a horse and my weight today was 1.8 pounds more than when I left the hospital 7 weeks ago. Makes Beck NUTS!
I have some neuropathy in the balls of my feet and in the left little finger, and the top of my left hand. This varies from a tingling sensation to profound numbness. The latter is rare, the former is constant; nothing that will slow me down much though. The concern is staying healthy.
In summary, my blood counts are “rock solid” and my GVH is in “total remission,” according to Dr. Linker, and I feel good. I’m getting exercise and we still occasionally get out and about. Beck is doing well, and we both feel a little guilty at times. Is this real, or are we on vacation? Life is good. We’re still not sure when we will be returning to Manteca. We don’t expect to get a warning. We expect to go to the clinic one day and they’ll tell us “We don’t need to see you twice a week any more, once is sufficient. You can go home now.” It will be met with mixed emotions. You can’t do in Manteca what you can do in San Francisco, and the scenery is much worse. On the other hand, it’s home.
That’s it from here. Keep those cards and letters coming, and if you want to get a personally guided tour of San Francisco or just have a fine meal, give us a call. Again, I don’t know how much longer we’ll be here so call soon. Our love to everyone.

Outside Ferry Building

Emily and Rick at “the big one”

GVH Man Walking...and Childrens Books

Things are still well here. Test results remain strong, attitudes are good, and weather has been perfect. I have been to the clinic several times since our last post. Graft vs. host disease (GVH) has begun. This is not unexpected, nor a major concern as of yet. We want some of it but we want to be able to control it. To do that, we have started a regimen of steroids (90 mg daily) and week ago I agreed to enter a clinical study. It seems we now have the ability to manufacture new stems cells from human bone marrow. These new cells are then infused into the patient (Subject Rick) where they migrate to the point of inflammation (GVH) and fight back. Because they are stored frozen, they are packaged in DMSO. So once again, I smell like corn chowder! There has been terrific success in Europe.In the US we've been fighting our President but there are nearly 200 subjects in various stages in the US, and many more worldwide. So far, there have not been any negative side effects. This study is a double blind, so I have no idea if I'm getting a placebo, however the psychological advantages alone are staggering! By the way, I'm the 1st subject in the trial at UCSF. Patient #1! Once again a hero!

Beck has been holding her own. We’ve managed to get out each day and see more of the city...part of the regimen for building my stamina. And we have been blessed with visitors of late. Neighbors Wayne and Tammy came and brought burgers. Sharon Castlen found her way here from Long Island, her stay was way too brief. The Gillespie’s followed and we visited the Conservatory of Flowers, The Butterfly Zone and the DeYoung Museum. Two great days. Then Gary Lee was in town on business. We saw him twice, but briefly. Those brief visits were spent eating and looking at the view from 36 floors up. We cherish all time spent with others.

In the interim, Beck and I have been traveling the city driving and walking and enjoying each other’s company. She even took time to write a child’s book about what I’ve been going through using photos and implementing lots of 3rd grade math and science tie-ins to give to her class. It’s a tremendous effort. Friday night, she attended a surprise birthday party arranged by daughter Emily and Beck’s teacher-friend Lisa Schnaidt. It seems a surprise can be kept in a large circle as long as I am not included in the conspirators! They were nearly 20 attendees, Cosmopolitans flowed freely, they laughed, they cried and generally had a terrific time. Beck spent Saturday being pampered (massage, facial, manicue, pedicure). She returned to San Francisco Sunday afternoon after a whirl wind weekend of celebrations in her honor.


Author at Work

There is a kinship in all things, but some are transcendant like the vendor selling handmade hooded sweatshirts across from the Ferry Building. Turns out he's a Leukemia survivor. We'd never met but his words were kind, gentle and understanding. He knew. The unspoken and universal acknowledgement of cancer survivors is a genuine hug. We'll never know his name, but we'll never forget his kindness.


That was a serendipitious meeting, there have been others, I hope there will be more, but all of you are even more special. You've been here from the beginning. Your myriad of cards, letters, emails, photos, calls, visits, and all the rest of it. You all do mean the most to us. You know too. Thank you for you love and support.

