Day Zero, aka TRANSPLANT DAY
Today started like yesterday with a physical exam from Nurse Practitioner Charlene, who declared all was well. Then around ten RN Pam showed up with the bag of meds, which were all literally in bags with the exception of the regulars lovenox and acyclovir, and a newly added med for constipation. IV bags were hung for anti-nausea, more steroids were given, and lots more fluids were dripped in.
While the first lot of fluids were given a lady from the lab wheeled in a water bath and plugged it in. She returned with a space-age looking cooler, along with a second RN, Fran, around 10:50. While Fran checked Karl’s vitals, Pam added more wires to the IV pole and the lady from the lab loosened the seal on the cooler to take out one of the bags of stem cells. Four bags were collected during the extraction, and two of the four were in the cooler to be transplanted back into Karl. The other two will continue to be stored for ten years in case a second transplant is needed. After she took the first bag out of the cooler she gingerly passed the bag to Pam and a form to Fran. Pam and Fran did the sing song chant checking the form and bag to Karl’s wrist band. We’ve become very familiar with this song since chemo started. Then the bag was passed back to the lab tech who put the bag inside a zip lock bag, and then placed it in the water bath to warm for 2 minutes. She carefully massauged the bag while it was in the water, probably to make sure there were no remaining lumps of frozen cells. Then the bag was taken out of the bath and handed to Pam, who hung it on the iv pole and hooked it up. Fran recorded the time as 11:00. After the cells dropped in for about five minutes Pam asked the lab tech to prepare the other bag. The same process as before was followed, including the song and the water bath. Pam was removing the first bag from the iv lines as the lab tech was taking the cells out of the outer bag that went in the water bath, so they did a seamless exchange of bags and the second one was attached. The second bag didn’t run smoothly so Pam asked Fran to get a flush needle to flush Karl’s catheter line. That didn’t help so she asked Fran to go get another set of iv lines from the chemo room. While Fran was gone Pam removed the bag from the pole and lifted it higher than the fluid bag which was also running, and then the stem cells started to drip. By the time Fran got back all was running well. Fran brought a stool and Pam stood on the stool holding the bag of cells until it was emptied. Fran recorded the finish time as 11:21. And that was it. Nine months of preparation for 21 minutes.
Fran checked Karl’s vitals twice during the procedure, right after it was completed, and again after fifteen minutes, and all was normal. Karl’s blood work from this morning also had all normal levels with the exception of hemoglobin, which was 111, with normal being 140. Karl’s hemoglobin was 88 when he was diagnosed. It reached the 130s during the last round of regular chemo, but never quite got to the normal range. The first high dose chemo just before the stem cell extraction caused his hemoglobin to drop to below 100, so it has rebounded again. It will drop again now, as will all the levels except creatinine, which we have to watch for a rise. It is expected, actually known, that Karl will become neutropenic again, which means his neutrophils will drop to 0. Remember this means his immune system is zero. That happened after the extraction when he got the infection in his perma cath. This drop will start now and he will probably reach zero count next Tuesday. Then he will be given Neupogen again for five days, or until his neutrophils start to rise again. When they start to rise this will be a day to celebrate because this will mean that his transplanted stem cells have started to grow in his bone marrow. The melphalan (chemo) he got yesterday killed all the old cells in his bone marrow, so any rebound comes from the cells transplanted in during that very important 21 minutes this morning.
Karl had a short nap after the procedure until he was woken by Fran to check his vitals. Then he had his lunch, and now he is napping again. I’m sure they can hear him snoring down the hall! I wouldn’t be surprised if they wheel in a CPAP machine soon!
All joking aside, it is good that he is sleeping. So far he hasn’t had any nausea or dry mouth, which are two of the first symptoms we were told to expect. He’s also still eating. The melphalan will likely change that soon because along with killing bone marrow, melphalan will damage Karl’s mucous membranes, which will likely lead to mouth sores, some damage to his digestive tracts, nausea, constipation and then diarrhea, damage to his taste buds...The actual transplant was easy. It’s the side effects of the melphalan that will flatten his immune system and make him very sick and keep him in hospital. But today was Day Zero. Tomorrow we start counting in the positives until he gets through all of this and gets to go home.
