A YEAR AFTER MARROW TRANSPLANT, CAPE FIREFIGHTER BACK AT WORK

Life has a whole new meaning to Cape Girardeau firefighter Mike Carlton, who has battled back from cancer.

Slightly more than a year after a bone marrow transplant, Carlton is back at work full time, a few pounds lighter but feeling fine.

Smiles come more easily these days. He says he feels lucky to be alive, having, in his words, been "to the brink of death."

The 48-year-old Carlton says this holiday season has been far better than last year's, when he was just beginning the long road to recovery following the transplant.

The medical problem surfaced in early 1992. At the time, he thought it was just a routine back pain. But the situation worsened and subsequent tests revealed he had multiple myeloma, a deadly cancer of the white blood cells.

Doctors recommended a bone marrow transplant, with the donor marrow to come from Carlton's twin brother, Ron "Ike" Carlton of Cape Girardeau. They said there was a good chance of success because the donor bone marrow was a perfect match.

But Blue Cross and Blue Shield of Missouri, the city's health insurance company, initially refused to pay for a transplant. Blue Cross officials contended it was an experimental treatment and there was no clear evidence that it would be any more effective than conventional chemotherapy treatment.

The Carltons hired an attorney. After four months of negotiations and discussions with Blue Cross, the company agreed in mid-October to pay for the costly transplant. At the time, it was estimated the transplant would cost in the neighborhood of $150,000 to $300,000.

The transplant occurred at St. Louis University Medical Center in October 1992.

Carlton spent six weeks in the hospital. "I got out the day before Thanksgiving in '92." He then spent a week at a St. Louis Holiday Inn so the hospital could keep an eye on him.

"I stayed close to the hospital," he recalled. It was after Thanksgiving before he returned to his Cape Girardeau home.

He was still weak. "I took rejection medicine for a long period of time." A nurse visited his home regularly to monitor his health.

"On a bone marrow transplant, the first 100 days are the most critical," explained Carlton.

During that time period, he had to return to the St. Louis hospital every two to three weeks for follow-up checkups.

"Then he (the doctor) let me go up to a month a couple of times," said Carlton.

Following the transplant, Carlton went through a period of severe depression. Recovery occurred in small steps.

Carlton suffered through a loss of appetite for several months. At one point, he lost about 60 pounds. Since then, he's regained some of the weight. He's now about 36 pounds lighter than he was before the transplant.

He spent the winter of 1992-93 at home working out on a treadmill, trying to build up his strength.

Carlton was so weak that lifting three pounds was a chore at first. "It's strange to lose your strength like that," said Carlton, who as a firefighter was used to lifting heavy fire extinguishers.

"Quite frankly, after 100 days I started seeing a change for the better," he said.

In late March, Carlton returned to light duty with the fire department. Last fall, he returned to full-time duty as a firefighter. "I went back to the crew in late August."

Returning to work was a big step in his recovery. "When you get out of the house and you start putting your work clothes on and you hit the streets, you start toughening it up," he said.

Near the end of October, he made another visit to the St. Louis University Medical Center, where tests showed there was no sign of cancer.

Carlton said the doctor told him to return for another checkup in a year. "It made me feel real good."

Twin brother Ike Carlton says he never had any doubt that the transplant would be a success. "I felt good about it all along."

Still, he says he's glad the ordeal is behind them and their families. The two brothers and their families have a close relationship, both emotionally and geographically. The Carltons' have adjoining backyards.

These days, the two brothers are recounting the ordeal at area civic club meetings in hopes of providing encouragement to others who may be facing serious health problems and need bone marrow transplants.

They also hope to interest individuals in donating bone marrow through the National Marrow Donor Program, headquartered in Minneapolis. The national program helps match donors with those needing transplants.

The Carltons say it's important to educate people about bone marrow transplants.

Ike Carlton said his brother's ordeal underscores that point. "We were going up against attorneys and medical authorities (for the insurance company) who were telling us that it won't work," said Ike Carlton.

But the Carltons persevered, detailing their situation to everyone from state insurance officials to state and federal lawmakers.

"We made a lot of phone calls," Mike Carlton remembered. But he added that he had no other option; it was his life that was at stake.

"Life is kind of fragile. You have to play the cards you've got," he said. "I had a lot of prayers from a lot of people."