(May 6, 2006 - Indianapolis Star story)
"Game Helping IU Player Recover"
condo and new life in progress....see below....
Graduation Day!!!!
(February '06)
"Inspirational Parker Continues to Battle Back"
"Senior Baseball Player Overcoming Cancer, Eyeing Return to Field"
(summer '05)
Newspaper story about Ryan
ryan's email address: rygparke@indiana.edu 
Ryan back at first, against Purdue!
3/12/06 - in Terre Haute w/Grandma
Sept. 18, 2006
Ryan's had two CAT and PET scans since the end of radiation treatments, and each time received an all-clear assessment! It's difficult to express our thanks to The Lord, and for the prayers and thoughts of all our friends and family.....
Life continues to begin anew....Ryan has begun working at The Midland Company in Cincinnati, a provider of specialty insurance products, in the marketing department. Midland has long also been heavily involved in youth baseball, and maintains a stadium and other fields on their property. Interestingly, Ryan played games there as a boy when he played for a "travel team" called the Ohio Merchants. Ryan and Ashley are in the process of watching their first home being built, a condominium in Ivy Hills. They're more than excitied about things, and Ashley will soon begin her job at Deloitte and Touche. Ask Ryan about his new-found interest in decorating and home furnishings!
May 8, 2006
Ryan (and Ashley!) graduated on Saturday, although Ryan had something known as a baseball game keep him from the ceremony itself. The Kelley School of Business awarded him his degree "with distinction" because of his performance in the classroom. We're trying to figure out a way to get a photo of him in a cap and gown (and his honors "attachments")....
The baseball team has ten games remaining, and, beginning with yesterday's final game of the Iowa series, Ryan is expected to be starting at first base for all of them. The weekend's story in the Indianapolis Star (it also appeared in the Louisville Courier Journal, on Derby Day...) came as quite a pleasant surprise to all of us.
Ryan says he's feeling ready to play. and has begun doing the sort of weight training that he had to stop last summer. He's getting stronger, of course, and folks commented over the weekend that it looks like his arms are getting even bigger. Although he didn't get a hit in Sunday's game, he did drive in a run and hit the ball solidly each time....unfortunately, right at someone. The news overall continues to be very, very good (as Ryan told the Star reporter)!
April 18, 2006
As you can see, it's hard to hold him back....beginning with the Northwestern series in early April, Ryan told the coaches he was available as needed. They check how he's feeling before each game, and the radiation has certainly sapped him....he gets tired more quickly, but has started a few games and played as many as six innings. He played a few innings in the opening win against Purdue, and made a great offensive play at first to keep Purdue off the bases in the final inning. In the final game of the series, he went 2-2 and made another great grab at first, leaping high to snare a high-bounding ball that a spectator said was "a major league play."
March 13, 2006
Today was Ryan's third radiation treatment, and all is going well. He'll have them Monday-Friday for the next three weeks. Not much in the way of side effects thus far, although he says it can feel a bit tiring. We spent the weekend together and also visited Grandmother Parker in Terre Haute....she was indeed surprised to see Ryan! His hair is starting to grow back, and he looks great.
Ryan did get the doctors' OK to at least swing the bat, given how well he's been feeling, and he did pinch hit in the series against Miami in Florida. He "hit a rocket" but unfortunately it was right at the shortstop....Ry said he was seeing the ball incredibly well, and felt strong.
Because of the radiation treatments, he had to miss the annual spring break trip to Florida this year, but should be able to travel with the team more as the season moves on and the treatments end.
February 23, 2006
Today's meeting with Dr.Kharkar, Ryan's radiation oncologist, brought great news! She told us that the CAT and PET scans Ryan had on Tuesday show no evidence of tumor activity. And while Ryan is still facing 17-19 radiation treatments, the doctors are confident that they can get him to complete remission. The stem cell transplant did its work, and the radiation can now effectively complement and help complete the job.
