Discharge Date Set as Platelets go to 13,000: October 8, 2014

Before leaving the hospital last night to go spend the night at the hotel, I put my hand on Todd and said a prayer that his platelets would come up today.

"I do set my bow in the cloud, and it shall be for a token of a covenant between me and the earth." Genesis 9:13

Day +21, October 7, 2014  Total Days in the hospital: 30

I gave praise when he texted me this morning saying: 13,000!  What an answer to prayer!  His other counts were steady even though his white count had dropped slightly to 1,070 from 1,810.   No transfusions were needed at all today!

Last night he did have a couple bouts of loose stools and he took 2 Imodium tablets to help.  This caused a bit of concern today when the doctors came by during their rounds.  While Todd has not had a fever, they are still cautious about any type of infection or Graft versus Host of the intestines.  They don't want to discharge a patient with an infection, only to have to bring them right back in for re-admission. So, today they were just going to keep an eye on it. They decided that he would get an IV bag of Neupogen, a medication which helps stimulate the bone marrow to increase the production of neutrophils (what I refer to as ANCs)  in white blood cells. 

The discharge papers were prepared and Todd's bone marrow transplant nurse coordinator stopped by to discuss the discharge process tomorrow.  So far, Todd has not had any diarrhea or loose stools today.  He walked a mile in the halls and ate two full meals and a banana for breakfast today.  This is the most he has ate in a single day since the chemotherapy.  He has lost a lot of body hair, but has just started loosing some of the hair on his head this week.   Overall  he is very healthy and they are not concerned about the 20 pounds he has lost from lack of appetite. 

We had to compare our own thermometer and blood pressure cuff to that of the hospital, so we could check their accuracy.  I had to show the nurse I knew how to change his Hickman Central Venous Catheter dressing and flush his lines.  We discussed diet, symptoms, and how and when to call or take him to the emergency room if there is a concern. 

He noticed a small patch of red irritation on his left arm after his nap this afternoon.  The nurses have made a note of it and we all have to keep an eye on it in case he is developing Graft versus Host of the skin.  Her first reaction was, a little Graft versus Host isn't a bad thing.  While I have blogged about GvH and have mentioned it numerous times as something that is bad, there is truth in the nurse's statement.  This is called the Graft versus Cancer Effect.  Essentially, if any of Todd's bone marrow survived the chemotherapy, it can be attacked by the newly grafted bone marrow that came from his brother.  Todd's new bone marrow will think the old bone marrow is an invader and work to kill it, keeping the chance of relapse to a minimum.  As a matter of fact, they will periodically test to see how much of Todd's blood cells are from his old marrow versus the new.  The doctors can then manipulate the amount of immunosuppressants they give him to increase the Graft versus Cancer Effect if they feel there is too many cells from the old marrow that has survived.  This effect will work to eliminate or keep those cells to a insignificant trace.

I brought a small suitcase today to start packing up some things to take back to the hotel tonight.  Tomorrow will be a busy day.  We will need to finish packing up, meet with the pharmacists who will go over all the medications Todd will be taking on a daily basis, go over discharge instructions with the nurses and the nurse coordinator, and say our goodbyes to everyone, etc.  We already have a three page schedule of appointments set for the next three months to put in our calendar!  Finally, I can drive him back to the hotel and get him settled in.  By then, he will likely need a nap!