While the first lot of fluids were given a lady from the lab wheeled in a water bath and plugged it in. She returned with a space-age looking cooler, along with a second RN, Fran, around 10:50. While Fran checked Karl’s vitals, Pam added more wires to the IV pole and the lady from the lab loosened the seal on the cooler to take out one of the bags of stem cells. Four bags were collected during the extraction, and two of the four were in the cooler to be transplanted back into Karl. The other two will continue to be stored for ten years in case a second transplant is needed. After she took the first bag out of the cooler she gingerly passed the bag to Pam and a form to Fran. Pam and Fran did the sing song chant checking the form and bag to Karl’s wrist band. We’ve become very familiar with this song since chemo started. Then the bag was passed back to the lab tech who put the bag inside a zip lock bag, and then placed it in the water bath to warm for 2 minutes. She carefully massauged the bag while it was in the water, probably to make sure there were no remaining lumps of frozen cells. Then the bag was taken out of the bath and handed to Pam, who hung it on the iv pole and hooked it up. Fran recorded the time as 11:00. After the cells dropped in for about five minutes Pam asked the lab tech to prepare the other bag. The same process as before was followed, including the song and the water bath. Pam was removing the first bag from the iv lines as the lab tech was taking the cells out of the outer bag that went in the water bath, so they did a seamless exchange of bags and the second one was attached. The second bag didn’t run smoothly so Pam asked Fran to get a flush needle to flush Karl’s catheter line. That didn’t help so she asked Fran to go get another set of iv lines from the chemo room. While Fran was gone Pam removed the bag from the pole and lifted it higher than the fluid bag which was also running, and then the stem cells started to drip. By the time Fran got back all was running well. Fran brought a stool and Pam stood on the stool holding the bag of cells until it was emptied. Fran recorded the finish time as 11:21. And that was it. Nine months of preparation for 21 minutes.
Fran checked Karl’s vitals twice during the procedure, right after it was completed, and again after fifteen minutes, and all was normal. Karl’s blood work from this morning also had all normal levels with the exception of hemoglobin, which was 111, with normal being 140. Karl’s hemoglobin was 88 when he was diagnosed. It reached the 130s during the last round of regular chemo, but never quite got to the normal range. The first high dose chemo just before the stem cell extraction caused his hemoglobin to drop to below 100, so it has rebounded again. It will drop again now, as will all the levels except creatinine, which we have to watch for a rise. It is expected, actually known, that Karl will become neutropenic again, which means his neutrophils will drop to 0. Remember this means his immune system is zero. That happened after the extraction when he got the infection in his perma cath. This drop will start now and he will probably reach zero count next Tuesday. Then he will be given Neupogen again for five days, or until his neutrophils start to rise again. When they start to rise this will be a day to celebrate because this will mean that his transplanted stem cells have started to grow in his bone marrow. The melphalan (chemo) he got yesterday killed all the old cells in his bone marrow, so any rebound comes from the cells transplanted in during that very important 21 minutes this morning.
Karl had a short nap after the procedure until he was woken by Fran to check his vitals. Then he had his lunch, and now he is napping again. I’m sure they can hear him snoring down the hall! I wouldn’t be surprised if they wheel in a CPAP machine soon!
All joking aside, it is good that he is sleeping. So far he hasn’t had any nausea or dry mouth, which are two of the first symptoms we were told to expect. He’s also still eating. The melphalan will likely change that soon because along with killing bone marrow, melphalan will damage Karl’s mucous membranes, which will likely lead to mouth sores, some damage to his digestive tracts, nausea, constipation and then diarrhea, damage to his taste buds...The actual transplant was easy. It’s the side effects of the melphalan that will flatten his immune system and make him very sick and keep him in hospital. But today was Day Zero. Tomorrow we start counting in the positives until he gets through all of this and gets to go home.
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