The radiation treatments will begin early in March, after two radiation "mapping" sessions are done. The treatment planning will take a bit of time, as the doctors agree that the best course is a fairly broad approach....with fairly wide fields of radiation, and lower dosage below his diaphragm. This is because the disease was originially spread across four areas (neck, under arm, chest, and abdomen) and somewhat resistant to the initial chemotherapy regimen. The doctors agree on the overall plan....his primary oncologist, the transplant team, and the radiation oncologist. We continue to be thankful that Ryan is in very capable and caring hands, and blessed with an abundance of prayers and best wishes from family and friends.
February 14, 2006
Everyone met today with Dayton, Ryan's oncologist in Bloomington. It was a lengthy and very helpful visit, covering the transplant and upcoming radiation treatments. Those are still scheduled to begin at the end of this month, in Bloomington. We meet next week with the radiation oncologist to finalize the plan and approach. It's most likely that the radiation "fields" will be larger than what we had originally discussed, to ensure that all tumor areas in question are reached. Those treatments will be Monday-Friday, and last about six weeks.
Ryan has been elected captain for this year's Indiana baseball team, and is also completing one regular class and an independent study in order to complete his degree requirements.... graduation is May 6. He doesn't expect to be able to play much this season, as his joints (cartilege) could be adversely affected by more than low-impact aerobic exercise. As Ryan told noted, it's not the way he envisioned his senior season turning out, but he has something far more important to defeat right now.....
February 2, 2006 - "Day Seventeen"
Ryan received the a-ok today to check out, and will spend a day or two back in Ohio to see his mom before heading back to Bloomington. Dr. Thompson said he recovered from everything amazingly well, noting that the most serious complication appeared to be a couple of days in the hospital with a (very) sore throat. His counts are now high enough that he has no restrictions, other than what his body tells him he can or shouldn't do.
We've been blessed by all the support he's received from family and friends, along with what we feel has been outstanding care and consideration from the entire staff at St. Francis Hospital (one of the country's top 100, by the way) and its Blood and Marrow Transplant Center. It is indeed astounding how medical treatment has progressed, especially in the area we've just experienced. A truly heartfelt thanks to everyone......
another top ten list....What Cancer Cannot Do....
January 30, 2006 - "Day Fourteen"
Ryan's counts continue to improve, so he'll have another couple of days off before checking in with the doctor on Thursday. We're hoping that he'll get the OK to return home then, and everything's indicating that's quite likely. The center normally expects to keep patients close for 28-30 days, but Ryan's progress has been better than most.....just the brief inpatient stay last week, one of the expexcted "bumps" along the transplant road.
We also spent time with Dr. Thompson about the upcoming radiation treatments, which will likely begin in about one month. He provided a very helpful diagram of how that final part of the treatment will likely run. They avoid radiation for a few weeks because of how it can affect white cell counts, which are already low for most patients.
Radiation provides a 95% factor....meaning that when it's given in the proper dose, it's 95 per cent likely that the tumor will not return or progress. The catch is that you have to be certain that the radiated field indeed covers all the tumor in questions. There's also the increased possibility of side effects, especially when applied below the abdomen. Chemotherapy, in theory, is a 100% coverage situation...meaning that it should be able to attack all the disease everywhere. That then allows the radiated fields to be more targeted. In Ryan's case, as in most, the doctors at St. Francis, his Bloomington Oncologist (Dr. Dayton) and the Bloomington Radition Onclogist (Dr. Kharkar) will consult to determine the necessary fields (or "mantel") to radiate and the dosage.
Ryan was also given the OK to get out to a restaurent yesterday, a nice break in the routine for the past couple of weeks. He should be seeing his friends and family within a couple of days....thanks again for all your support and prayers......
January 27, 2006 - "Day Eleven"
On schedule, Ryan's white cell count dramatically increased today, and the "strong" white cells outnumber the "weaker" white cells by a ratio of about 8/1. His other counts are up as well, and it looks like he won't be needing any additional platelet or hemoglobin transfusions. He might need some potassium and magnesium, but that's about it.
