Wednesday, 20 July 2011

The Countdown Begins

It is now, more than ever, clear to me that cell harvest is the fun part of this transplant business. That was taking helpful stuff out of my body.

The next stage will involve mass invasion of my system by four different chemo agents, all of them sounding perfectly horrible and the final one being described to me as "particularly hard-hitting". Their point of entry will be a line fed up my arm and into a vein in my upper chest, known as a "PICC line".

The drugs will be administered over six days and on the seventh day the previously harvested stem cells will be sent down the same line to begin the process of rescuing me from the ravages that will have been set in action by the chemo. While this is going on the NHS will be putting me and my wife up in a hotel only a short distance from the hospital. The reason for this is not, as one newspaper has recently alleged, in order that public money may be wasted on needless luxury. It will in fact be cheaper than providing a hospital bed and have the added benefit of enabling me to feel like a normal member of society for just a while longer. This stage is termed "ambulatory care".

Around day seven, although timing is unpredictable in these things, I will not be feeling like ambulating very far at all. The chemo will have laid waste to my bone marrow, stripping out uncountable multitudes of cells, both good and bad. The crucial consequence is that, quite apart from the immediate side effects of the drugs themselves-hair loss, nausea, fatigue and so on-my immune system will be pretty useless and I will be neutropenic, vulnerable, not only to infections from outside and therefore needing to be isolated, but also, and more disturbingly, from bugs that inhabit my frame all the time but which are kept at bay by the immune system. My defences will be down and the little so-and-sos will take advantage, helped by the fact that the drugs will have damaged a lot of the physical barriers within the body that normally prevent the travel of infectious agents to places where they do mischief. The last drug, melphalan, damages the lining of the digestive tract from top to bottom (yes, "bottom" as in rear end) causing mouth soreness and ulcers as well as diarrhoea.

Flash had never before encountered anything with the power of the evil Melphalan

At a suitable point around the end of the first week, therefore, I will abandon the comforts of four-star accommodation and take up temporary residence in the hospital. Typically the hospital stay is two weeks or slightly more and the first seven days are the worst, as the stem cells will need some time to begin restoring normal blood production, including those components of the blood that deal with infection. I have no idea what this period will be like but it will not be nice and infections are guaranteed, so microbiologists will be on hand to perform tests to identify possible infectious agents and head them off at the pass with a battery of tailored antibiotic regimes. I will not feel like doing very much at all and blogging is likely to fall by the wayside.

By the second week in hospital I should start to feel better, assuming I am not one of the unfortunate five percent who have to go into intensive care (septicaemia being the likely cause). Once my immune system has recovered sufficiently I will be discharged home, to be monitored in frequent outpatient appointments. I will not be back at work until after Christmas at the earliest.

Yesterday my wife and I were given the date when all this is due to start: 10 August. I finish work this week and we then have a holiday. In six weeks or so, if I come through as well as I am told I have a reasonable chance of doing, given my present good health, the worst should be behind me. My head is bowed and I just want to get on with it.

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