Happy Birthday Beck

All,
Another week has passed and the doctors still insist I’m doing great; the numbers are good, my stamina is beginning to return and I had the catheter removed on Tuesday. At the apartment, our routine is beginning to get monotonous. Up at 7AM, eat breakfast, I sleep until 10, take pills, then try to find something fun to do away from the apartment. Tuesday we drove over the Golden Gate Bridge and ate at Scoma’s in Sausalito (2 ½ stars). Yesterday we wandered around an upscale neighborhood checking out all the shops, and today we had lunch at Scoma’s on Fisherman’s Wharf (5 stars). As long as I feel good and have the stamina, we hope to continue exploring San Francisco. As you can see, the weather has been perfect.

Today is Beck's Birthday, so in her honor...

There once was a girl from P.A.
Who everyone agreed was OK
She took care of Rick
When he was so sick
'Not today" says she "It's my birthday"

And indeed she is taking the afternoon off visiting a woman she met as a result of my hospitalization. The two have become fast friends. Happy Birthday Beck, I love you.

Sprung, Smashed and So Long

We live in the cream house with the big tree in front...

Having met the departure requirements, I was sprung from the hospital on Sunday. I got my first look at the apartment that Beck found so fortuitously. It’s perfect, 2BR, 2 baths, and a sunroom. Gorgeous. On Monday, the home health care nurse arrived with medical supplies, an IV pump and magnesium. Nurse Terry spent several hours here, teaching Beck and Linda how to set up and operate the IV pump. Being intelligent women, it still took them a few days to master the process.


Tuesday was my first scheduled visit to the clinic for labs. (The clinic is a zoo!) Late that afternoon, the clinic called to say the level of one of my meds the MOST important of them was too high, stop taking it immediately. (This is the drug the doctor described as THE life saving drug, an immunosuppressant).They seemed to think that perhaps we had taken a pill prior to having blood drawn against their instructions. I disagreed but promised to return on Wednesday for more labs. Long story short, they kept getting the same readings every day, so on Friday they decided to draw the blood peripherally (as opposed to from my catheter). That proved to them that there was an issue with the catheter.....subsequent blood draws will be peripheral (thank goodness for good veins). The doctor and nurse practitioner both agree that as of Friday I’m doing extraordinarily well and my “numbers” look great. Beck and Emily are task-masters and keep me honest about getting exercise as tolerated, eating and drinking appropriately.

Thursday started with a shock. We went out to the car to go to the clinic and found the car has been broken into, the window smashed and handicapped placard stolen. Handicap placards are in high demand in The City as parking is at a premium and if you are lucky enough to find a space, a placard allows you to do so w/o time limits. After returning from the clinic, I found a glass company to fix the window that morning at our apartment. Beck made 2 trips to the ONE DMV in SF to get the placard replaced. Luckily it’s fairly close to where we’re staying. The placard now remains in the apt, and Beck diligently watches for parking patrols, and moves the car if necessary. Linda, yet again, postponed her return to Portland so that we could care for these things and not leave me unattended.

On Saturday, Emily arrived from Manteca with car load of requested items. Beck went home for the day. Emily masterfully operated the IV pump based on the instructions written by Beck and Linda. On Easter Sunday, Rick, Beck and Emily enjoyed a sumptuous Easter dinner of turkey and the trimmings. With the bazillion trips into SF, Beck and Emily have found different routes in and around The City. We also said so long to Linda. She returned home after 2 weeks of selfless assistance. We were grateful to have spent the time together.

The weather has been beautiful this week, so Beck has taken the opportunity to walk to dog that lives below us….actually, they walk each other in and around Golden Gate Park….soooo MUCH nicer than the streets of Manteca. Gotta love the flora, fauna, architecture, and art not to mention the diverse population!

A public thank you to Emily for manning the fires on the home front all week, then giving up her weekend to care for dear ol’ dad. Thank you Sweetheart.