He'll probably be able to 'take the weekend off' as the doctors say, although they still want him to be cautious because it's a good time to avoid crowds for anyone.....lots of infectious things floating around right now, apparently. It will probably be best to limit visitors for a couple more days, as well.
But it appears that he should be able to return to Bloomington early next week. He'll then have about three weeks before he'll most likely begin a series of targeted radiation treatments. Plenty of good news to share......thanks again so much for all your support and prayers!
January 26, 2006 - "Day Ten"
On schedule, Ryan's white count advanced significantly today, three times yesterday's level...so he's now well over the 1,000 mark, a great sign. His fever is also gone, and the blood culture was negative. His other counts are also up, and he doesn't need any more hemoglobin/red cells (he did have another hemoglobin transfusion yesterday).
So it's time for him to head back to the apartment this afternoon, and return to outpatient status. We're still looking at sometime next week for a full discharge, allowing him to return to Bloomington, but it's still one day at time for now......
**(If you've emailed or called Ryan recently, he's not had his cell phone with him, and hasn't been able to access email for a bit.....)
January 25, 2006 - "Day Nine"
*8pm update - Ryan's temperature went down this afternoon, and has now gone down further...the fever appears to have left the building.....
Dr. Dugan thinks Ryan should be able to go back to the apartment by Friday. His white cell count is up to 450 (it was just under 200 yesterday), but he did get a fever last night and is on IV antibiotics. His temperature went up to 101.3, and has gone down to 101.1. (101 is the target number for concer)
Because of the fever, they took a preacautionary x-ray this morning, which showed no problems. They also are doing blood cultures, to make certain there's no infection in the blood stream causing the fever. It will take 24-48 hours to see the results of the blood culture. When there's a deep inflammation in the system, it can get into the bloodstream.
It's also possible that a fever can be a direct result of white cells rapidly increasing, which is likely in Ryan's case because of his youth and excellent physical condition. Dr. Dugan explained that in his case the system could be working "overtime," which essentially overstimulates things inside, and thinks his white count could be a high as 1,000 tomorrow.
His throat is feeling much better and they've started to cut back on the morphine IV drip he's been getting for the pain. That's another reason he won't leave the inpatient unit as soon as we'd hoped. They have to slowly cut back on the morphine, and they had it fairly high because of the pain level Ryan experienced yesterday.
Ryan's skin irritation is also clearing up, and he ate eggs and ham this morning....small bites, but a great sign. He hadn't eaten much but shaved ice and ice cream yesterday. He's also ordered chicken fingers and fries for lunch today.
So, barring any complications showing in the blood culture, Ry's still pretty much on schedule with things. As Dr. Dugan noted before leaving last night, this is just another "bump in the road," and not anything surprising.
January 24, 2006 - "Day Eight"
Because his sore throat became more aggravated, Ryan's gone to the hospital's inpatient unit, probably for a couple of days. It would no doubt have been difficult for him to eat much today, and possibly quite hard to swallow the antibiotic pills he still needs to take. He's still had no fever, and his red cell and platelet counts are up somewhat although his white count is relatively the same. There's no sign of throat sores as far as can be seen, and Dr. Dugan suspects either some additional irritation further down the throat, into the digestive system (not unusual), and more than likely a blockage of the canal that runs from the ear to the throat....probably accounting for the pressure Ryan's feeling on the right side of his throat.
Ryan had a hemoglobin/red blood cell transfusion yesterday, as his red count was close enough for caution. He had no reaction to that, however, and was able to eat and drink when back at our apartment. Unfortunately, the throat pain and pressure kept on through the night, however, and by about 6am the uncertainty and lack of sleep had taken enough of a toll to prompt a call to Dr. Dugan, who was on call. He was reassuring, but agreed it would be best to check in as an inpatient at least for a day or two. It does feel like a bit of a setback, but Dr. Dugan emphasized that there's no real cause of alarm, just some caution and monitoring. He says Ryan is still on course to see his white counts start on the way up, which will go a long way toward dealing with the difficulties. He did take special note to emphasize to Ryan that the pressure in his neck has absolutely nothing to do with Hodgkins itself....a bit unnerving for a moment, but reassuring.
