And so it begins.....

On Monday....early no doubt.... we will trek off to the hospital to have surgery to implant the portacath.
The oncology people worked very hard to squeeze Brian's surgery in last minute so we could get chemo started later monday afternoon.
It will be a complicated day. The surgery is done at one campus of the hospital "downtown" and then we will have to trek "uptown" to the other campus for the doctor's appointment then get admitted for the chemo.
The picture shows where ports can be placed. Since Brian's already had a port on his right side, the surgeon will most likely place it on his left. Especially since the area where the old port is moderately covered in scar tissue but even after all this time, the skin is very thin there.
The port allows for repeat blood draws, and corrosive chemotherapy agents (yes, CORROSIVE) to be injected directly into the vein. It has many advantages when there is a need to access a vein regularly.
Brian will start his first round of chemotherapy late monday and will likely be in the hospital until thursday.
They expect to do 3-4 cycles of chemo at this time. Each cycle is determined by Brian's bloodwork and how quickly his cell counts recover, but we expect them to be about 3 weeks apart.

As I suspected, it was also necessary for us to be ready to make a decision on a transplant hospital. Which is why we took as long as we had to discuss and investigate our immediate options.
After many hours discussing with a variety of doctors, social workers, hospital coordinators (both finance and otherwise) we came to one conclusion that was impossible to ignore.
If we chose to come back to RWJUH the possibility that we would have to delay treatment to work through the bureaucracy of state to state paperwork was a real possibility. One that we just felt we could not risk.
Today's additional news that we may have to consider an allogenic transplant as well, we decided that the transplant will be done at Hershey Medical Center.

Our next obstacle will be to address how we can manage the neupogen costs which are not covered by the hospital ( and are huge) since they are done after discharge and will not be covered by medicaid even when that does start. It is a big obstacle that I will be working on all week, so should anyone have any good ideas, references or suggestions, please send them along.

I will admit that it was some what unsettling to hear the words salvage chemotherapy even though I knew that is what it is.

Brian took all of this stoically, only with the comment that obviously the cancer hid out and was not gotten entirely last time.
I feel a storm brewing and while I sigh at it's arrival, I also welcome it. I have been concerned at Brian's calm acceptance. I know that it was his anger and determination that got him through the ordeal of last time.

Special thanks to Jean for the note, and Itunes cards. It was very sweet of you to remember Stephanie when sending them, and she really was thrilled by her inclusion.
Also thanks to Scott's sister Donna for second donation. With the medical bills already over $7000.00, that is really important.

I haven't quite gotten the internet from the computer issue worked out while we are in the hospital and we don't have the budget to add a wifi card to our cell bill, so we'll have to see how we can work around that issue.