Hard Graft

It has been a long time since my last post, Baby Talk Part Two,, 4 months in fact which was just before I was about to go into hospital for my cord blood transplant. Since then, I have not really felt like writing a post due to a combination of depression and fatigue, nor at times have I been physically able to do so. So much has happened in these 4 months that if I wrote about it in one post it would be far too long and boring, even I will concede that! So I will break down the updates into mile stones starting with my time in hospital and then do some further updates very shortly, except to say I’m still here and doing reasonably well day 111 post transplant!

My time in hospital was extremely tough going both mentally and physically, far tougher than I had anticipated.  When I signed the consent forms and was told that I would spend 4 to 6 weeks in hospital, what the side effects were and complications that might arise, it didn’t really sink in what the reality would be, how could it? I was admitted on Friday 20 March as planned and started my chemotherapy conditioning regime the same day, that was day -6, more chemo days -5 to -2 and then off to Christie’s by taxi on day -1 for total body irradiation. During that short trip I had my only glimpse of the outside world, the sky, the fruiting trees in Whitworth Park and Platt Fields park brimming with pink and white blossom in their full frothy glory. And that was really all I saw of the lovely spring we had as my room did not have an outside view, as you can see. I had those self pitying thoughts that creep up on me occasionally about why me, life’s not fair, why can’t I be like those people walking in the park, enjoying the sunshine, NORMAL HEALTHY PEOPLE!

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The purpose of the chemo and the radiation I had was to wipe out my bone marrow so it wouldn’t reject the new cord blood stem cells. On the 26th March I received cord blood stem cells from an Australian male and the other from a UK female by two simple injections into my Hickman line, one of them would hopefully eventually replace my immune system. No big deal in terms of the actual procedure but a huge deal in terms of the consequences.

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Now it was a question of waiting for my neutrophils to go to zero which would mean my bone marrow had been wiped out and the cord blood stem cells to engraft which I was told could take around 3 weeks during which time I would need to remain in hospital because I would be neutropenic and at high risk of infection. The first week passed fairly quickly as there was a lot going on and I wasn’t feeling any side effects from the chemo yet. I had quite a few visitors, tried to stay active within the confines of my room and was given antibiotics for a low temperature which the docs said could be a sign of infection as much as a high temperature. No infection was identified which is quite usual but antibiotics are given at the slightest whiff of infection as a precautionary measure.

The next 10 to 11 days  the side effects kicked in, nausea, vomiting, diarrhoea, fatigue, boredom, lack of appetite (especially with the disgusting hospital food on offer). I couldn’t concentrate on anything due to fatigue but I couldn’t sleep during the day due to the constant interruptions of nursing and support staff entering the room.  I also got a skin rash on my body which the docs seemed to think might be graft versus host disease (when the donor’s immune system attacks the recipients body). I was on drips all the time for this or that and occasionally oxygen because of low saturation levels. It was much harder than I imagined and harder than the two previous transplants I had using my own stem cells. I felt extremely low and started to question whether I had made the right decision although it was clearly too late to change my mind. I wondered how I was going to cope mentally with another couple of weeks in hospital. I couldn’t be bothered to get out of bed most of the time or watch all those TV box sets I had brought in with me or have visitors.  Looking back now it all seems like a horrible blur. My concept of time altered and time as I knew it didn’t exist. The days were long and passed slowly blending into the nights but the weeks were short. Time to me was defined by the daily routine of being in hospital, the regular observations, my bloods being taken, the cleaning staff coming in to their jobs, the tea trolley rounds, meal times, doctors visits, medication times and visiting times.

Then on day 15 post transplant after three weeks in hospital, a ward doctor told me I could go home as my neutrophils were more than one so I wasn’t neutropenic and the cord blood stem cells had engrafted. I was somewhat surprised as my consultant who was on holiday that week had said I would take around 3 weeks for engraftment and she would see me next week. Anyway I wasn’t going to argue and  feeling pleased to be going home off I eventually went with my mum and my sister. The next day following a high temperature during the night I was admitted via the day unit to a different general medical ward having lost my room on the haematology ward and pumped full of antibiotics for a suspected infection which was never identified. I was also neutropenic again. I felt frustrated that I had clearly been discharged too soon and was back in unprepared for a further stay in hospital. After a night or maybe two a room was found for me on Ward 44 where I remained  for a further week and two days until my temperature stabilised and I was no longer neutropenic. During this time I received a platelet top up and suffered anaphylactic shock, a severe reaction to the platelets which caused a rapid swelling of the throat and puffy itchy face and eyes. I pressed the buzzer and the young nurse that was looking after me eventually came and didn’t seem to know what to do when I told her what was going on. She told the support assistant to take my blood pressure, saying she would have to get my drug chart which was downstairs. I told her to get the doctor urgently as I could hardly breathe due to the swelling in my throat and a couple of minutes later the doctor came along with several other nurses.  I can’t remember what I was given other than oxygen but I gradually improved. I found this very scary as I could see from the look on the doctor’s face that she was worried. Ironic that my life threatening experience was not caused by the transplant procedure but by a routine platelets top up!

Finally home on 19 April I began the routine of twice weekly clinic appointments to check my bloods etc. I had another allergic reaction to platelets in the day unit even though I had been given what is called cover as a prophylactic to prevent this though it was dealt with much more quickly this time. Fortunately I have not needed anymore since then. I was weak and tired during this time, slept a lot and struggled to eat due to lack of appetite and feeling sick all the time. I felt depressed and anxious, and didn’t feel ready to have any visitors other than my parents who were staying to look after me.

Two weeks later I was off to hospital again in the middle of the night via A&E with a high temperature, diarrhoea and pain in my kidneys. I was pumped full of IV antibiotics, put on a saline drip and admitted to the acute medical unit. The temperature settled but then my consultant became quite concerned about the skin rash over my legs, arms and torso which was getting worse. She said it was definitely acute skin GVHD. I had to stay in another couple of days to have high dose IV Prednisolone, a corticosteroid similar to Dexamethasone which I have mentioned many times on this blog and not in a good way!

I was discharged 6 days later on May 7th, general election day in the UK, got home about 9pm and then went straight to the polling station to vote, not that it made any difference to the outcome.  After a total of 5 weeks in hospital began the long process of recovery. I was told that the new stem cells had engrafted and I had 30% donor cells which was an excellent start so soon after the transplant, but it was a bloody hard graft!