Day Minus Four

Yeah, so eff cancer. That’s my attitude tonight.

Here’s Dad’s Stem Cell Transplant process (to the best of my understanding):

  1. First, you should know that stem cells are badass. They start as general cells, and then when they divide, some of them stay stem cells, and others of them develop into other kinds of cells—including red blood cells.
  2. Dad’s stem cells went wonky and don’t produce enough good red blood cells. So he needs new ones.
  3. In some types of cancer, people can actually have their own stem cells harvested, cleaned up, and put back in. (The technical term for that is autologous, and my explanation of it is remarkably non-medical. So please don’t try to impress your friends with it.)
  4. An autologous transplant wasn’t going to work for my dad, so Siteman found him a donor, who happens to be a young man in Europe, through Be The Match. This is called an allogeneic transplant.
  5. To make sure dad’s immune system plays nice with the donor cells, part of the treatment is, well, destroying his immune system. In other words, they want to remove the possibility of Dad’s body saying to those pretty new cells, “Duuuuuuude! Who the hell are you? Get the eff outta here!” (The technical term for that is graft-versus-host-disease, or GVHD. Obviously, this is also a ridiculous explanation, but it’s the best I have to offer.)
  6. In addition to suppressing his immune system, it’s important to get rid of any remaining malfunctioning stem cells before the new ones go in.
  7. So, one week before the transplant, otherwise known as Day -7, they began giving Dad all sorts of nasty medicine. On -7, -6, and -5, he got Fludarabine (Flu), a chemotherapy medication. Today, -4, they added Busulfan (Bu), another chemo med. Dad’s tolerated those two drugs remkarably well.
  8. HOWEVER. Today they also started him on an immunosuppressant (see #5) called Thymoglobulin (Thymo). It’s incredibly unfriendly stuff. When I left for a walk, Dad had been on the Thymo drip for a couple of hours, and he was totally perky, had just finished a piece of pizza, and was all smiles. When I returned 90ish minutes later, he was on oxygen, was covered in a pile of blankets, had a wicked headache, and was completely ashen.
  9. Which is the exact moment I flipped his cancer the bird for the first time.
  10. Mom and I stuck around for another couple of hours, and in that time, Dad’s blood pressure dropped and he developed a fever. This is all perfectly normal. They expect his body to react this way.
  11. Still, they want to make sure he hasn’t developed an infection, so they did some blood work and a chest xray and a urine test. And because his fever was all hold my beer they decided to start him on IV antibiotics. Just in case. Even though they’re quite sure it’s all just that damn Thymo.
  12. Thymo and I have a love-hate relationship at this point, of course. It’s evil, but it’s also prepping Dad’s body to accept his donor’s cells—which will save his life. Soooooo, eff you Thymo I love you so much.
  13. In the meantime, we had to get back to the house to relieve my canine brothers. It’s not easy to leave under these circumstances. But, Dad texted a bit ago and it appears he’s turned the corner: BP’s coming back up, fever’s gone, headache’s better. Whew.
  14. Tomorrow is Day -3, which brings more Flu, Bu, and Thymo.  Day -2 and Day -1 are nothin’ but Thymo. By the end of that mess, his blood counts will be in the toilet. All of them. The concern at this point will be infection (no immune system) and bleeding (no platelets).
  15. Thursday, Day Zero, it’s nothing but stem cells. The whole procedure takes about 10 minutes. We won’t know what time the transplant will actually happen until Thursday morning, because it will depend on what time the flight arrives. What flight? The one with his donor’s stem cells on it. From Europe. Amazing. 
  16. Then we wait for two or three weeks for the new cells to start doing their job. <—- This part is way more complicated than that, but it feels like it’s so far into the future I can’t really think about it tonight.

And that’s that. Colonel T’s Stem Cell Transplant in 16 Easy Steps. Any questions?