To the many whom have/continue to send cards, notes or call……WE THANK YOU! We appreciate your continued support and encouragement. It lifts our spirits and warms our hearts to know that we are being thought of. This has been a long journey with much ahead of us.

Thank you for loving us.

Homeward Bound…but where are my pants?

Patiently waiting for the 1st floor...

Greetings!

We are alive and kicking despite seemingly falling off the radar in the last week or so. I must start out by apologizing if this seems a little scattered, it is a truthful representation of our lives at this point. The days have all started to run together and what took place when all seems a bit of a blur, so I apologize for any of that that comes out here :o)

Since last updated Dad was released from ICU, although his overall state was not good. It has been a long arduous week for Dad. He has been, up until Friday-ish, continually struggling with GI issues that have been monitored closely, his stamina was slim to none, and again he had no real desire (or ability) to be out of bed. With some "Becky Encouragement" Physical Therapy was called in for a consult, as our concern was Dad’s ability to get up the 2 flights of stairs to the flat. He lasted about 5 minutes of exercises and that did him in. It really wasn’t until Wed. or Thurs. that he started to entertain the notion of food.

Friday afternoon brought everyone to the hospital for "post hospitalization training" for Mom and I, and Aunt Linda (Dad’s younger sister who arrived last weekend for emotional support and stress relief) too. This day was an emotional day for Mom and I. At that point we were not at all comfortable with the notion of him being released on Monday based on how "punked" he had been during the week, and culminated in Emily and Becky’s Emotional Meeting of the Minds with a Doctor and Physician’s Assistant (Read: emotional break down). There had been a continued break down in communication between members of Dad’s Team, i.e. doctors with doctors and other hospital staff, which filtered down to Mom and Me with many opposing answers to the same important questions, such as roughly what date are you thinking for release? Needless to say, the Lavely women clearly and respectfully made their point, and then it was like a NASCAR race. We had training for what to watch for and consider when Dad is released with the Physician’s Assistant, a meeting with Pharmacy on drugs and dosages, taining on how to clean and flush his Pic-Line, a meeting with physical therapy, being sure that the staff of 11 Long knew that we were apprecitive of all of their help Dad (arguably all of us) wouldn't have made it this far if it weren't for them. With our final conversation between Dad, Mom, and myself: You say you feel good and fine, prove it. You have to be sitting up in bed, walking, and drinking your fluids. Until you act like you say you feel WE won’t let you leave. And we’re off. The fear of mom and I not letting him come home got him moving around a bit more, and as he moved about, he started to feel better.

Saturday March 15th—HAPPY BIRTHDAY TO DAD! We got permission that Dad could have a homemade cake on his Birthday so I baked his favorite chocolate cake and took that to him. He promptly ate a piece for his morning snack! If he weren’t required to have high-caloric snacks, I don’t think that would fly, but there are exceptions to every rule! This day was also Moving Day for Mom. Who found herself, with the help of The Bertchtold Boys, packing up a few things, the least of which is Dad’s coveted recliner, and heading over to the flat (address forthcoming…). The flat is lovely, sitting off of Park Presidio opposite Golden Gate Park, it is minutes from the hospital, has 2 bedrooms, 2 bathrooms, a sun room, and came fully furnished. We are very thankful to have had this place fall into our lap with the help from a few friends.

I am also very pleased to say that as of about 1:30 this afternoon Dad is no longer a resident of 11 Long, but was released home, or what will be home for a minimum of 3 months. This too was not without a bump in the road. We received the all clear, he had his last IV medication, got in the shower and started to get dressed, "Can you hand me my clothes? Where are my pants?" It seems that in packing for the release his pants were inadvertently left out! My Dad, being his normal dignified self responds, "I don’t care, I will leave here naked if I have to, just give me something to hold in my lap!" So we did not intend to "steal" hospital bottoms, but given the alternative….

We have received numerous questions and compliments on our Team Rick Shirts as they have been out and about The City recently. I do promise that if you ordered one, that they are here, and will be enroute to each of you shortly! Linda generously stayed at the flat, and started organizing Dad’s many pill bottles, and Mom and I were able to have one last little bit of together time—at the Grand Hyatt drinking Cosmos! Oh and they were gooooooooood! It was a time to relax, celebrate finally getting to this point, and process the journey that we have been on for nearly 3 years.

