My Bone Marrow Transplant: Day -4

LOCATION: Vanderbilt University Hospital - Stem Cell Unit
DATE: 8.10.12      DAY: -4
MOOD: Very mellow in the morning; in a good mood and high spirits.
MENTAL STATE: Fuzzy from the lack of sleep.  I notice I mentally struggled to form sentences to ask any questions I had and to concentrate on my pronunciation. 
PHYSICAL STATE: No headache in the morning.  Arms and legs began to swell and felt as though they were falling asleep.  Nurses believed it was because I was so full of fluids and the 2 units of blood I received in earlier that morning.  Developed a face rash around 7:00p that evening. Felt like a sunburn.

Side affects, side affects, side effects.  That what was on my mind during and after the chemo treatment from the night before.   If side affects don't happen immediately or during a chemo treatment they may show up a day later.  One major side affect of Cytoxan is blood in the urine.  The premeds I was given before the Cytoxan included a drug to help prevent bladder damage (Mesna) and after the chemo ended around 12:30a I was given Lasix, an IV drug that makes you want to pee.  It worked REALLY well.  All the fluid they had pumped into me decided to make its grand exit in wee morning of Day - 4.  Urine samples were to be taken every for hours at 2, 6, and 10a.  I was wide awake for the two o'clock meeting.  Around 2:30p I asked for an Ambian to help me sleep.  Didn't help.  Because my blood counts were so low, I needed to receive 2 units of blood.  Premeds for the blood transfusions were given at 4:00a and they included Tylenol and a small dose of Benadryl.  The sleep fairies swatted the Benadryl away with a twitch of their wings because all I felt was a nice warm fuzz.    Day -4 did not start off with me as rested as I had hoped. Obviously, getting up to go pee a lot didn't help my attempts to fall asleep and I was also told the steroids I was on could deprive patients of their rest - let's blame it on them, shall we?

I was extremely exhausted, drugged, and fuzzy-headed but just could not go to sleep. I did not hurt or have any pain after the chemo finished and thankfully no blood in the urine either. Way to go bladder!   At 4:15a, my vitals were taken by a Care Partner and taken again by my RN at 4:35a right before she started the blood transfusion.  Blood transfusions last a good 1 and half hour or so depending on the rate the pump is set to release it into your body.  Last pee break for the night was around 4:45a and I believe I finally fell asleep sometime after 5:00a and slept until a little past seven.  Shift change for the medical professionals occurs at 7:00 everyday so all the new nurses and doctors introduced themselves.  Around 7:30a, the attending physician, Dr. Savani, popped in along with his fellow, an LPN, and the social worker to see how I was doing.  A-okay.  No questions.

By 8:00a, I knew sleeping was futile.  Breakfast came and was not at all what I had ordered the night before.  The nurses warned me that the nutrition department struggled to get orders correct and that I should inform them when my order was wrong.  Ten minutes after I reported the error, my correct breakfast was brought to me and I raised my glass of milk to Vanderbilt and saluted.  Around 9:00a, the numbness in my legs and arms became worse and I assumed I had just been in bed too long and needed some exercise.  The stem cell unit is in a square shape with all the rooms along the outside of the square, a hallway in the middle and the nurses stations in the center.  Patients are encourage to walk daily so I put on my walking shoes and hot footed it out of my room.  I walked for 30 minutes from 9:25a - 9:55a and made 31 laps.  Not too shabby after the rotten night I had before.  At 11:00a I was given a small under the skin shot to check for possible reactions to the Thymo chemo I would start around noon.  The chemo for today is like the ATG (Atgam) I had in the fall of 2011.  Thymo is derived from rabbits and Atgam is derived from horses.  I experienced a bad case of serum sickness with the Atgam (see my earlier blogs titled Health Matters) so the physicians decided to try the rabbit version this time around.  

At 11:30a I was given premeds for the Thymo which included 50mg of Benadryl and steroids.  Finally, sleep was crashing down on me and I slept for a solid 2 hours.  Thankfully I  had no immediate reaction to the drug although towards the end I did feel slightly energized in my body, and I could tell whatever they had put inside me was definitely doing something.  After the Benadryl haze wore off I did notice I had a dull headache and full body aches.  Not necessarily like the flu aches but just a little sharper.  The nurse gave me 5mg of oxycodone and it took the headache and aches away.

Around 2:50, having skipped lunch, I ordered a small meal to be sent up to me.  Patients on the stem unit are able to order from a small menu anytime they want and it's supposed to be delivered within 30 minutes.    Two and a half hours later my food finally showed up.  Not cool.  My nurses were not happy that I had to wait that long for my food so they filed a complaint regarding the episode.  I'm not one to ruffle the waters much, but having not had food since breakfast at 8:00, I was glad they took the initiative to correct the situation.

After my "lunch" at 5:15, my legs were still aching so I decided to walk laps again.  48 laps in about 45 minutes brought my day's total to 79 laps which equals 3 miles and is the equivalent of walking from the hospital to downtown Nashville.  Sa-weet.

My parents came over around 7:00p and stayed for about an hour.  I noticed I had redness in my cheeks close to my nose and some redness on my neck.  An obvious reaction to the Thymo I had earlier that day.  It felt like a sunburn and is warm to the touch, but it was not painful or itchy.  I told the nurse and she offered some Benadryl so I made sure to get my daily shower in before she returned with it.  Benadryl is administered straight through the IV so it kicks in really fast and turned me into a zombie really quick.   I wasn't about to try to take a shower with it already administered.

At 9:15 my nurse primed me with premeds for the next round of Cytoxan that would start at 10:00.  I was given a pill to help my liver, IV for my bladder, Benadryl and another Ambian.  I fell into a wonderful blissful sleep from 9:30 to 12:15a.

The day ended well!