Day Plus Sixteen

Dad’s home. It’s so good. And it’s a little scary.

It’s good for obvious reasons: Stem cell transplant patients aren’t discharged until there’s evidence their new cells have punched their timecards and gone to work (i.e., engrafted). There’s gobs of evidence in Dad’s case, and it happened in what feels like record time. (Surprise-surprise, the retired USAF Colonel’s an over-achiever.) For real, though: His WBC is up. His ANC is WAY up. His platelets are up. His RBC stayed constant (which is a notable improvement). His HCT is even up, which isn’t supposed to happen so soon.

It’s scary for obvious reasons, too: Dad’s no longer in a semi-controlled environment where medical professionals are checking in on him every hour or two. He has to monitor his own temp and fluid intake. He has to keep an eye on his rash, and there are no nurses to say, “Yep, that’s a rash. Doesn’t look like GvH. Here’s some cream. Not to worry.” He has to keep track of his array of medications, and he has to make sure not to take anything else. Not for a headache. Not for joint pain. Nothing. He has to be disciplined enough to stay out of the sun and stay in a terribly uncomfortable N-95 mask if he leaves the house.

And, let’s be honest, the reason all of this is scary involves a high risk of infections and the very real possibility of Graft vs. Host Disease (GvH). Most people who receive stem cells, especially from an unrelated donor, will develop some form of GvH at some point:

  1. Acute (within the first 100 days post-transplant)
  2. Chronic (anytime after that)
  3. Both
  4. Neither

Some people experience mild GvH. Some experience severe forms. Like, really severe. How big a deal is severe GvH, you ask? Big. Youge. During Dad’s discharge meeting yesterday, he received a page-turner called Graft Versus Host Disease: Living with the After Effects of Bone Marrow/Stem Cell Transplant. He stopped reading about a quarter-way through its 126 pages. “If they gave people this before their transplants, they probably wouldn’t go through with it.” And then he addressed Mom: “Do not read that book. I mean it.”

Obviously, we’re keeping our fingers crossed, praying, and sending mad juju into the universe that Dad’s over-achiever-ness results in Option D, rather than Option C. I hope you’ll join us.