A quick update for tonight. Brad is doing a bit better today, but when I was at the hospital this morning was quite tired. The good news is that engraftment continues very quickly. Today his white blood cell count was 3.7, his neutrophils 2.4. The neutrophils, which are one subtype of white blood cells, are the measure the medical staff are really looking for, and they want to see a sustained set of readings over 1. (That 1 represents a count of 1000 neutrophils per microliter of blood; thus 2.4 is 2400 per microliter, and so on.) A normal white blood cell count is somewhere between 4.5, or 4500 cells per microliter, and 10 (10,000/mL) so Brad is not all that far below the normal range. This is great news, indicating that engraftment has been swift and continues apace. (Thanks again for those great stem cells, James.)
The possible downside of a quick engraftment is the appearance of GVHD, graft vs. host disease—essentially, Brad’s new immune system attacking his body, the host, as if it were a giant disease. GVHD can express in a number of ways, from irritating (rashes) to potentially dangerous (GVHD of the liver, for instance), and he is being constantly and minutely monitored for everything that could indicate GVHD, from skin irritation to liver enzymes. Brad does have some rashes and skin irritation (for some reason his elbows have been bright red; who knew elbow rashes were a thing?), and there’s some disgreement among the medical staff as to whether they are GVHD or just random rashes. The attending transplant physician, who has years of experience, thinks the rashes aren’t serious enough, or clearly enough GVHD, to quite warrant medication (systemic steroids), given the amount of medication Brad is already on.
In fact, they’re trying to step down the various meds and things he gets through his central line, including the IV nutrition. Brad’s throat has healed up enough that he is now attempting solid food; he told me he had a heart-to-heart with the dietitian today and expressed his strong preference for real food as opposed to the hospital’s “liquid diet” of sweetened yogurt, Ensure, and various pureed pap. Rumor has it his first attempt to eat dinner will be a French dip sandwich.
Those who have read Brad’s two latest updates may be either mildly relieved or very disappointed to learn that he has also been taken off his PCA, the patient-controlled dosing of the narcotic he was getting for his mouth and throat pain. The good news there is that the pain is substantially lessened; the bad news, for those of you following at home, is that slightly loopy updates may be less frequent in future. I’ve done my best, however, by pouring a glass of wine before I wrote this one.