New Pipes

Tomorrow is the big day.  Day Zero.  Transplant time.  Not sure yet when tomorrow it will happen, likely in the morning.

The actual transplant is undramatic. It will be like just another transfusion. Jim has had a lot of them. The stem cells are semi-frozen when they are transfused and they need to get into the body quickly which brings us to the topic of plumbing.

What kind of plumbing? The kind of plumbing used to put stuff into a body.  I'll assume you know about IV lines, but there are other bigger, faster and longer lasting jobbers that do the same sort of thing.  Jim already has a PICC line; that's the thing that has been dangling out of his right elbow since early July. It's nice, works well for blood and platelets but is too narrow to properly transfuse the stem cells. Most folks getting a bone marrow transplant get a line in the chest called a Hickman (I'm sure whoever Mr. Hickman was, he is fondly remembered). The Hickman lines are bigger and can handle the thick, semi-frozen stem cells just fine. Jim didn't get a Hickman (if you want to know why, ask) but he still needed a line capable of handling the thick stem cells.  So, a temporary, new line was installed in his neck this evening. Very nice; now he has little tubes dangling from his neck.  They will be in use just for the transplant then removed shortly thereafter, so forgive me if we don't post pictures of them.  They look a little raw tonight.  

Frankly, both of us feel a little raw.  Jim with reason (signing a waiver to get your neck cut, even by a thoroughly kind and charming surgeon is a bit unnerving) and I'm raw because I'm nervous. Watching your husband's neck get cut into, again by a really lovely doctor, while genuinely interesting, is also a fair cause for jumpy nerves.

Counter balance to the present nerves is the longer view. Jim did really well through all the chemotherapy (that's done, say thank you) and we've every reason to believe that the road from here on out will generally trend up.  There will be downs as well- we've been told that a little GVH reaction is a good thing.  

What's GVH?  It's Graft Versus Host.  It happens is when the body figures out that the transplanted material, in this case, the stem cells, are foreign bodies and tries to knock them off.  While the effects of the attempted removal of foreign materials is usually uncomfortable (fevers and such), apparently the act leads to greater long term success.  Okay. 

Some time frame information: 

7 days- that's the time we've been here so far, getting chemo and playing with The Rabbit.

21-25 days- That's about how long it will be before we see the blood counts go up- see that the stem cells are becoming new bone marrow. In the meantime, Jim will continue to get transfusions and drugs to support the blood he has.  He will stay in this room until his white counts are 1.0, today they were 0.3.  They won't go up until the transplanted stem cells start to work.  When they are over 1.0 then he'll be able to go outside this room and use the PT equipment on the 6th floor.  That translates as patience with a capitol P.

2 1/2 - 3 months- That is about when we expect him to get out of the hospital, when his blood (and the rest of him) is strong enough to survive the outside world.

100 days-  a recognized milestone.  By then, we should see Jim solidly improving and expect that to continue.

Right now, raw neck, raw nerves, lights out, Tylenol in, and time for bed.  Ah, and thanks to Ron Harvey and Greg Dolan for visiting today.  It was great to see both of you.