Transplant Day!

 At around ten am this morning the activity started in Karl's room. People from the lab came with special warmers that they filled with chemicals, and then they left. Nurses came with lots of anti meds...antivirals, antifungal, antinausea...plus dexamethasone and I can't remember what else. Some given orally. Some given through iv along with the fluids that have been constantly running since Tuesday. Then the lab personnel came back with Karl's stem cells in a portable freezer. They had been frozen for the past seven and a half years. She told us that the freezers that store cells like these are checked every thirty minutes to ensure they are working properly.

At about five to eleven the room filled up. The person from the lab (I don't know her title), 2 RNs, a NP, three nursing students, and me. And of course Karl. We all watched as the two bags of cells were put in the warmer, massaged a little, and then hung on the iv pole. They dripped into Karl via his port in just under fifteen minutes. Done. The room cleared out.

That's the transplant. How does it work? White blood cells are produced in the bone marrow, and they live in the body for about 3 days before they are replaced by new ones. The Melphalan from yesterday killed the bone marrow so that it can't produce any more white blood cells. So right now Karl still has some of the cells that his body produced before eleven am yesterday, but within another 48 hours he will have very few or no white blood cells. He will be neutropenic. But soon after that (they have it timed pretty much to the minute), if all goes well the stem cells re-introduced into his body today will be mature enough that they will become bone marrow and start producing new white blood cells. That's the transplant.

Karl will be very tired during this process, and very susceptible to picking up any nasty (or even not so nasty) bug that is going around because essentially he will have no immune system. He is going to be closely monitored, and meds for every possible scenario they can think of are on standby. Hopefully none will be needed. He will be in hospital for up to three weeks (T + 21) if he doesn't have any complications. Last time it was T + 16. Then he will have to stay within 15 minutes of the hospital for another few days. When we are given the go ahead to go leave the St. John's area, he will have to be very careful about what he does for the first 100 days as his body builds up his immune system. Then he will have to have all the vaccinations and immunizations that most of us have as children. It will be Karl's third go round with these.

The next few days are just waiting. Karl's white cells will be measured every day, and we will know when they are at zero. Then we wait until they are measured to be something other than zero. Last time Karl said he felt different as soon as the cells started to grow; he felt better with each passing minute.

Unless there is something to update, I don't plan to write for a few days. Prayers and good thoughts are always appreciated!

Getting the cells ready

Hanging the cells onto the iv pole

Watching the cells from the first bag drain as the second bag is being prepared and Karl's vitals are being monitored.

All done. Let the recovery begin!



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