Ryan was able to eat and drink yesterday, but the throat pain made it difficult to sleep and by 6am it all prompted a call to the hospital. After asking a few questions, the doctor didn't didn't see any major cause for alarm but suggested it would be best to check in as an inpatient for a day or two. Another hemoglobin transfusion might be necessary, as his red cell counts could be a bit higher. A morphine IV for the throat pain is also in progress, along with the drug Ativan...which has an overall calming effect on the system as well as dealing with nausea. Those drugs should make it easier to take the necessary oral antibiotics. Of course, the best thing will be to see Ryan's white counts begin to creep upward by tomorrow, as expected, which will go a long way in helping resolve the current difficulties.
January 22, 2006 - "Day Six"
It's been a quiet weekend, as Ryan white cell count decreased to the expected level of 100. It's actually up to 200 today, but the staff decided it would still be wisest to give him a platelet transfusion....again, as expected. The slightly increased white count doesn't really mean much at this point.
It's possible they'll do a red cell (hemoglobin) transfusion tomorrow, but the doctor now on unit rotation (Dr. Thompson) thinks it's likely he won't need it. All other counts are fine, he says, and everything continues to be on schedule.
Ryan's throat is a bit sore today, but that's very normal and his temperature has been normal as well. We do have to watch for some reactions to the platelet transfusion, such as a low fever and a rash. Ryan's skin irritations appear to be improving, and his energy level is slightly but not dramatically lower. His appetite remains good, although today and possibly tomorrow might be liquids only days because of the throat irritation.
Ryan is dealing with all of this amazingly well, and overall remains in pretty good spirits. The throat situation will make him a lot less talkative for a couple of days, but all still seems to point to things moving upward by the middle of this week. And IU beat Purdue yesterday, so we had something to cheer about!
January 19, 2006 - "Day Three"
Ryan's white blood cell count is at 500 today, which is the "target number" indicating the need to be extremely cautious about possible infections. Any temperature approaching 101 is cause to call the hospital, as is any case of shaking or chills. Ryan needs to take his temperature at least three times per day. Aspirin is a no-no, as it thins the blood (a danger with platelet counts down), and Tylenol can mask a fever. But he's not complaining about any aches or pains....just a little "tenderness" which has not been unusual during the chemo treatments.
The good news is that there's no indication of any of these problems. His weight has remained at about 200, which is very good (many people lose 10-15 pounds during the transplant process). His sleep patterns have also been interrupted a bit, but he says he's ok with the rest he's getting....there are also afternoon naps to help him regenerate. Overall his energy level hasn't changed dramatically within the past few days. The lowered cell count is going as expected, which means that we can hope to see the counts start back up sometime around days 8-10. The count will drop to about 100 before that happens, however. We've all decided it will be best to not have visitors until about the middle of next week.
These days, blood cell transplant patients (as opposed to bone marrow transplant patients) can expect to see the counts increase in 10 days or so after transplant. Not long ago, before the use of drugs now used to stimulate cells for harvesting, patients waited 30-60 days....and ran a huge risk of spontaneous infection, while also having to be closely isolated in hospital rooms. It really is amazing to learn how far along things have come....one of the oncology nurses here told us that she's worked in different fields, but the progress in this area over the past decade is incredible.
Of course, Ryan also continues to take a few different antibiotics. These drugs can also help improve acne outbreaks, which are common to transplant patients no matter what their ages. (The high-dose chemo tends to thicken the oils that rise to the skin, causing outbreaks even in folks who've never had problems with pimples.)
The proverbial light at the end of the tunnel is getting closer, despite the hurry-up-and-wait current situation. thanks again so much for all your thoughts and prayers which help move it closer......
