Journey

A new plan for Wednesday March 10th. I get to have a Myocardial Perfusion Scan.

I glossed over one of the things that happened right at the end of my last Friday’s meeting with the CAR-T coordinator. “You may have had a heart attack so we want to get a cardiology consult”. Whoa, news to me!

The MRI of my heart done back on February 1st apparently showed some “issues” and this is the first I’m hearing about it. Anyway, they have consulted with a cardiologist and they have requested yet another test, this Myocardial Perfusion Scan, more specifically a Exercise Sestamibi Test.

This test will take 4-5 hours and as a result of this new twist, chemotherapy has been pushed back one day so its now happening on Thursday, Friday and Saturday. So far, the admission (March 16th) and infusion (March 17th) dates are holding. The test is in another building in the UHN complex so I’ll get to explore the Toronto Western Hospital which is roughly in the same city block as the other hospitals I’ve been cruising through.

I’ve got to admit it’s getting harder to “go with the flow”, “roll with the punches” etc. So far, no details on the specific reasons driving the test, if the heart issue is serious or not, if it will affect the CAR-T process or not. It could be just a precaution, after all they have checked virtually every other part of my body. Hopefully, some better answers in the days ahead.

To top it all off I can’t have any coffee until the test is complete!

Today I’m back at Princess Margaret Hospital (PMH) for more testing and a meeting with the doctors and Andrew, our CAR-T therapy coordinator. It’s Day -12 as March 17th is the day I’ll be getting my CAR-T cells infused, which is referred to as “Day 0”.

First up is a PET scan that will be used as the base-line pre-treatment. It’s interesting to note the differences in the processes between HSC in Winnipeg and PMS in Toronto. The Toronto folks seem to be much faster and have seemingly streamlined the procedure while still doing the same job.

The check in process was about the same but the injection was quicker and they didn’t leave the IV in for the duration like they do in Winnipeg. Changing is into a pair of hospital pants only, in Winnipeg they are more into a full gown mode. In the PET scanner it seemed faster here which might be due to a newer machine. The one in Winnipeg is 10+ years old and just now being replaced with a new model. Winnipeg is typically 2 – 2 1/2 hours, here I’m done in under 1 1/2 hours.

Next up is some blood work and a return visit to the AWA (Ambulance Waiting Area). This is where they collect blood if you have a Port or PICC line. If you were just getting blood drawn the “normal” way via a jab to an arm vein they have a pretty high-tech operation with dozens of stations to get the job done. Back in the AWA it’s more like a backwater ghetto, a holding pen with an assortment of mismatched chairs scattered about and lots of people getting in line for the two techs who can do the job. Still, not bad, a 20 minute wait and the very efficient tech gets my 5 tubes of blood with blazing speed and I‘m free to go.

Now it’s about 10:15 am and my next appointment is 1:30 pm, so some time to kill. After a Tim’s coffee and muffin I’m out for a walk to explore some of downtown Toronto. Not too much is possible as Toronto is still on a full lockdown with “stay at home” orders. The only things open are some restaurants but I’d have to eat out on the street and while it’s sunny it’s fairly windy and a little on the cold side so that option is not too appealing.

The 1:30pm meeting is primarily about reviewing my status with the various nurses and doctors. Vitals and a mini-assessments with a nurse, a more detailed review with the resident, and a recap with the senior hematologist all covering pretty much the same ground.

After the doctors are done Andrew reviews the plan for the next week up to my admission and I’m given another bunch of prescriptions for various anti-nausea meds to deal with the upcoming chemo treatments. The prescriptions were a bit of a surprise and another reminder that the chemo might not be a “walk in the park” so it’s off the the hospital pharmacy to get them filled.

I thought this would be an easy day but, by the end I’m a little emotionally fried from the testing and talking about everything so much. I’m relieved to see Shirley & Leslie waiting in the car to take me home.

Well, actually were flying😊✈️. Sorry, I seemed to have used the same title 2x in a row no less but I can’t think of anything better. 😜

Unlike the last trip the flight is packed! But, we’re on the 2 seat side of the plane so this is as good as it gets today.

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.

Apheresis, and more specifically leukaperisis is a fancy name for collecting your white blood cells and that’s 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, I‘m good to go. However, Shirley as a “visitor” or “support person”, 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 I’d be treated. The idea being that she would be able to be closer and get me anything that I might need, like Starbucks 🙂 .

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 couldn’t wait anywhere in the hospital building and was asked to go outside where it was -8°C (thankfully we’re not in Winnipeg where it was more like -35°C). 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 “no man’s zone” between the front doors and before you are actually in the hospital. Tears were involved.

Meanwhile I’m 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, it’s up to the 12th floor for the procedure (didn’t get lost this time). I check in and I’m shown to my home for the next 4 1/2 hours.

There is quite a bit of pre-work as the machine runs through it’s self-testing to ensure it’s operational and not leaking, that’s 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 I’m hooked up. WARNING: if you’re squeamish, you might want to skip over the next couple of picture.

First there is the outflow. It’s actually three tubes. One is my blood, another is feeding in an anticoagulant and the third is for something else that I can’t recall right now.

On the other side it’s 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.

So while I’m in the chair I can’t move too much and I’m limited to one handed texting and browsing social media etc.

And when we’re all done, here is the result.

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 I’ve 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 I’m not exactly sure where it’s going but it’s 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 cousin’s house. We’re both a little exhausted even though it was just a day of sitting around, It’s been an emotional process even though we’ve 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 we’ll 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.

So I’ve 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.

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

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

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. “Breath 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 panting”. Lots of breathing. The technician and I get along well and have some casual conversation along the way. I think I passed.

Next it’s off to the “Echo Lab” for the echocardiogram. Signage in the hospital is great and I don’t get lost dropping down 7 floors and navigating to a completely different area of this very large hospital. I check in, and again it’s almost no waiting. A nice German woman is conducting the test and it’s all business. “Change here, BP, weight, height, lay down here, arm up, on your side, move closer, on your back, breath out and hold, breath in and hold”. Lots of breathing today.

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

Tomorrow, it’s the T-cell collection for most of the day and an early 7am start. Wahoo!

The system is proving to be quite efficient and I’m getting scheduled for several things while I’m 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 we’re talking, I’m 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 I’ve 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 we’re 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.

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 “normal” place where people without ports or PICC lines go, it’s a special area called “AWA”, 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 “special” people. 17 tubes of blood later I‘m 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 I’m 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.

It’s 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.

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

We’ve been here one hour and have not even seen a plane. Then 1 Air Canada flight arrives and lets of 20-30 people. I’ve 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

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 don’t think they are making money on these flights!