T plus 2.................March 6, 2008

Well, we are at T plus 2 (Transplant day plus two additional days). This is the vernacular used by the doctors and nurses to pinpoint where we are in the process. We are focused on T plus 20, that’s when we hope to be discharged and relocate to a quiet apartment for some isolation, uninterrupted naps, and recovery.

The transplant occurred on schedule late Tuesday morning. Tuesday was not a good day for Jan emotionally. She was extremely distraught and frightened throughout much of the day. The nurses were quick to react with some mild sedation, but eventually had to escalate the dosage as it became clear that relief was not forthcoming. Eventually, Jan was able to get composed and relax. The nurses all complemented Jan’s brother Pack for having donated a very generous volume of stem cells. He had been exercising and eating right for weeks in hopes of providing a wholesome sample of stem cells, and it proved to be just what the doctor ordered. The actual administration of the stem cells was almost anti-climatic, not very much different than a blood transfusion. It only took about an hour, and was monitored closely by a nurse the entire time. Jan’s vital signs remained good throughout the entire procedure, with no side effects.

Jan’s immune system continues to be in decline (which is normal, and expected) as we head toward neutropenia (where her white count will be near zero). She will be neutropenic for approximately two weeks until her new stem cells engraft. It is during this time that she will be most at risk for infection, and thus she will be closely monitored and many types of antibiotics will be administered. Her current medications included anti-everything drugs. She is being given anti-infection medication, as well as anti-viral, anti-fugal, and anti-graft vs. host. Basically, if there’s a risk, she’s being given something to counteract it.

Yesterday, day T + 1, was one of her best days. The anxiety was under better control, and her appetite returned. She confirmed with the PA (Physician’s Assistant) that she can eat pre-packaged food items, so I ended up making two trips to a local grocery store to get a few essentials (donuts, Rice Krispie treats, lean cuisine spaghetti, and hot dogs). She ate about half the items, with an eye towards today to finish the rest. The nurses were all very excited that she was eating, especially since they expect very little appetite during her last two weeks in the hospital. The reason for that may be any, or all, of the following: nausea, lack of appetite due to the excessive medications, mouth sores, and extreme fatigue. The nurses claim that most patients lose about ten pounds during those last two weeks of hospitalization.

So far, today has been another good day. To me, any day that Jan does not have much pain or discomfort is a good day. Her hemoglobin was low this morning, so she is currently receiving her second unit of blood. She complained earlier of a headache, but that was medicated and she reported that she felt much better. So now we focus on T + 3 and beyond.