On the road again

Well, not today but a little sooner than expected.

We received a call from Andrew, our CAR-T coordinator, this morning and we have the date for our return to Toronto!

We will fly out on March 4th and things start happening on March 5th at 8:30 a.m.. First up is a PET scan as a pre-treatment baseline. I’m sure the schedule will unfold over the next several days. Their online patient portal is very good and I get emails about any new appointments or test results. I expect to know my hospital admission date pretty soon.

My Valentines Day Present

We’re back from Toronto at about 1am and after a snack and some unwinding it’s 3am before we’re in bed.

Surprisingly, I’m up at about 8:30 doing the usual stuff and planning day 1 of 14 in self isolation. The main activity this week for me is the Tour of Sufferlandria and I’m already a day behind. I’ll need to do 3 rides today to get back on track. No worries, I’ve got all day and then the “gift” arrives.

I get a call from St. Boniface MRI and there has been a cancelation today and can I make a 1pm appointment, which is in 2 hours. So a quick breakfast/lunch and off I go.

As I’m waiting I hear the receptionist calling to fill other cancelations. Surprisingly, many people turn down the opportunity. Given the typical wait time I’m not sure why folks are missing out on the opportunity.

The Tube

Apheresis

Apheresis, and more specifically leukaperisis is a fancy name for collecting your white blood cells and thatís what today was all about.

Things started off with a bit of a bump due to COVID and exacerbated by the newer COVID variants being detected in the Toronto area. At the hospital entrance there is quite intense COVID screening. As a patient, IĎm good to go. However, Shirley as a ďvisitorĒ or ďsupport personĒ, not so much. The letter detailing my appointment today stated that she would be able to accompany me into the hospital and be allowed into a waiting area near where Iíd be treated. The idea being that she would be able to be closer and get me anything that I might need, like Starbucks ūüôā .

However, the very official screener person was not having any of that. Without a very specific letter allowing Shirley to accompany me, he denied her entry. Plus she couldnít wait anywhere in the hospital building and was asked to go outside where it was -8įC (thankfully weíre not in Winnipeg where it was more like -35įC). Fortunately, she was able to go across the street to Princess Margaret Hospital where she explained the situation and they allowed her to stay inside a sort of ďno manís zoneĒ between the front doors and before you are actually in the hospital. Tears were involved.

Meanwhile Iím off in the Toronto General to the blood lab for some more testing prior to the apheresis. This time I did get a bit lost and asked for some directions (not a guy thing). Blood work completed, itís up to the 12th floor for the procedure (didnít get lost this time). I check in and Iím shown to my home for the next 4 1/2 hours.

The Machine

There is quite a bit of pre-work as the machine runs through itís self-testing to ensure itís operational and not leaking, thatís a good thing. Then there is quite a complex procedural thing about the very special box that will be used to ship my blood product to the USA. More on that later.

Then Iím hooked up. WARNING: if youíre squeamish, you might want to skip over the next couple of picture.

First there is the outflow. Itís actually three tubes. One is my blood, another is feeding in an anticoagulant and the third is for something else that I canít recall right now.

The Outflow

On the other side itís the inflow. This is my blood minus the part that they are collecting plus an IV of some calcium to counteract the anticoagulant that has been mixed in with my blood on the outflow. Apparently the anticoagulant can cause some minor side effects, none of which happen to me.

The Inflow

So while Iím in the chair I canít move too much and Iím limited to one handed texting and browsing social media etc.

Just hanging out for 1/2 a day

And when weíre all done, here is the result.

The white blood cells. Look sorta red eh?

This stuff is now being treated like gold. There is an extensive process that must be followed to the letter on a computer system about recording all the various numbers on the above bag, the box numbers, the serial number of the temperature monitoring device that will go into the box with the blood product and a whole lot more. The process takes four different people form various parts of the organization to witness the process and sign off on various steps. Once the box is fully sealed and Iíve witnessed the process I can go. Shortly, a dedicated courier from Detroit will arrive and take possession of the box. He will then drive the box back to Detroit. From there Iím not exactly sure where itís going but itís being worked on starting on Friday.

I get re-united with Shirley and we eat some of the lunch we packed and are picked up and driven back to my cousinís house. Weíre both a little exhausted even though it was just a day of sitting around, Itís been an emotional process even though weíve done it once before and COVID has certainly not helped the situation. We get take-out Thai for dinner and relax with a movie before calling it a day.

Thankful that this phase is complete and that weíll be returning home on Saturday. It will be approximately 4 weeks before we return to Toronto for the main event. Some time to relax and think and do some more (sort of) normal things.

Testing, testing, 1,2 1,2 testing

So Iíve heard that some posts might be too detailed or too technical. Well, today will be more of a sight seeing tour and staying more lighthearted. By the way the title is a bit of a sound guy joke.

Todayís testing is brought to you by Toronto General Hospital Peter Munk Cardiac Centre, literally directly across the street from Princess Margaret Cancer Centre.

