Day 13: Engraftment

Okay. Today is actually Day 15 (16 by the time many of you read this), but the first signs of engraftment showed up on Sunday, Day 13. We've just been too tired and busy to blog about it. With the help of GCSF (white blood cell boosting drug), his ANC has jumped up above 2000. He'll continue to get GCSF for a day or two and then he'll be on his own. His counts will drop, but we're hoping his body can keep his ANC>500 on its own.

What's engraftment?

• It means the stem cells found their way back to the marrow space, attached themselves to the bone and replicated themselves enough to fill the space and then start to produce the daughter cells (white and red blood cells, platelets). Think of it like a factory (the bone marrow space). You have to spend time hiring employees (stem cells) to fill the factory. When you have enough employees you can start production on your product list (white and red blood cells, platelets). Over time, the employees become stronger and more efficient and can more easily negotiate production malfunctions (need for transfusions, infections).
  

Does this mean the transplant was a success?

• Yes and no. This is great news that the stem cells are showing signs of production. However, the transplant won't be deemed successful for about a year or so. There are a lot of different cells involved (i.e. B and T cells) and these don't begin to recover for 3-6 months. Different cells fight off different things. Radiation treatment will also prevent some cells from recovering during that treatment period. William's immune system will be quite fragile for about a year and we will all live a life with varying precautions and restrictions during this time. Of course, these will ease up as time progresses.

When does he get to come home?

• We are anticipating a Tuesday, the 22nd, discharge. It was to be Monday, but since it's a holiday.... (We have this thing with delayed discharges and/or delayed test results during Monday holidays!!!)
• Coordination for home health to deliver medications and supplies and provide a nurse to do the I.V. pump orientation is a bit of a headache, but we're excited and beginning the countdown.
• Let the serious house sanitizing process begin!
  

Checklist for Discharge

• No pain meds---check. PCA (morphine button) removed today.
• Zofran only administered as needed---check.
• Other various medications discontinued---check.
  
• ANC>500 for 3 consecutive days.
• Eating and drinking. I.V. nutrition to be discontinued tomorrow and hopefully the appetite will return.
  

Thanks for all the letters, pictures, Valentines! He loves them and loves the daily mail delivery. We've taped all his cards on the window and it makes his room so cheery. I'll post a picture soon. Actually, I have several pictures to post if I can just get into a better routine of blogging before it's late and I'm exhausted.