Update on Days +3, through +8
Day +3 (Friday May 11). The Stem Cell Transplant doctor told us that day +3 or +4 Ken would develop a fever. On Day +3 and Day +4 Ken would also get the last of the chemo to combat the incompatible stem cells but, not destroy the compatible stem cells. Right on schedule Day +3 the fever began. He developed rigors (chills) which was from cytokine release syndrome which is common when foreign cells are being attacked, destroyed and releasing toxins. This is watched and monitored very closely. In addition, Ken gained 7 pounds of fluid from the transplant and was given a diuretic. By early afternoon, Ken began feeling better after receiving meds for the chills and was more himself. Late afternoon he had a visit from a friend and Ken enjoyed the visit. Dinnertime, he was able to eat part of a burger and a few fries and commented that he thought the fever was returning and fell asleep. The nurse checked his temperature, and although it was slightly elevated there was no fever but Ken was perspiring. I left for home so Ken could sleep for the night. Shortly after I left there was a flurry of activity because the nurse could not wake him to answer questions. Labs showed he was dehydrated and had low potassium. He was given more fluids and potassium and returned to normal a short period of time later, within a couple of hours.
Day +4, Saturday, May 12, 2018
When I saw Ken, he was doing well but very weak. He was encourage to shower but he was too weak. He tried but because he was so weak, he was unable to stand as his legs could not support him and was lightheaded. He was helped back to the bed. His blood pressure was orthostatic(low blood pressure upon standing from sitting or lying down). They didn't want him to stand without assistance so he would not be in danger passing out and falling.
Day +5, Sunday, May 13, 2018
About 10:00 a.m. a particular medication was administered to prevent graft vs. host or lessen the effects when engraftment occurs. This medication either contains rabbit DNA or horse DNA. Ken received the rabbit DNA. He developed a fever of 102 and rigors and side effects from the chemo on Days +3, and +4. His muscles were very tense and caused his normal low back pain from the hospital bed to escalate from a 4 to a 9 on the pain scale (seemed like a 10 to me observing him). He wanted to sleep but the pain and chemo side effects prevented him from resting. As the day went on the rabbit juice (the technical term) finished around 4:00 p.m. Things slowly started to improve. Ken transferred to the hospital recliner which helped his back a little to allow him to get some rest. We had gotten approval from the doctors and staff to bring his recliner from home which is sometimes the only place he can sleep when he gets back pain. The doctors are all for anything that helps without the use of pain meds which did not help him at all.
Day +6, Monday, May 14, 2018
Ken's labs have been trending downward, but today he is officially neutropenic! He has no white blood cells and undetectable neurtophils (the little soldiers that fight infection along with the white blood cells). This has been expected and it allows the new donor cells to engraft and start rebuilding his immune system. This is expected somewhere in the Day +teens. Ken has been feeling better but still weak and retaining fluid and continues receiving a diuretic.
Last week I had his recliner professionally cleaned and had arranged to bring it to him. Before transporting I vacuumed it thoroughly with a brand new vacuum cleaner used the first time on the chair, wrapped it in freshly laundered sheets and moving cling wrap. Some dear friends helped take it to him and after getting it cleared through the hospital supervisor and infection control, the chair was delivered to his room and Ken was able to sleep comfortably for the first night in a while and able to be without back pain. I guess we caused an uproar because this has never been done before.
Day +7 Tuesday, May 15, 2018
Day +8, Wednesday, May 16, 2018
Overall, these have been good days. He is still retaining fluid and getting a diuretic. He continues to be neutropenic. When his labs start to register an increase in values, that is an indicator engraftment is taking place. Until then, we are just waiting...