12 stories in this part. Iíll be on 10 & 3 today and 12 tomorrow.

Also across the street from Sick Kids Hostital where I did some time as a young lad when we lived in Toronto.

This is what it looked like in the late Ď50s when I was there. Now itís been expanded from about 1/4 of a city block to the full block or more and very much higher. I remember my dad pulling up to that front entrance late in the evening when I was having some serious breathing issues.

First up is the Pulmonary Function test. No waiting and practically straight in. A nice Asian woman took me through the process of multiple tests each performed 3-4 times for comparison. ďBreath normally, big breath in, breath out slowly, more, more, more, OK breath normally. Big breath in, hold, hold, hold, breath out, breath in then out as hard and as fast as you can, then pantingĒ. Lots of breathing. The technician and I get along well and have some casual conversation along the way. I think I passed.

Not me, but the setup looked exactly like this. Lots of huffing and puffing.

Next itís off to the ďEcho LabĒ for the echocardiogram. Signage in the hospital is great and I donít get lost dropping down 7 floors and navigating to a completely different area of this very large hospital. I check in, and again itís almost no waiting. A nice German woman is conducting the test and itís all business. ďChange here, BP, weight, height, lay down here, arm up, on your side, move closer, on your back, breath out and hold, breath in and holdĒ. Lots of breathing today.

Still not me but it went like this
About 80 images captured plus video and audio

In short order all the testing for today is done, and itís time for Starbucks and a ride back to our home base. And now, a couple of photographs for no particular reason. ūüôā

Princess Margaret Cancer Centre. The original older 6 story building has been extended back behind for a city block and then up for a few more floors, the shiny new looking part in the middle. The inside is all quite modern looking.
Some bushes in winter, just because.
A couple of guys hanging around, probably pretty famous or important dudes in the medical field.
Some downtown Toronto skyline as Iím walking between tests.
Nice and sunny.

Tomorrow, itís the T-cell collection for most of the day and an early 7am start. Wahoo!

Scheduling

The system is proving to be quite efficient and Iím getting scheduled for several things while Iím here in Toronto.

This morning we spent two hours talking with our very lovely social worker who was quite caring and supportive and is available to assist both Shirley and I in several areas.

While weíre talking, Iím getting email notifications from the UHN system about some new appointments. They have a web portal that I can sign into and see most of my appointments and test results which is very cool. Far ahead of anything Iíve experienced in Manitoba.

Tomorrow is a COVID test and dental exam. Wednesday is a pulmonary function test and a echocardiogram. Thursday is the big all day T-cell collection process via apheresis. So far, nothing on Friday and then we return home late on Saturday.

The trip is going well and weíre enjoying our stay with family instead of in a downtown hotel, which is pretty much a ghost town these days as Toronto is in full lockdown.

Overload

It was a long day. This might be short.

Arriving at Princess Margaret Hospital (PMH) at 12 noon we head off to find the blood lab which will access my port to draw the blood. This is is not the ďnormalĒ place where people without ports or PICC lines go, itís a special area called ďAWAĒ, the Ambulance Waiting Area. The AWA is where they stage people on stretchers awaiting ambulance transportation. And, oh yeah, they also collect blood from us ďspecialĒ people. 17 tubes of blood later IĎm good to go for the ECG.

For the main part of the afternoon, from 1:30 to 5:45, we meet a lot of people, answer a lot of questions, hear a lot of information and sign a lot of consent forms.

The good news is after laying eyes on me they continue to think Iím a good candidate for the CAR-T therapy and things are moving ahead. The main doctor explains the process, risks and benefits in quite a lot of detail. The CAR-T coordinator explains the logistics, talks some more about the company and product that they will be using to modify my T-cells (Kite Pharma Inc., and the YESCARTA product).

The blood work and ECG are just the tip of the iceberg in terms of testing that will be done prior to the infusion of the modified T-cells. Here are the ones I know about today. A tuberculosis test, a 2D echocardiogram of my heart, a pulmonary function test, a dental exam, an MRI of my brain and a PET scan.

This Thursday, February 11th is the appointment for the T-cell collection. The process is identical to the stem cell collection and is likely to take the better part of the day.

Itís a lot to take in and it will take us a couple of days to absorb all the information and more fully comprehend what lies ahead. Thanks for standing with us.

Leaving on a jet plane

Our 1st COVID era flight, very strange. We arrive the requested 2hrs in advance and we are literally the only passengers in the terminal.

Ghost Town

Weíve been here one hour and have not even seen a plane. Then 1 Air Canada flight arrives and lets of 20-30 people. Iíve been on red-eye flights and late night flights and never seen the airport this empty. One restaurant is open, everything else is closed.

Not very many departures on the board

The Short List

I overheard the gate agent say there currently are 27 people on the flight which I guess is good for social distancing, and she just confirmed that we currently have the whole row to ourselves. Our plane has just arrived and only 35 people get off. The Boeing 737-700 has seating capacity for 143. I donít think they are making money on these flights!