It has been a long, eventful, and emotional 41 days since Dad was hospitalized and 25 days since his transplant, and we have many more long days to come. We are by no means out of the woods. We know that there is a 50/50 chance that he will be readmitted to the hospital during this next phase, and we know that it is important the we remain vigilant with his care and be his advocate. And through all of this we also know that Dad, Mom, Tori, and myself would not have made it to this point without your love and support. The cards, or as I like to call it the air assault, calls, and emails have been so much appreciated. It should be noted that Dad received more hospital greetings (via the hospital link) than ANY patient in the hospital. GO TEAM RICK!!!

A few very special Thank You’s, per Mom’s request: The Bertchtold Boys (Mike and Tom) who willingly and without hesitation gave us a Saturday to help make the move to The City much easier (despite having to stop 3 times to re-tie the recliner :P) Aunt Linda, who has come and provided direction, organization, and focus during this chaotic week of transition, and who has graciously offered to stay-on longer to help make sure things are settled. The Staff of 11 Long—None of us can express enough how thankful and appreciative we are of the doctors and nurses who work on that floor. They are amazing, and we cannot sing their praises enough!


Much love and many thanks!
Emily (with Dad, Mom, & Tori)

Spirit Needed

The good news is that Rick was released from ICU last night and taken back to his floor. He continues to need oxygen, however that is lessening as his O2 levels are balancing out quite well. While we were all relieved to have him back on 11 Long and the pulmonary issue seemingly under control (Emily was eavesdropping on the consultation outside the door she overheard the doctor say ‘we dodged that bullet’), Becky and Emily were discouraged to find Rick overall not feeling well today. Simply put his body is worn out. We find him again fighting nausea, GI issues, and the catheter site is again being monitored as it is showing signs of infection. Generally, he is weak and lethargic. He hasn’t eaten anything in about 9 days, and hasn’t been out of been bed for about a week. He is tired of not feeling well.

We are all tired of this road we are on. It seems like we get over one bump in the road and another one comes up. We are not entirely convinced that we are not on the same bump with dips in the road

His blood counts have continued to increase steadily, the doctors are all very pleased with how the new cells are growing. We heard today "you may have seen the last of your transfusions" (while he is in the hospital, post-hospital is a whole different ball game).


This has been an emotionally draining week for all of us. While Mom and I took great Care not to photograph Dad in his present condition, he felt different about the situation and wanted to take the opportunity to show you how he feels:

Please keep us in your continued thoughts and prayers.

Much Love,
Rick, Beck, Emily & Tori

p.s. The shirts were all the rage on the floor today! Pom Poms provided by Cheer Team Capts. Maria & Kermit

One step at a time

Greetings,

Mom was not kidding he really is hooked up and monitored from here to hell! Things are looking better, he is still not ready to be released back to his floor, but they are slowing looking up. The Doctors (11 Long, ICU, AND Lung specialists) do not believe that he has an infection in his lungs which is good news. Earlier this evening he had 2 extra liters of fluids in him, so they are working on getting rid of that (he is peeing A LOT right now!) to hopefully prevent any future pulmonary edema and infection. His breathing is getting better, and his O2 levels are getting back to where they should be. They are working on weaning him down on the O2 that his is receiving, and we are working on taking ‘Big Breaths’ to hopefully have him off O2 at all. But one step at a time. They will continue to monitor his lungs to make sure that no infection develops, monitor his O2 levels to make sure they don’t drop, in addition to his overall state.

I mentioned the hallucinations to the doctor this afternoon and he said that can be a side effect of one of the drugs he is on, so they are dialing that back, and hopefully they will subside. Not gonna lie, I think part of us is sad to see them go, when he was conscious of what was happening they could be pretty funny! But if this means his inability to tell the difference goes away, we’ll take it. He is not mentioning being in pain as much, and admittedly isn’t using his pain button as often as before. Also good news. He slept for most of the day but late this afternoon we watched some TV and he sat up in bed and drank some broth. He looks better over all in my opinion, both of his 11Long doctors have mentioned that as well, and he says he feels better. We hope to have him back on his floor sometime this weekend, if all continues to improve.

