Transplant 2 Day -6

This is Karen, posting for Dad today.

Yesterday morning, Dad and Mom had a regular appointment in the cancer clinic to see the doctor.  Because it was also pretransplant admission, Dad had to give a lot of blood at the lab first.  

Afterwards in the clinic, the doctor went over a few things in regards to the transplant.  The doctor has continued to study Dad's bone marrow biopsy from two weeks ago.  They have found new translocations (abnormalities) in the DNA of the cells in the marrow.  They understood then that the disease is changing and "ramping up", which is seen when the leukemia is progressing.  The doctor was very glad then that we went at it so hard in September with the first transplant and that we are already going back at it again now.  He reiterated that the disease is ruthless and the prognosis is poor.  We will continue to try and fight!

They then went upstairs to the oncology floor.  The hospital doesn't have an isolation unit room open yet, so Dad is in a regular ward room on the oncology floor.  This is okay for this week, as his counts have not bottomed out yet.  We are used to living with low blood numbers and not in complete isolation - we've been doing this for quite a while. They hope to have a room available on Friday or Saturday, and move him into his own private isolation room (a different one from last time - so no pink, tiny room.  The new one is a bit bigger and blue! A small but great blessing.).  It will be a relief to get into the isolation room by the weekend.

The bloodwork showed that Dad needed blood transfusions and platelets, so they started an IV in his arm and gave him a unit of blood.  He then went for chest x-rays, all part of admittance into the transplant program.  They brought him back to his room and he then had a technician come up with a portable EKG to check his heart.

He then started his chemotherapy regimen.  The two drugs he will be receiving are fludarabine and cyclophosphamide.  He will get both of these chemos each day, Tuesday-Saturday.  He'll be getting more drugs of a different nature on Saturday-Sunday.  These drugs aren't chemotherapy but a biodrug that will work at nullifying his white blood cells.  This drug comes from rabbits and the purpose is to attack Dad's cancerous white cells.  Under normal conditions, an immune system would go crazy if fluids from another organism are injected in.  So the doctors will give Dad other drugs to help control the side effects (fever, chills, shakes, hives, etc.) as even his weakened immune system will likely react violently.

Then Uncle Clarence and Aunt Irene came by.  They had been at the cancer clinic all afternoon, doing pre-op for his donation of bone marrow.  I was also there at this point and it was good for everyone to visit together.  While they were still here, the doctor also came in.  It was really neat to have the doctor, patient, and donor together in the room at one time!  The nurses were happy to see it as well.  After the doctor left, we were able to leave the room for a bit and have coffee together.

Dad then went back upstairs and back onto his IV pole.  They ran another unit of blood and platelets.  By the time he was all done and disconnected, it was 10:30 in the evening... it had been a long day.

When Dad describes his night, he says, "The night's rest was fair" (such a "Dad" comment :)...)  By 7:30 am, he was hooked up to receive platelets again, in preparation for getting a central line put in again this morning. When that was done, they took a blood test and his platelets were only at 22 after receiving two units.  They ordered another unit of platelets and ran it in, during the procedure downstairs in the OR.  We are thankful that the procedure went well, with no issues with bleeding.

The isolation unit head, Adrienne, came to visit them this morning.  She explained the procedure for the transplant a little bit.  They rarely work with fresh bone marrow.  If they do work with actual marrow, it's usually frozen as it's been collected earlier and not on the same day.  She also talked about the fact that Dad might not be staying in quite as long as last time if things go well.  They aren't sure how Dad's numbers will be with the Reduced-Intensity chemo.  If he takes things well, they are confident that he is capable of living at home with low counts and staying safe (as he has been doing for the past few weeks), and they will keep tabs on him in the clinic.  Dad, on the other hand, isn't so keen on spending too much time in the clinic with very low numbers and would rather stay in longer (after engraftment) than wait with other sick people in clinic.  We will have to wait and see.

From the blood tests this morning, Dad found out that his hemoglobin (red blood cells) went from 66 to 68, even with two units of blood.  They're guessing that is due to the chemotherapy.  The doctors decided to give him another two units of blood again today.  Adrienne also said that if the numbers tomorrow are still poor, they might not necessarily give more blood but will try to assess his needs and deal with them in other ways.  Too many transfusions isn't good.

Dad received his two bags of chemo this afternoon, which went smoothly.  So far, he isn't experiencing many side effects.  He is receiving drugs to counter nausea but hasn't experienced any yet, which is a blessing!  His appetite is not great, but Mom is a pro at getting Dad to eat a little bit here and there.  :)

Dad is feeling very tired and sore from the Hickman procedure this morning.  They gave him a little bit of sedation this morning and he still hasn't really recovered his energy from that.  He is expecting that a good night's rest will help feel a bit more comfortable tomorrow.  Mom also brought in a warm, thick quilt from home so he's excited to sleep.

He has enjoyed the connections and familiarity with the nurses on the oncology floor and they have been a blessing.  It makes the transition back in a bit easier.  It's also easier for Mom and all of us, as we are used to making the hospital work well for us and we are falling back into our hospital routines.  Mom and Dad were able to skype with a few of the grandboys last night and talk/text on the phone with all of us kids.

Dad asked that I leave you with Psalm 46:1-3.
God is our refuge and strength, a very present help in trouble.  
Therefore, we will not fear though the earth gives way,
though the mountains be moved into the heart of the sea,
though its waters roar and foam,
though the mountains tremble at its swelling.

Prayer Requests
1. Give thanks that everything has gone smoothly so far with minimal side effects.
2. Pray that the chemotherapy will do its job well!
3. For good rest for both Dad and Mom tonight.