On Sept 21 Wednesday, Amaey was supposed to be admitted int he hospital for his 60 day bone marrow test and a biopsy that was due early on the 22nd. They wanted him in because he needed IVIG and platelets before the procedure. Since they did not have a bed we came home after his radiation, the two of us were very happy about that. We took a nap and later we enjoyed chai. Amaey loved my chai. He had promised to learn to make chai so that he could make it for me. Since Amaey did not really have an appetite and we were really trying to help him get off the TPN, I had started mushing all his foods into baby food consistency. Vicki helped me mush some beets, cataloupe for dessert, and my butternut sqaush soup. We were getting everything ready incase we had to leave for the hospital and have dinner there. At 5:30 they called and told me they had a bed. Amaey and I packed up and got to the hospital at 6:30. We had to go to the BMT area. Pratish and Bharvi came to spend the evening with him. They watched some TV, played on the ipad, itouch, giggled like crazy. Best of all was when they watched Big Bang Theory, Amaey could not stop laughing. I fed Amaey food and he had quite an appetite today. I was so thrilled.
After they left, we settled and the nurses started his infusions. Amaey wanted to sleep with me and we chuppered for the longest time and then fell asleep. He was my normal Amaey, happy, content, and with me.
Since coming home Apurva and I had started talking about Dr. Slavin. We wanted to do some background check on him, find out from some of his patients, find out about his reputation and work in Israel, and finally, talk with him and see what he thought would be a good course of action if Amaey were to have a full relapse. We did a conference call with him on the 20th. We informed him of the fact that Amaey's counts were doubling ever day. He really did not care about the counts, all he asked was that the patient be in good clinical condition. Amaey was weak but in good clinical condition.
Who is Dr. Slavin... actually he is called Prof. Slavin in Israel. Before Amaey's transplant, we had a conference call with a doctor Renneker who is based out of SF. Our friend Rita had made the introductions. He mentioned Prof. Slavin was doing some out of the box treatment to treat cancer patients. But by this time Amaey was already on a transplant path. Miraculously he also had a 10-10 donor just in 2 weeks of looking for one. This is usually unheard off for ethnic and minority patients. So we had Slavin at the back of our mind but never thought we would be reaching out to him.
Apurva was also very busy calling doctors in Seattle, Minnesota, Germany, and France. He had sent Amaey's file to Sloane Kettering in NY as well and St. Judes. We were trying to figure out about DLI (donor lymphocyte infusion), NK cell transplant, and Haplo identical transplant. While Apurva was talking with all these centers and some of the best doctors, they all said that the counts doubling is worrisome but he still had time so a DLI or Plan B was definitely in the books. They thought that radiation in the meantime was a good idea too.
Armed with all this information we made sure that Amaey's team initated NMDP to contact the Donor for DLI. We were really upset that the doctors did not start the process earlier. This is where we have a huge problem with the BMT team, we felt that they were very by the books and not open to out of the box solutions. They should have started the DLI process the minute they found out about his skin relapse. On the flip side, they knew more then we did.... or did they?
Early in the morning when the urologist stopped by to get my consent for the biopsy I went outside the room to talk with her. I did not like the conversation one bit. Everything she was informing me about seemed like I was putting Amaey in the a difficult situation and in the harms way. The complications she mentioned sounded grim. I could not sign the consent. I told her I needed to think and get back to her. By this time I had Amaey's counts from the early morning and yes, they had doubled again. Thi was not good. Amaey's ONC doctor stopped by to see how things were. We talked about Amaey's counts and what all this meant. He said that it was not good that they had doubled again. He was worried that when we would do his bone marrow test the cancer might have spread inhis marrow. However, all his other numbers regarding neutrophils and ANC were more stable compared to his overwhelming WBC.
Around 10:30am Apurva, Pratish, and Arjun come to the hospital. Apurva took Arjun to the passport office in the city. Maureen had found some info on expediting the passport. Davina had sent a notary to my house the day before and had my signature on everything because I was going to be at the hospital with Amaey. I tell Apurva about my worry with the biopsy, he sees Amaey's latest counts and we both decide that this is it. Everything has to stop, we are not putting him through no more procedures, we are taking him home and leaving for Israel tomorrow instead of Saturday.
I call Arjun's school, Pratish takes Arjun to pick-up his books. Apurva and I meet with his ONC doctor and have a very frank talk with him. We tell him that we are leaving for Israel tomorrow (we do not have tkts yet) and we don't want to do no more procedures. His doctor, who has been with Amaey for 6 years now since the day he was diagnosed in the ER on Nov 2005, says, he does not recommend it but he understands where we are coming from. On his side there is nothing he and the BMT team can do. All they could offer was to keep him comfortable and help with his quality of life at home. He said that Amaey looks good and is definitely fit to fly and in good clinical condition. However he would like to give him one more round of platelets to help him with his flight.
We then go and meet with the BMT team, the social worker, and ONC doc. They tell us how sorry they are that they don't have anything more to offer and understand that we plan to take Amaey to Israel.
Apurva said something that I will never forget, we have had 9 amazing years with Amaey, all these years we have worked hard and he has gotten better because of hope. We told Amaey that his team has given up on him but there is a doctor in Israel who has an option that might work and Amaey has picked hope over sitting and doing nothing so we will take our chances.
I went home since it was 3pm. If we were leaving the next day there was a lot to be done.
Pratish, Arjun and I went home. Once I got home the frenzy of events that took place were... Brian came home with Arjun's expedited passport. Davina had booked a hotel for us, Carmen had contacted her friends in Israel that we knew as well and they were planning to pick us up and they would bring food for us. Swati was flying with us and was meeting us in Philadelphia from where we were to fly direct 16hrs to Tel Aviv.
Korine a mom from Arjun's school found a private jet for us. Yes, this amazingly generous person, Mark Benioff, sent us NetJets. Suddenly I'm talking with his assistant and planning our flight from SFO to Philadelphia on Friday September 23 at 9:30am.
Apurva had managed to cancel our Saturday tkts and found business class tkts on US Air from Phili to Tel Aviv. We had to fly business class to keep Amaey comfortable and confined in a smaller area.
I don't remember if my friends were already home when I got there or if they came in one at a time... but all I remember is a room full of bags, hand bags, carry on bags, almost 10 people packing us. We were packing for an infinite time... I did not know when Amaey and I would come back. The plan was for Arjuna nd Apurva to return home in 2 weeks once Amaey had started his treatment. I had called my parents and told them to get ready to come to Israel if I was to be there for a very long time. I knew I would need help.
When Amaey came back from the hospital something was off. He seemed much slower then when I left him at 3pm. We still don't know if it was the 2nd platelet infusion that knocked him down. I wasn't happy that he was getting a second infusion because he got a fever or some infection from the transfusions if they were back-to-back. But by that time... there was too much else going on and it seemed like the best thing for him so that he could be strong on the flight.
Apurva and I are still trying to figure out if it was the transfusion or that fever they could not pinpoint on when they sent us home along with his counts doubling up each day that caused him to catch an infection because when he got onto the tel Aviv flight he did look sick and around hour 10 into the flight he had a slight fever.