Engraftment

 

 

Good news today.  Kristina’s in the engraftment stage.  There’s still the Mucositis and all that goes with it, but the general trajectory is good.  With Cancer you need to grade on a curve, as A+ doesn’t really feel like A+, but if there was a silver lining a few days ago, the good news is clearer and backed my metrics today.

What, exactly, is engraftment?  So glad you asked.  The stem cells have found their way into Kristina’s bone marrow and are doing what they should be doing.  By the process we described earlier, they are starting to make good blood cells. 

Kristina’s blood counts are getting better.  Platelets, Crits, and those crime fighting Neutrophils are all up.  Neutrophils count is 510 for those of you keeping score at home.

She’s also getting prepared to leave the hospital on the 25^th or 26^th.  Her care team is weaning her off the TPN feeding tube (IV feeding that bypasses the digestive system) and getting the ‘ol esophagus back up and running.  First getting food down then keeping it down are the two goals.

They are also converting her meds to oral meds to ease her time at home.

Kristina also needs to build back some strength – walking around when she can.

All this while she’s still fatigued.  With limited energy she’s requesting ‘no visitors’, but in the case there is a visit, only one at a time.  Even talking on the phone takes effort and she needs to harness her strength.  She’s says she’s still pretty shaky.

Her childhood friend, Lizie, is coming in on the 25^th and will take the first stint at caregiving.  After she gets home, she’ll still need to visit Fred Hutch every day as they closely monitor her progress.

That’s it for this morning.  More news when there are developments.

 

Kristina texted this morning that her Neutrophil count had climbed to 410.  Surprising, perhaps shocking, but great news.

She's still requesting no visitors.  She does expect to be released from the hospital on or around the 25th and a long time friend from her youth is flying out from the east coast to take over care duties for the first couple of weeks.

She does, however, say she is feeling largely like crap, which, if I dare read between the lines, may be a small improvement.  but not much.  So Mucositis is still very much a thing with all the 'stuff' that goes with it.

Hopefully the symptoms will wane in the next few days as the blood counts improve.

Neutrophil Count at 190 and climbing

Kristina texted -- still no visitors, she's still dealing with Mucositis and all that entails.  Hopefully she'll start feeling better soon.

The good news is that the Neutrophil count is on a climb.  Previously she had warned it wouldn't be linear, but so far it's climbed every day.  A good sign.

Silver Lining

 I got a brief text from Kristina.  Still in the throes of Mucositis, vomiting and all.  But she noted a silver lining.  Her Neutrophil count.  40 on Thursday, 140 on Friday.  So even with all the misery, some positive news.  A silver lining.

Neutrophil Count at 40

 Kristina texted with the update that her Neutrophil count is at 40.  That's pretty low, but significantly better than zero or 'too low to count'.  It's a start.  It's a sign.  A good one.  

When I texted her back "Good start", I got four thumbs up in return.

She's still dealing with "all that other sh$&t" as a result of the chemo and is hoping it magically clears up.  

She is spending her days trying to sleep, but I suspect that's difficult.  

Short update today, but the positive news is that it sounds as if there are the first faint signs of cell recovery.

Tuesday August 15th. The deep dark hole after Chemo

 

Kristina knew the post transplant period could be intense, but I suspect she was hoping to dodge the worst of the complications.  She texted that she didn’t know it would be this intense. 

Right now she’s still fighting the after effects of Chemo with ‘Mucositis’ being one of the primary things she’s dealing with.

Mucositis causes mouth sores and inflammation of the digestive tract.  The symptoms are painful and miserable.  The sores can become an entry point for infection, and it’s already caused her care team to feed her via an IV, getting nutrients into her bypassing both the mouth and the entire digestive tract.

As the side effect is common, there’s a common trajectory that it takes.  It starts, spreads, then creates ulceration and inflammation and finally the cycle ends with healing.  The care team tries to manage pain and keep Kristina fed while the painful cycle takes its course.

Added to the problem was a hard sneeze she had earlier last week with a bite to the tongue.  Without platelets, blood clotting doesn’t happen and, well, it got pretty gross pretty quick.

Then there’s the ‘Chemo brain’ that sets in – the foggy feeling where it’s difficult to concentrate. 

So other than not being able to think clearly, or talk, being fed through an IV, things are, well, about what you’d expect.  She says she’s going through that “deep dark hole of chemo, mucositis, and everything else that goes with it.”

Her care team is confident that cell recovery will begin to take place in the next few days – usually between day 12 and day 28.  She’s at day 14.  Earlier she had hoped that she’d start feeling a little better by today but by the sounds of it, that hasn’t happened. 

It’s too early for graft vs host disease (GVHD), as that may happen when cells start to multiply. 

“GVHD” is where the immune cells from the donor attack the host, Kristina in this case.  It’s not a sure thing she’ll have some version of it, but four out of five non related donor patients are impacted.  The very treatment that introduces life saving and rather magical stem cells also introduces a small army of immune cells who take it upon themselves to attack the very patient that the stem cells are trying to save.  I’m sure that there’s a more technical way of putting it, but with cancer, it seems that every treatment comes with significant side effects that need to be managed.

So that’s where we are today.  At her request there have been no visitors, and for now (unless you hear it from her directly), that holds.

Send prayers and positive energy.

Friday Aug 11th. Still not feeling well

 

The emoji's above were all I got this morning.  Just these three.  I'll hang my hat on the last one.  The battle continues.

The team thinks the tide will turn on day 14, August 15th.  Hopefully then, just 4 days from now, she will start to feel better.