Day +24. First Outpatient Treatment post BMT

Todd's first outpatient treatment appointment was at the Taussig Cancer Center this morning, October 10, 2014 at 8:15am. We didn't know what to expect at this appointment except they were going to do lab work to check his blood counts, magnesium level, potassium level, and Tacrolimus level. Tacrolimus is a immunosuppressant they have Todd on to help him from developing a serious case of Graft versus Host Disease. 

Our nurse introduced us to the treatment center and the treatment procedure when he comes in for a visit. First they took his vitals. No fever! This is always a praise. 

Then, they had to take his blood pressure sitting and then standing. If his blood pressure drops more than 20 points or if his pulse drops from sitting to standing they consider him dehydrated and they have to give him IV fluids. This was the case today. His blood pressure was 110/65 sitting but dropped to 90/50 when he stood up. 

She told him that the new requirement for liquid consumption is now 2- 2liters of water per day. This does not include any decaf coffee or tea either. He can count Gatorade and some juice in that total. 

They drew bloodwork and we were so happy to hear the results about 30 minutes later. Outpatient requirements or thresholds for counts are a bit more tough. Hemogloblin has to be over 9.0 instead of 8.0 to avoid a blood transfusion. Todd was at 9.5 today!  

His white count was 2,610; ANCs were at 1,680; and platelets were at 15,000. (So happy his marrow seems to be making enough!). 

It took about 2 hours to get his IV of fluids. By then his magnesium and potassium levels were back; both levels were within the acceptable ranges. Potassium was at 4.4   Infusions are given if levels are at 3.3 or less (normal is 3.5-5.0 mmol/L).  His magnesium was at 1.6. Infusion is given only if it is 1.3 or less. (Normal range 1.7-2.6 mg/dL). 

Todd's next appointment will be Monday. He will go through treatment screening again and receive anything he needs. He will also be getting a breathing treatment of Pentamidine to help prevent infections. The last one he had was done shortly after admission. He has to have this treatment as an extra precaution along with Amoxicillin since he can't take Bactrum (a suspected drug allergy).  He will also have his weekly appointment with his bone marrow transplant doctor. 

He has three appointments scheduled each week through the end of November. He will go down to two appointments per week in December.