Transplant -1 (Tuesday)

Ok...so I can't count! Tomorrow is Day 0 (zero). I had to skip a day to get the countdown to work correctly. I wan't great at math. I guess that's why I didn't get that job at NASA doing the countdowns to blastoff:)

Jackie had her radiation treatment today. Tomorrow is transplant. She is feeling sick most of the time. She is now on a schedule of regular anti-nausea medication. We are told it will get much worse over the next several weeks. They expect her to hit bottom about 4-8 days after transplant. That is when her counts will be at their lowest. They will remain low for about 2 weeks at which point the transplant should begin to engraft. Engraftment will be a slow process. If all goes well she will be 100% engrafted within the 100 day window. Her full counts will take up to a year to recover. As you can imagine there are a great number of variables!

She is feeling better this evening. She is up and around. Much of how she feels is dependent upon her anti-nausea schedule. She feels better about 30 minutes after she takes the meds and then feels worse as the effect wears off.

The chemo and radiation certainly has something to do with her nausea. That is not the entire reason, however. The chemo kills off the fast growing cells in your body. Of course it is very effective at killing off the CLL cells in bone marrow. The first cells to die are those in the outer lining of the mouth, throat, stomach, and gut. As these cells slough off it alters the taste of foods, causes a dry mouth and throat, and is one of the key reasons for the nausea. It takes several weeks for these cells to rebuild. During this time period nothing tastes good. Jackie's tastes changed immediately after the radiation treatment. Things begin to taste like Styrofoam or cardboard.

Tomorrow is T-Day. We are to report to the transplant center at 5:30 AM. The stems cells arrive by air tonight about 10:30 PM. They recount them in the lab at the Mayo and perform other (unknown) tests. Jackie will get 4 hours of IV fluids, then the cell infusion, and then another 4 hours of IV fluids. We should finish about 4:00 PM tomorrow. The actual stem cell infusion won't take long. I'll post more on the process tomorrow.

They give 8 hours of IV fluid to make certain her kidneys are well flushed. Until the cells arrive we won't know if the cells will be bone marrow cells (very unlikely), true stem cells (very likely) or a combination. From time-to-time they cannot collect enough stem cells from the donor and it becomes necessary to get the remainder from their marrow. With the advent of growth factor stimulation shots this has become rare. The donor cells will contain stem cells as well as some red blood cells. The red blood cells are mostly destroyed by the collection process and need to be quickly filtered through the kidneys. I'm sure someone knows the reason, because I have no idea, why the stems cells are not filtered by the kidneys. For whatever reason they slip through and eventually migrate to the bone marrow where they begin to engraft. Engraftment takes about 2 weeks. This, of course, is the real danger period. With no immune system Jackie is subject to all the normal infections we had (and fought off) off as kids. Pneumonia is a real danger. For that reason she is masked anytime she goes outside the apartment.

Well, enough for one day. As I write she is feeling pretty good. She is watching American Idol and rooting for Kelly and Taylor (naturally!).

Bruce and Jackie
from Rochester, MN