GOOD NEWS: Diane’s cells are kicking butt and taking names! They are growing quite well, there are no signs of GVHD, overall they are happily nesting in their new home.

Thank you for your continued thoughts and prayers. We take each day as it comes, one step at a time, some days as you can imagine are better than others. But one of the things that continually amazes us is the number of people who are thinking of us and lifting us up, and that shines light on even the darkest of days.

Much Love,
Emily (Mom, Dad, & Tori too!)

p.s. Also for those of you that are sending him messages via the hospital link, please do NOT put his room# as L1122, there is someone else in that room now, how rude :~) You can simply put L11 (or leave it blank) and it will get to him wherever it is that he may be. Thanks! https://www.ucsfhealth.org/adult/contact/patient.html

A bump in the road...

Greetings,

Rick has continued a downward slide since late last week culminating with him being transferred into ICU on Tuesday. He has Pulmonary Edema (fluid) in his lungs, his carbon dioxide levels have been high, and he was having difficulty breathing. According to the Doctor and Nurses he was very difficult to arouse, almost non-responsive. He has been very confused and has slid from conscious hallucinations (i.e. he could vividly describe what he was seeing, but knew that when he opened his eyes it would not be real) into greater states of confusion and adamant that he is not hallucinating. He continues to come in (more often than not) and out of sleep and has not been out of bed since last Saturday.

At this time he is receiving very high levels oxygen to help balance out his O2 and CO2 levels, and is receiving IV nutrients. In all reality, we do not know when we will be released back to his floor, we would guess he would remain in ICU for another couple of days, but we really don’t know. Mom says that he is hooked up and monitored from here to hell, I will see this first hand when I see him tomorrow.

The GOOD news is that we have started to see engraftment (the transplant is taking hold) and the cells are growing well. There was actually a concern that the white cells were growing at too rapid of a rate so they cut off injections which were stimulating growth.

Much Love,

Becky, Emily, & Tori

So it goes...

Hi all,

This weekend we have found that Rick’s mouth, tongue, and throat are covered in sores which are causing him extreme discomfort and his pain meds have been upped as a result. He is now on oxygen as his O2 levels have been fluctuating. Due to his inability to swallow all of him meds are now being administered through his IV. Beck was at the hospital today and states that he was not at all at a functioning level. We are in a wait-and-see pattern at this point, although he can answer questions when probed, when speaking of his own volition he doesn’t always make sense and his speech is garbled.

As always, we cannot express enough how much your outpouring of love means to us, and brings your love and warmth into his hospital room. Becky and Emily would also like to extend a special thank you to everyone who has extended themselves to us during this time. A simple message left on our voicemail letting us know that we are in your thoughts, and those who have invited us in for a meal or brought one to us so we don’t have to cook. We are burning the candle at both ends, and are continually exhausted, but these gestures of love help to keep us going and give our batteries a much-needed boost. Continue to keep us in your thoughts and prayers. More as time tells…

Much Love,

A quick one...

Hi All,

I wanted to give you a short update. Mom and I just back from the hospital. Dad is feeling better, although I say that cautiously. He seems to again be battling a low fever, and they are monitoring the site where is catheter is inserted as there is a small infection that they believe maybe causing all of this. He is being treated with 2 different antibiotics and as of earlier this evening his blood cultures were not growing anything. In addition he has been given a patient controlled pain drip. So he will receive his normal does of pain meds every hour, and now at certain intervals he can get another small does to help better control the pain with the mere click of a button! He continues to come in and out of sleep more often than not, but we were relieved to find him in a little better state than when I left him yesterday. More as time tells.

