Details, details.

My transplant started last Wednesday, which means that this is Day 3.  I have been making daily visits to the ABMT Clinic to have blood samples drawn and analysis performed.  The results are reviewed and if any type of treatment is required, such as adding potassium or magnesium, that is performed, after which I am sent back to our apartment to repeat the cycle again tomorrow.  This will continue until approximately Day 21, by which time I will hopefully be showing enough progress to be released to finally return home.

Each day, twenty-one different tests are run on my blood samples.  While all are reviewed carefully, there are three that are monitored most closely.  The first is hemoglobin, which carries oxygen to cells throughout the body.  Low hemoglobin levels cause anemia, which in turn causes fatigue or weakness.  The normal range for hemoglobin is 13.7/17.3.  My level is 10.0 and if it drops below 9.0, they will probably give me a blood transfusion to boost my levels.  The second is platelet count, which is a measure of the blood's clotting capability.  The normal range is 150/450 and my count is 36 which means I am at risk for excessive bleeding.  Most likely I will receive an infusion of platelets in the next day or so.  Finally, there is the white blood cell count, which has a normal range of 3.2/9.8, and my level is 0.9.  White cells are cells of the immune system involved in defending the body against both infectious disease and foreign materials.  So at the present time I have essentially no immune system.

While all three of these are alarmingly low, they are also expected to be falling below normal levels.  In the next few days my white cell count will probably fall literally to zero.  All are the unfortunate casualties of the high dose chemotherapy treatments I received a week ago.  High dose chemotherapy is  more effect than standard chemotherapy at destroying cancer cells, but it also does so much damage to the bone marrow that the marrow cannot recover on it's own.  That is where the stem cell transplant 'rescues' the patient by providing healthy stem cells to begin rebuilding the bone marrow, which in turn begins producing new hemoglobin, platelets, white cells, etc.  But it takes time for the marrow to be rebuilt and new cells to begin being made.  In the meantime, the counts fall to very low levels.

One thing that I did not really understand until just recently was, if the high dose chemotherapy destroys fast growing cells (like cancer) and I received my last high dose treatment on Tuesday, followed on Wednesday by transplanting my stem cells, why wouldn't the chemo kill the stems cells too?  Good question, they said.  The answer is that the chemo itself attaches to the fast growing cells within the first 24 hours after being infused.  After that period, there is little 'active' chemo left in the system, most having already attached to cells and the actual destruction takes place over the next 1 to 5 days.  So when the stem cells are reintroduced into the blood stream, they are relatively safe and can begin their migration into the bone marrow to begin the rebuilding process.

While the rebuilding begins slowly, the destruction is in high gear, so for a short period of time the body can not replace cells as fast as they are being destroyed and the counts fall.  That is where I am right now, and that is why they watch you so very closely during this period.  Hopefully a week from now my counts will begin to recover, but in the meantime, please excuse me if I seem to go out of my way to avoid contact with other people, who carry potentially lethal 'bugs'.  But until my counts recover, that is the way it shall remain.

I sometimes go into far more detail here than most will find necessary, and this is probably one of my deeper excursions.  But I do find it very fascinating, and have received comments that some of you do so also.  Other than being tired all the time, a definite result of my low hemoglobin, I am doing amazingly well otherwise.  I continue to be blessed by being able to avoid most of the undesirable side effects of chemotherapy, and I continue to give the praise to my gracious Heavenly Father.  PTL!

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