Ask the Guy who is about to get a Stem Cell Transplant

What we’ve read is that the bones may undergo some healing, but that the lesions will always remain. My followup MRI from last month bears this out. No change was seen which is apparently a good thing (as opposed to worsening).

For those following along I had my Hickman Catheter installed last Wednesday and got a bunch of fluid overnight. Then I got a whopping dose of Cytoxan Thursday and continued aggressive hydration. I think I had a total of 12 bags of fluid from Wednesday night to Friday afternoon when I was sent home. I’ve been giving myself daily injections of Neupogen since then (to help stimulate more white cell and stem cell production) and having my bloodwork checked MWF. My white blood cells bottomed out on Wednesday and have not recovered much in the last two days. Fortunately, my red cells and platelets have been high enough not to need a transfusion. I am still scheduled for stem cell harvest first of next week, and the transfusion about 10 days after that.

Have you freaked out at all? Like, any “omg I have cancer, why me? What am I going to do!?” moments? Would you say being a doctor has helped you to avoid having as many of those moments as a layperson might?

No I haven’t freaked out at all. The only thoughts I really have regarding my mortality involve me not seeing my daughter grow up. I suppose having knowledge of treatments and remission rates may be helpful, but I’m just it the type of person to freak out in general. It would be hard to work in the ER with that mentality.

Bumpity bumpty bump.

How have you been doing???

Oh, thanks for reminding me! I could have sworn I posted while I was in the hospital, but I was kinda out of it for a while.

Anyway, I was admitted for my transplant on Feb 20. I had a big dose of Malphalan (mustard gas derivative) that day and I was given my stem cells 2 days later. From there it was a waiting game. My blood counts bottomed out the following Wednesday which was expected. I was on preventative antibiotics and antifungals during that time. Most transplant patients require transfusion of red cells and/or platelets, and I was no exception. Most also get a fever during the time their counts are low. In my case my fever was persistent despite having my antibiotics jacked up (Vanc and cefepime for those who are curious). There was one day where my temp was over 104F the whole day and would not come down, despite Tylenol (they dont give ibuprofen due to bleeding risk with low platelets). They wanted to put me on a cooling blanket, but they couldn’t find it. :rolleyes: So instead, I got packed in ice which didn’t do much except make me miserable.

And then I developed the bloody cough. CT scan showed a multilobar pneumonia. I was taken for bronchoscopy (this is a procedure where you get sedated and they run a flexible camera down into your lungs). Partly to clean things out but moreso to collect a washing to find out what was causing the infection. Turns out I had CMV (cytomegalovirus) which is very common and generally doesn’t cause much of a problem in healthy people but can be serious in immunocompromised folks (like me!).

So in the end I got several days of IV antivirals and turned the corner pretty quickly. I went home on day 16 I think with oral antivirals. I’ve been gradually getting my energy back over the last several weeks. My blood counts have not been improving as quickly as we would expect and turns out the oral antivirals can cause bone marrow suppression. So I stopped those a week early and things have been improving since. Actually yesterday was the first time my counts went up significantly.

I have my follow up bone marrow biopsy next Wednesday so hopefully everything will look good then. Interestingly I’ve lost almost all of my acquired immunity. So I’m no longer resistant to all the little cold and flu viruses that I’d been exposed to since I was a kid! I get to look forward to a year of runny nose and cough. Working in the ER and having a 2 year old at home will hopefully accelerate the process! I’ll also need to redo all of my childhood immunizations next year.

That’s crazy!

Here’s to a healthy and happy recovery, sniffles and all. :slight_smile:

What does this mean for any allergies you have?

I asked and apparently they don’t think there will be much of a change. My itchy eyes the last week attest to that fact. Pollen everywhere!

Well that’s no fun - you could at least get one nice unintentional positive side effect out of this, right?

Uh, just thought of something - did you have chicken pox? Could this trigger the re-emergence of the varicella early and cause shingles?

Yep, I’ll be on suppressive therapy for a year as well. 800mg of acyclovir twice a day. Freakin horse pill.

Hey, that’s where I work! :cool:

Yes, people, please sign up to be a volunteer marrow donor on our registry.

And I wish the OP well in his journey. Please keep us updated.

A columnist at our local newspaper was also diagnosed with MM about a year ago, and every once and a while a column will focus on his medical situation.

Hugs I’m glad you’re doing okay, USCDiver. :slight_smile:
And amused you were on Vancepime- the cop out answer for Medstudents (and some interns’ Pimping guesses) everywhere for when you absolutely positively have to kill every and any bug out there!

Thanks!

The follow up question should always be “what specific bugs are you worried about and which antibiotic covers which?” That’s the worst. It’s one thing to memorize which antibiotics go with which diagnoses, it’s another to remember why!

Good news. Congrats and thanks for the update.

The “Fuck Cancer” thread reminded me I needed to do an update here.

I had a bone marrow biopsy in late April, 60 days post-transplant and it was normal. No evidence of residual disease. So in myeloma parlance, I am in CR, Complete Remission.

I’ll be on daily oral supprssive chemo for the next few years and I’ll have periodic biopsies and bloodwork to monitor for recurrence but for now I am disease free and returning to work full time this weekend. It’s been 8 months since I worked full time, but I picked up a few shifts in May and I’m confident I’ll be able to handle the workload.

That’s wonderful! :slight_smile:

Hooray! Thank you for the update.

Woo-hoo!

Yes, thanks for the update - glad to know you’re in remission and getting back to work! :slight_smile:

I just read this thread today, I don’t know how I missed it before but HOOOOOOOOAH for the good news! :cool: