Dispatches from TransplantLand: Day +9 (We Receive Some Excellent News)

This morning's blood tests show Beth's white blood cell count headed back up. It's still extremely low, .2 (times ten to the ninth power), but for the past two days it has been less than .1 (normal range 3.2-9.8). The normal course of a stem cell transplant is to have high-dose chemotherapy, followed the next day (or two days, as in my sister's case) by the infusion of the stem cells. Over the next few days, the white blood cell count starts downward until it gets to below .1, usually around day 10. Sometime about 48-72 hours after this nadir, with the help of daily injections of Neupogen to stimulate the bone marrow's production of white blood cells, the white count should begin to go steadily up until the stem cells have engrafted. Then we can go home. I've hugely oversimplified this explanation, just to give the general idea.

Now that she has hit the bottom of the WBC curve and is headed back up, I can start to breathe a little sigh of relief. The scariest part of being a caregiver is being responsible for keeping the environment clean enough for somebody with a severely impaired immune system. First it's the handwashing. Remembering to wash my hands before I touch anything, then wash them again after I touch anything, then jump down, turn around, wash my hands again. Then there's following a neutropenic diet, washing all the food, cooking it really well, and scouring the kitchen counters every time something touches them, trying to keep all bacteria away from her. She is taking Cipro antibiotic prophylactically, but I need to be hypervigilant about cleanliness. Fortunately, hypervigilance is something I have years of experience with. Just tell me what I have to watch out for and I'm on it.

Taking care of somebody who has neutropenia is a lot like having a newborn baby in the house. I had flashbacks to boiling baby bottles and paraphernalia, washing hands constantly, keeping people with colds away, etc. I guess there is some resemblance between a newborn's undeveloped immune system and a post-chemo patient's destroyed one.

One annoyance is that the company with which Duke contracts to provide housing for outpatient transplants didn't tell us that their cleaning service is bi-weekly. That means only every OTHER week, which seems bizarre for cancer patients. I only found this out on Tuesday when I called to say that we had been here a week and not had any housekeeping services. Why provide any service at all if it's not going to be at least weekly? I'd been keeping the kitchen clean, but I hadn't done any vacuuming, nor had I cleaned bathrooms. If necessary, I certainly would have done the cleaning, but Beth called a friend who is in the cleaning business and she came on Wednesday.

We're not out of the woods yet, but so far things are right on schedule, or even a day ahead. She hasn't had any fevers or major side effects other than extreme fatigue and some mucusitis. Those should begin to diminish as her counts go up.

Thank you to everyone who has sent their good wishes and prayers. If you feel inclined to help in a more tangible way, you can make a donation to the International Myeloma Foundation to support research and patient support. Be sure to say it's in honor of Beth Morgan's Stem Cell Transplant.