Day +5; Happy Mother's Day!

Today, despite the gray, snowy weather, was a better day.

My stomach issues seem to have stabilized and while they're not completely gone, they're a little better and that makes me happy.

I'm still pretty exhausted, but not worse than yesterday and maybe even a teeny bit better (helped by not having as bad of stomach issues, probably).

My counts continue to be low, but not precipitous. I didn't need potassium or magnesium or any blood products.

The lab tech was able to get blood (to check Tacro levels) on the first stick! My levels were on the high side, so they will decrease my dose and test again in three days (this is pretty typical).

I felt more productive overall today, participating in a Podcast club (Zoom), knitting quite a bit, walking, and doing Mother's Day dinner via Zoom with my family.

Greg also paid a visit to swap out clean vs. dirty clothes and waved to me out my window.

Cara gave me a cool cross stitch for Mother's Day and Ash drew a great Pokemon, Kangaskhan, who is a mom!

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During rounds, I pressed Dr. Shaw a bit more about the mechanics of the transplant and there were a few things that just kind of clicked for me in our discussion. A few people had asked how the transplant was done right after the chemo--didn't that knock out the new bone marrow? And I knew that there was a lag, but Dr. Shaw explained it more thoroughly.

Basically, chemo attacks rapidly dividing cells. That's cancer. It's also things like the lining of the GI tract (thus the mucositis), hair follicles (why I'll lose my hair again), etc. However, it doesn't attack "normal" cells that are not rapidly dividing. And the chemo is completed (with a one day break) before the transplant, so those cells are protected anyway. But there is a lag in the blood counts because the rapidly dividing cells that MAKE the blood cells are wiped out, while the mature cells are still in the body. The drop in counts is actually a lack of new cells being made because there's no marrow to make them. This happens about a week or so after the chemo has wiped out the cell-makers. That's where I am now. My mature blood cells that were in my body when I entered the hospital are reaching the end of their life cycle and dying off. There are no replacement cells (we hope) because the chemo killed off the leukemic bone marrow and nothing is being produced. It appears to be hitting my platelets first (they're at 17K and I'll need a transfusion at 10K). My hemoglobin is also dropping (it's at 8.5 and transfusions are at 7.0). The few remaining WBC and neutrophils are hanging on, but not at a level that's very protective. However, WBCs come back quicker, so that will be the first level we expect to see rising when my new bone marrow takes hold.

Dr. Shaw also explained that the reason that bone marrow is usually slower to make the full graft and get blood cell production up higher is not a difference in the cells per se, but a difference in the VOLUME of the transplant. If I were getting peripheral blood, they could theoretically keep cycling the blood through a machine and keep pulling out stem cells while the donors body would keep making more (they come out of all the marrow in the body). But because this came from marrow directly, they are limited by the volume (they don't drain from all the bones--I think only the hips). Fewer cells mean that they have to settle in, make more stem cells, and also do the work of making new blood cells. So to get to a point where there's enough new blood cells to have normal counts will necessarily take longer.

At any rate, all of this made sense, but it helped me to talk through the entire process with Dr. Shaw. I like to be able to visualize what is happening in my body and this made it a more smooth process instead of the disjointed bits I was previously picturing. In order to build more stem cells as quickly as possible, I need to be sure I'm providing the best building blocks possible (protein). I think I know how I'll fall asleep the rest of the time I'm in the hospital. I'm going to visualize my massive protein intake working to ensure that those new hematopoietic stem cells make themselves at home in every one of my bones! Welcome, new cells. We've waited so long for you!