January 17, 2006 - "Day One"
One of the books about transplantation given to us notes that many survivors consider transplant day a "second birthday"....so it's a happy birthday for Ryan. Things still are going well overall, with only a bit of nausea and skin irritation to deal with. He's also got to make certain that his fluid intake stays up, so they decided to give him a simple fluid IV after today's transplant procedure. Hopefully that will help him avoid having to take home a backpack IV of fluid.
He received the remaining two bags of his harvested cells this morning. His white blood cell count is a bit lower today, although platelet count is actually up...meaning that there were a fair amount of platelets in what was collected from him at the end of December. By tomorrow, his white count is likely to be low enough that he'll have to avoid fresh fruits and vegetables and take other precautions to prevent infections. Of course, he is taking anti-infection prescription drugs, as he did back in December following the mobilization chemotherapy.
This is the last actual "treatment" day for him, and tomorrow begins the monitoring process...complete blood counts and general checkups once each day. Dr. Akard says he's getting through the transplant process as well or better than expected. Any side effects this week are the result of the chemotherapy's damage to his system (most noticeably the digestive system), and not the transplant itself.
January 16, 2006 - "Day Zero"
Today was the first of two days of transplant (or re-infusion of his previously harvested cells). All went very well, and Ryan didn't even notice the start of the transfusion. At that time, Dr. Akard was answering Ryan's question about whether the transplant does anything besides replace cells. The answer is that it possibly has some theraputic value; because what's being returned to his system is more than just immature stem cells (it includes platelets, mature white cells, etc.) it might somehow trigger the body's immune system to a limited extent. The doctor explained that the chemo attacks the bone marrow, and the transplant is essentially intended to repair that...otherwise the risk of infection would be overwhelming.
We learned that he'll have a second day of transplant tomorrow, which is a good thing. Because they were able to harvest so many cells from him (about 16 million, much more than is normally expected), there's more to put back. But there is a limit to the amount of white cells they'll re-infuse at any one time, because of the risk of side effects, it will be done over two days.
One of the nurses noted that not everyone tolerates the transplant well, and everyone is a bit different in their response. Ryan's was uneventful, and he didn't really notice the odor of the DMSO that's used to preserve the cells when they're frozen prior to transplant. "Boring is good," in this situation, she noted.
They expect Ryan's blood counts to drop slowly over the next few days, and be on there way back up by the middle of next week....possibly earlier. His appetite and energy levels have remained constant, and he's a bit sleepy this morning. That's likely a result of the two drugs (Ativan and Benadryl) that were given to him just before the transplant.
January 14-15, 2006
It was a quiet weekend, with a quick chemo treatment on Saturday followed by bloodwork and a quick checkup on Sunday. Ashley was able to stay for a couple of days, and they went out for dinner on Saturday night. IU trainer Joe also stopped by Saturday. Ryan began spreading out his meals/eating, which is recommended to help deal with potential side effects such as loss of appetite and nausea.
Unfortunately, we had to watch both the Colts and Bears lose on Sunday. But we took some consolation in the fact that a bit of Steeler fan lingers, a holdover from the years we lived in Pennsylvania....
January 13, 2006 - Day "-3"
Ryan's counts are down a bit today, as expected. This is the last of the double-dose chemo, where he goes in to the hospital at 8am and again at 4pm. Tomorrow is a single-dose day, and Sunday will be a day of rest to allow the chemo drugs to exit his system in preparation for the stem cell transplant on Monday.
Dr. Akard says white blood cell count improvement is not likely until day 8-10 (following the transplant). It is a day-by-day monitoring process.....hurry up and wait, as he put it.
Most transplant patients wind up need at least a platelet transfusion. we learned about that today, which was new to us. If you already donate blood, you might want to consider also being a platelet donor; it's a longer process that a normal blood donation, but very much needed for supporting cancer patients.
