Back In and Back Out
6/15/2022
On Day +13, Ian was readmitted to the hospital due to the dreaded symptom of mucositis, which made swallowing terribly painful. The nurses welcomed us back with little surprise – most transplant patients return for something! Over the next few days, Ian was able to get all of his meds through IV. He was up to six IV pumps and a double-decker tower! He had an on-demand pain pump, which helped him swallow enough Gatorade and Jello to stay off IV feeding. During this period of neutropenia (zero white cells), he also ran a low fever, which is par for the course. To our surprise and delight, his fever never got high, like in previous chemos. More concerning was when the four incisions from his gallbladder surgery became inflamed inside and out, prompting daily visits from surgeons. They believe that the rash and swelling were caused by the return of Ian’s white blood cells. White cells play a key role in wound repair, so when they reappeared, they headed straight back to the incisions to finish the job! Thankfully, the inflammation reversed course with a new antibiotic. And as his white count slowly raised, the mucositis also began to heal, making eating more tolerable.
The return of white blood cells (after being knocked to zero by the chemo) is a major milestone in a stem cell transplant. It means that: 1) risk of infection is greatly reduced, and 2) the donor stem cells have found their way to the recipient’s bone marrow and are beginning to mature and multiply into healthy blood cells. The white cells recover first, followed by the red cells, and lastly the platelets. It takes several weeks for the new cells to fully “engraft” and blood counts to return to their normal levels. Unfortunately, a symptom of engraftment is severe fatigue and it has shown no mercy on Ian. For a few days, he was completely exhausted and slept a lot. Beyond his body, his spirit seemed tired too. In progress, lies sacrifice.
On June 15, after 7 nights in the hospital, Ian was deemed fit for discharge. Regardless of fatigue, all other symptoms were clearing, so treatment could continue via the out-patient clinic – and this time, with only one IV pump in tow. To give you some stats, when Ian left the hospital on Day +20 his basic blood counts were: White 2.4 (normal is 4.5-10); Hemoglobin 8.4 (normal is 13-17); Platelets 28 (normal is 150-400). Ian will continue to get blood and platelet transfusions until his counts recover (so ya’ll get out there and donate!).
