And now we rest!

Nathan's four day round of chemotherapy pre-conditioning is over! Now he has two days of rest before his transplant day on Monday. I was really worried about how he would feel on chemo but it really wasn't as bad as I had thought it would be. He had lots of ups and downs for sure but it seemed the first two days were the hardest on him. He mostly slept a lot and had a few intermittent bouts of diarrhea and some vomiting too. On days three and four, he began to perk up and feel a bit better so I hope these two rest days will give him the strength he needs for the next part of his journey. The post-transplant effects are highly variable. He can feel great and have very few of relatively minor issues or he can have a whole host of complications in the forms of serious graft-versus-host disease and delayed chemotherapy side effects. The next month will be critical. I am nervous yet also very excited.

A few people have asked what medications he is on and I will warn that it is a very long and intimidating list, and I am likely forgetting at least a couple medications as it is very difficult to keep track of the daily changes. I am guessing these words won't mean anything to most people except maybe those in the medical field or other BMT patients. His chemotherapy medications over these past four days were Fludarabene, Cytoxan and R-ATG. To support his body through the chemotherapy phase, he also was given Decidron which is a steroid that reduces his risk of reacting to the ATG as well as Benadryl for the same purpose and Mesna to protect his bladder. All of those medications are done now but he is continuing on a high dose of Tacrolimus (similar to Cyclosporine) to suppress his t-cells so they do not attack the new stem cells upon transplant. In addition to these key conditioning medicines, there is a whole host of medicines that he will continue on in order to manage side effects and reduce the risk of infections and viruses while his immune system is suppressed. These include antibiotics (Pipercillin-Zosan), antifungals (Micafungin), antivirals (Acyclovir), antacids (Lansoprazol and Ranitidine), Zofran for nausea, Amlodopine and Enalapril to control his blood pressure, Ursidiol to support his gallbladder, Hydrocortisone to support his adrenals through the transplant, Heparin to protect his liver and a high level of IV fluid maintenance with supplemental magnesium and potassium added. Soon he will begin new medications to address any post-transplant complications and also reduce the risks of various other effects... namely Methotrexate to prevent GVHD, Rituximab to prevent EBV and periodic IVIG transfusions to boost his immune system. Unfortunately both methotrexate and Rituximab are considered chemo drugs, albeit without the traditional chemo effects and in significantly lower doses in this case, but still our time with chemo isn't quite over yet. And then there are all of the unknowns post transplant that will have to be controlled for as issues arise. It's overwhelming to think of this list of complications and medications but it is what it is and all of it is temporary. Suffice it to say, a bone marrow transplant is kind of a big deal.