Day 28

Same song, different verse.

It's Friday, but half the time I can't keep up with what day it is. They just all run together. If I can figure out the date, though, I know what day, post transplant, it is. I had the transplant on September 1, so I just take the date minus one and get the post transplant day. Isn't math wonderful? In October I'll just add the date plus 30 (the number of days in September) and then take 1 away.

I'm here now in ATC getting my phoscarnet, magnesium sulfate, and immunoglobulin. The immunoglobulin is infused weekly on Friday's. The other stuff is daily.

I did get the day "off" yesterday. That only means that I didn't have to do bloodwork and I got the phoscarnet and magnesium via a pump that they hooked up in my room instead of having to sit/lay in a hospital bed for 4+ hours. I might get the weekend off, too.

They begin to give you a few days off after about 2 weeks of seeing you daily in the ATC. Once they see a stable pattern, they give you a few days off each week. But, again, "off" just means you get the infusions via pump on your own.

The counts are about the same. The white count continues to be a yo-yo, going up and down based upon the Neupogen shots. I just got another Neupogen shot just a minute ago, between paragraphs 2 and 3.

The red counts bounce a little bit within a fairly narrow range. They were actually down a little bit this morning as was the platelet count. But they should go back up over the next few days.

I found out this morning that the white counts may take a little longer to stabilize because I got Campath as one of the pre-transplant drugs. Campath is actually a monoclonal antibody, like Rituxan. Rituxan targets cells with the CD20 protein on the surface of the cells. Campath targets cells which have the CD52 protein. It's a little broader in effect because more cells have CD52 on them than CD20. Some healthy cells, in addition to diseased cells, have CD52 on them, so Campath kills some healthy as well as diseased cells.

Campath has worked well killing CLL cells in studies and has worked somewhat effectively on me in the past as well. Apparently Campath also inhibits GvHD, graft versus host disease. So the benefits are there. It will just take a little longer for the white count to stabilize and grow on it's own.

Michael, the PharmD, was telling me about these additional effects of Campath this morning. PharmD is short for pharmacy department. It's pronounced "farm D." Medicine has it's own lingo like this. Michael appears to stay in ATC all day. Amber was the PharmD on G11, the transplant floor in the hospital. She was quite a bit cuter than Michael. Amber is a Virginia Tech grad and Michael is a North Carolina grad. Small world. I'm trusting that they will take care of their ACC kin.

In addition to the PharmD, there is the APN, the advanced practice nurse. Then there is the floor nurse, which can vary day to day. And there is the doctor. Dr. Khouri is the doctor here. He is my main doctor in the BMT department. Together, they comprise "the team." Each patient has a "team" that keeps track of him. On G11, the team there had different members, of course. The doctor varied also, depending on who had "rounds" that week. They also had a few more folks on the team, like an extra doctor or two (maybe trainees) and an extra nurse or two. On G11 they would knock briefly and come into the room virtually unanounced. They caught me in my skivvies a time or two. There is no modesty in a hospital.

In the hospital the team was all female for a couple of weeks. Dr. Sphall wanted to hear the Tech fight song, to which I obliged. I unwittingly volunteered that there some "off color" versions of the fight song, too. After that, they were more interested in the off color versions than the real thing and insisted for several days that I sing the other versions. Being a gentleman, not to mention older and a little wiser than in years past, I steadfastly refused to sing the off color versions to all these women. This despite the fact that they threatened to drug me with additional Benadryl to make me comply.

Well the IV bags are getting closer to empty and so is my mind, so I'm off to read the sports page.