Ryan's in good spirits, is eating well, and slept very well last night. Again, the potential side effects are more likely to be felt next week....but each case and individual are of course different.
Your thoughts and prayers continue to be so much appreciated....take care, and hug someone you love today.....
January 11, 2006 - Day "-4"
Today is "day minus four" because "day zero" is the actual transplant day, next Monday. All is well overall, with Ryan feeling only a bit more tired today. His weight remains the same, and his blood counts are virtually the same as when we began this week....but by the weekend he can expect to see the counts drop.
Dr. Akard told us a bit more today about the upcoming transplant. The process on Monday will take about 30 minutes, and it's not unlike a normal blood transfusion. The solution will be a bit cooler than body temperature when its re-infused, and because it naturally has a high concentration of white blood cells (as well as the immature stem cells), Ryan's white count will go up quickly. But it will also drop quickly, as that's the nature of white blood cells' lifespan as they enter the bloodstream. The cell solution is preserved by DMSO, which carriies a garlic/tomato/vegetable sort of taste and smell.
The doctors tell Ryan that's he's doing absolutely fine through the process, apparently much better than is normally epected. Side effects have thus far been no problem, although we're told that it's likely that delayed side effects can normally be expected next week....but the specific side effects and their severity depend more on the individual.
All in all, tha light at the end of the tunnel is getting a bit brighter each day!
January 9, 2006 - Chemotherapy
Yesterday Ryan began the 6 days of "BEAM" chemo that precedes the stem cell transplant. BEAM stands for BCNU (Carmustine), Etoposide, Ara-C (Cytosar), and Melphalan. Monday's treatment was only about an hour long, while today through Friday will require morning and afternoon treatments...and a final short day of chemo on Saturday.
Ryan had little if any side effects from yesterday's chemo, and his appetite is good. The BCNU drug is actually alcohol-based, but other than being a bit flushed and maybe tired Ryan was OK. This week's treatments are more spread out, unlike the original and more recent chemotherapies. He might see more effects next week, however.
His weight is holding steady, and cell counts, although down a bit, are OK.
IU trainer Joe Luken visited last night, and the doctors actually encourage visitors until Ryan's cell counts drop significantly after the chemo is complete. It will probably take about two weeks after the re-infusion of his stem cells for things to start back to normal.
(Stem cells produce cells that evolve into blood cells...red blood cells distribute oxygen and carbon dioxide throughout the body, white blood cells fight infection, and platelets control bleeding.) Because of a particular drug he's now taking, Ryan's white blood cell count will appear to be a bit higher than it really is....the drug (Decodrin) tends to push white cells into the bloodstream.
Following the transplant and recovery period, the doctors expect to start "limited field" radiation. This would probably happen toward the end of February, and would be done back in Bloomington. Ryan is registered for his final class this semester, by the way, with graduation in May. As for the road to full recovery, the doctors say if his platelet count is ok, then he can do whatever his body tells him he can.
December 28, 2005 - Stem Cell Collection
Ryan underwent his first day of stem cell collection, or "harvesting", yesterday. The goal was to collect 5-million cells, and the final total was 8-million. That's considered a "fantastic" result, although a second collection is being taken today for backup purposes. The collected cells are "processed" to ensure that any cancer cells are eliminated, and then they're frozen for re-insertion after the 6-day intensive chemotherapy regimen in January.
Ryan's platelet count is also very high, so we've not had to be concerned about any possible transfusion. His spirit is as strong and upbeat as his physical condition and collection and test results. He'll now also be able to mix and mingle with groups of people again, and ate his first restaurant meal last night in about two weeks. After the mobilization chemotherapy, he had to limit people contact because of the increased risk of infection. Now he won't have to be relatively isolated until his January chemo and the two weeks after the transplant procedure.
Thanks again so much for your prayers, thoughts, and concern. If you have any specific questions about the procedures and such, let us know by writing to doug@ikarensell.com .
Take Care....Ryan, Karen & Doug