Much Love,
Emily

Feelin' the Love

Rick continues to be par with the course at this point. His blood counts have been steadily dropping, which was to be expected and is a good thing at this stage. He has had 3 platelet transfusions thus far and has started to receive injections to help stimulate his White Cell count. Late Tuesday/Wednesday he started to develop mouth sores, which are severely painful and make the simple act of talking and uncomfortable not to mention eating and drinking. He as also experienced an increase in his muscle and joint pains in the last few days. He has done an excellent job of making sure that he gets his daily laps around the floor in, but recently this has become more strenuous.

Emily dove over today to spend the day with him, he seemed to be doing well. We watched a movie and went on a walk, albeit brief, and then he promptly fell asleep. For the last week or so he has been having what can best be described as rolling nausea that would come in waves, but he never actually became sick.

The evening of his transplant Dr. Linker stopped by and when we were asking what we could expect he stated that next weekend (i.e. THIS weekend), he, would either be very sick, or not. This evening he became fairly sick. At this point we are unsure of how long these symptoms will last, or their severity. At this stage these side effects are not related to the actual stem cell transplant, there will be other issues and symptoms when the stem cells begin to engraft. We have turned off his phone at this point, but please feel free to call and leave a message he does enjoy hearing from you. His wall is covered in cards that he has received from all of you which are such a bright spot in everyone’s day. Additionally, the Hospital has a space when you can send patients messages online and they are printed out and delivered. Emily has tested this a few times and it does work so feel free to send a message by clicking on https://www.ucsfhealth.org/adult/contact/patient.html (his room # is L1122).

Becky and Emily are thinking of creating a Million Mile Driving Club with the number of trips and miles that they are collectively wracking up! It makes for long days driving over and back, sometimes leaving after work. Tori has been doing an amazing job of maintaining her sanity while she is away during this time. She has been excellent at calling Rick each day to check in, in addition to calling Becky and/or Emily. We too are appreciative of the support and people’s extensions of kindness during this otherwise crappy time. Continue to keep all of us in your loving thoughts.

Much love and thanks.

A Rainbow… New Beginning, and…Cream Corn

After a 3 hour commute to get into the city today, Beck saw a beautiful rainbow just to the left of the Bay Bridge. She took this as an omen. Rick said he saw the rainbow out his hospital window and he also took this as a sign of good things to come. In short, we were doubly blessed. Actually, Rick was already feeling like God was on his side because his FAVORITE NURSE, Lindsey, whom he hadn’t seen this hospital stay, had been assigned to him today!



The stem cell transplant took place this morning and in some respects was anti-climactic. Rick had been given a myriad of medications, from anti-rejection drugs, antibiotics, anti-fungals etc. to a large dose of basic Benadryl which knocked him out for a bit. Prior to that a person from the lab rolled in a cart on which sat a "warming bath" in which the frozen cells would be brought to temperature. The cells themselves have a pinkish/blush appearance like that of ruby red grapefruit. The 3 bags were individually warmed and hung for transfusion. In addition to the IV drip of cells, the Physician’s Assistant used a huge syringe and collected cells from the IV and then "pushed" them at a faster rate. All in all from start/set-up to finish it was a bit over 60 minutes with the transplant taking about 35 minutes. All the while Rick was being monitored and tested. He came through with flying colors…thus, Rick’s "New Beginning". All the while, Beck snapped pictures of the momentous occasion. At lunch he was presented with a small birthday cake and candle to celebrate his new life. To tell the truth, I think for both of us the enormity of what took place today didn’t really hit until later and we’d had a bit of time to reflect on all that’s gone into getting to the BIG DAY!



The doctor warned us yesterday that the "smell" of the transplant might make Rick and me nauseous. Couldn’t figure out what she was saying. Smell? How would we smell anything that’s multi-sealed in IV bags? Well…the donor cells are frozen in a DMSO preservative. Once the cells enter Rick the smell is emitted through him…his skin and breath! OMG….it smells like a newly opened can of cream corn! VERY pungent. You can actually smell it outside his room. We were assured that it would disappear in a few days!!! Rick said he took a walk after dinner and a couple of people congratulated him, apparently the smell is a dead giveaway that you have just had a transplant! Gotta say this was one thing NONE of the books talked about!! Who knew life would begin like this?!