Here's how it goes.
The transplant team escorts you into a private room via double-door entry; this room is for transplant patients only and each room has a separate, state-of-the-art hepa filter air purification system to reduce moisture and airborne pathogens.The team calls over to the Mayo Cellular Lab (2 blocks away) to order your stem cells, which have been previously processed and frozen (in John's case, back in December). After about 15 minutes, the bags of frozen cells are hand-delivered by a special technician who is responsible for defrosting them and transferring the bags one by one to the nurse team in the room. Our guy was Steve, a PhD in chemistry/biology who was one incredibly smart dude. Steve, however, never enters the room. He sits outside the room at a special monitor that is attached to the defrosting unit, watching through a double set of windows for the signal from the nurse that another bag is needed.
This is a highly choreographed process. In John's case, there were five bags. These arrive in a cooler much like you would take to the beach for a picnic. Your name and other specific information appears on the labels on each bag, and this info is double-checked against their central data bank to verify everything. The bags are relatively small, and as each one is emptied, a new one is passed in. The actual infusion of the stem cells directly into your heart through a central port takes about an hour or so. After infusion in complete, you are free to go, as this is all done on an outpatient basis.
Piece of cake, right? Well, you all know it took 10 long months to get to this point, so that was no easy thing! And there was a last-minute glitch on the day of transplant that almost took us off the schedule yet again, but in the end only delayed us from our scheduled start time of 1 p.m. to 6 p.m. Did we care? No! We were just so glad to finally reach our goal.
The complex process that then begins is amazing. The chemo basically kills all the blood cells in your bone marrow, but now regeneration takes place, ever so slowly. The stem cells which have been infused take a few days to find their way from the bloodstream to the bone marrow. Once in the bone marrow, they begin to create brand new blood cells, differentiating into the various types of blood cells that are needed by the body. The white blood cell count (WBC) comes back first, and the most critical of the white blood cells for repair are the neutrophils. Post transplant the WBC count goes down to .1. Transplant day is known as Day Zero, and at Day 11, John's neutrophils began to regenerate to the point of being measureable. They continue to increase every day. If you have a .5 increase for three days in a row, you are said to have achieved "engraftment." That is the term for the stem cells settling into the bone marrow and creating new cells. It means you are on the path to recovery, yet full recovery of the various types of blood cells, both white and red, takes about a year. That John achieved engraftment on Day 11, basically right on schedule, was the best news we could have heard and the doctors were very happy. We have hiked to base camp, but we still have Mt. Everest to climb.
Post transplant, even though John is rebuilding his blood from the ground up, he has no immune system and must wear a mask at all times except when he is in our room here at the Transplant House. Since his blood cells will be new, he no longer has any immunity to the diseases he has been exposed to during his life, thus when we come back for the one-year checkup, he will be immunized for all major diseases at once. They do not want to do that prior to one year, as the blood cells are not fully mature until that time.
Currently John is dealing with the very significant issues following chemo, which I will not go into here. His very low blood pressure is a constant challenge to the medical team, but he is being monitored very closely and hopefully he will be feeling better soon.
Well, friends, sorry for the extra long entry. Days are long and very busy and it is hard to find time to blog. As a side note, anyone wishing to see various photos of our transplant day can email me and I will gladly share.
We think of you all often and thank you for the cards, emails and phone calls. As we have said before, we are forever grateful for the love we share with our friends and family. And as for the incredible Mayo Clinic and Gift of Life Transplant House, there are no words to express our gratitude. More on the amazing people here at a later date!
Bye for now!
