A Healthy Doctor Sam

Day +365: Transplantiversary in Pittsburgh

Do you remember back when the titles of the posts in this blog counted the days from my transplant?  The whole world seemed to revolve around when we would reach Day +100.  Then the hundredth day came and went, and I still didn't feel all that normal.  The road back was so excruciatingly slow at times, that it was hard to get a big picture appreciation of how well things were moving along.

Well, at some point I started feeling normal again, and we stopped counting the days.

But for this post, the count is back for a very special date.  Today, March 27th, is the anniversary of my transplant.  A year ago today, having been beaten down by lymphoma, chemo, and a lot of radiation, I lay in bed at Sloan-Kettering and watched an infusion of Normy's bone marrow stem cells drip into my Hickman catheter.  

You've already read about the most difficult parts of that journey (I myself just went back and read some of those old posts... I'm already forgetting just how bad things were...) so here are some recent examples of things falling back into place now:

- At the end of September, almost exactly 6 months after transplant, I returned to work, albeit a temporary job.

- You've all read about the engagement!  Part of the reason for no new posts recently is that I kind of liked the idea of Alissa's smiling face staying at the top of this page for a while.

- In late January, a mere 10 months after transplant and a year and a half after that lump in my neck derailed all plans, I returned to Pittsburgh and once again began my hand surgery fellowship.  I'm doing the fellowship 100% full time, with no restrictions and no difficulty (beyond what every fellow faces!)  In just two months here, I've done over 200 surgical procedures, and I start my third rotation of the year on Monday.  The staff here was amazing to me while I was gone, working tirelessly on my behalf to get my position reinstated, funded, and accredited, allowing me to return.  I'm on a bit of an unusual calendar with my January start, but as soon as things worked out we all wanted to jump and take advantage of it and not wait until the beginning of the academic year in August.  I've waited long enough!  I'm now counting down the months remaining in my fellowship, which is a very different sort of anticipation.

- Dr. P, My transplant oncologist at Sloan-Kettering, helped me find her counterpart in Pittsburgh to care for me locally while I'm here (though she'll still be my main doctor out of New York).  We'll refer to him as Dr. A.  I saw him a few weeks ago, and he sent me on my way to the zillion 1-year-check-up tests that I need at this point.  I spent this week getting a new PET/CT, a nuclear medicine esophageal motility study, pulmonary function tests, a cardiac MUGA scan, a brain MRI, and culminating with my official anniversary visit with Dr. A this morning, where I was informed that all the testing was normal and I had a clean bill.

I'm doing well being back in ordinary day-to-day life.  Even though I've felt pretty well for a while now, it wasn't until I returned to Pittsburgh and fellowship that I felt I had at last been able to pick up where I had left off, and that feeling is tremendous.  I'm still not perfect.  I'd say I'm at 85-90%.  I've had no major complications, but the list of the little and bothersome remains more than a handful.  Most of the symptoms I have today are attributable to signs of chronic graft-versus-host disease, which is the major long-term problem of bone marrow transplants.  My hair has thinned considerably, I have some difficulty swallowing, my mouth and gums are sensitive, I have patchy dry skin, persistent neuropathy in my feet, and swollen edematous legs.  Enough things to remind me I'm not young and in perfect health anymore, but nothing severe enough to require any treatment.  Just careful monitoring and regular doctor visits.  The only medication that I'm officially on is a daily multivitamin, and even that I must confess doesn't actually happen daily.

As for Alissa, she is living with my mom back in Connecticut, kept close to NYC by her job.  Luckily, she has been able to visit often.  We spent Persian new year together here in Pittsburgh, with a tiny little haft seen.  And this weekend she's back for the transplantiversary celebration.

We celebrated with a nice dinner out at restaurant ELEVEN, one of Pittsburgh's finest and just a few blocks from our apartment.  Chef Derek Stevens made a special tasting menu for the two of us, which was delightful.

So that's my one year anniversary, and everything that's been happening recently.  

There's a fun little wedding coming up in less than two months, so you might anticipate hearing news of that on this blog.  But otherwise, it's back to normal life and not much to report here!

Did I Mention That I'm Back At Work?

Yes, that's right.  Back to seeing patients, back in the O.R., and back to waking up at 5:00 A.M.

It's just that I've been so busy doing it that I haven't had a chance to sit down and write an update for you here!

I mentioned in my last post that I was feeling better and better--in fact nearly back to normal strength--so my estimates of restarting work this winter were readjusted a bit, and here I am.

It's not hand surgery yet.  My fellowship plans remain on hold, while the wonderful folks in Pittsburgh are working on the bureaucracy that is in the way of me getting hired there again.  Hopefully we'll have good news on that front soon, but for now it's still pending.

In the meantime, I've temporarily rejoined the Einstein/Montefiore orthopaedic surgery department (where I had done my residency).  I'm not working as an attending, but rather a clinical fellow, which is a perfect scenario for me to get my skills back up to speed without suddenly being back out there on my own.  I have, after all, been professionally dormant for the last 15 months or so, and both my hands and my brain need some practice to get back up to full speed.

I'm managing to work full-time (that's "normal" full-time, not "doctor" full-time--I'm not doing any night or weekend calls just yet), and the energy level has been holding up well.  I'm really enjoying being back at work.  My skills are definitely rusty (and my dexterity is still recovering from the transplant), but I'm getting a chance to do a little bit of everything, and it's great.  Of course, I'm dead tired after a really long day in the O.R., but that was the case even before I got sick.

The commute from Connecticut tends to be about 45 minutes each way, which explains the early wake-up times.  Alissa has about an hour each way, and she and I are still trying out different transportation permutations for our commutes, so that we may figure out what combination is most ideal.

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On the health front, I've now gotten back the results of my 6-month checkup.  PET and CT scans are totally clean, as is the bone marrow biopsy.  I saw Dr. P for my now monthly visit last week, and she slowly chopped the list of my medications shorter and shorter.  Gone are the immunosupressive drugs, steroids, antivirals, antacids, and minerals.  I'm now down to taking just a daily multivitamin and folic acid supplement.  Pretty good for 7 months from a transplant!

My immune function tests are still not back to normal yet, though they are creeping in the right direction (for you medical readers, CD4 count has broken the 200 mark, on the way up...)  So this means the restricted diet remains in place.  No sushi yet, though I'm eating salads at home.  I'll be re-tested next at the 9-month point.

Some Good News For A Change

It was on July 11th of this year, on a flight back from Chicago, when I discovered the lump on my neck which lead to the ordeal that I am in the midst of right now. As you've been reading on this blog since then, it's been pretty much an uphill battle after that.

The reason I was in Chicago at that time was for the orthopaedic surgery board exam. If you've known me in the past year, or even in the past five years, you no doubt were aware that this exam has been a huge obstacle looming over me.

I wasn't expecting the envelope until mid-October or even November, so when my mom handed it to me in today's mail, I was sort of stunned and unprepared. But I opened it immediately, and the enclosed letter began as follows:

Dear Doctor Moghtaderi:

I am pleased to inform you that you passed the Part I examination of the American Board of Orthopaedic Surgery on July 09, 2007.

Yaaayyyy!

You have no idea how big a delight this is for me. If there wasn't the little matter of dealing with cancer right now, this letter would officially signal that everything in my life was going well.

So yes, this again reduces the number of problems I'm dealing with to exactly one. I'm looking forward to the day in the near future when that one gets cleared off of my plate as well.