Day Plus Thirty-Two

It is Sunday morning about 6:00 am Jody is sleeping.  I think this may be the best time to work on my posts. My day is full with taking care of Jody. We have medicines to take four times a day, a two hour infusion, a one hour walk, preparing and eating three meals a day, trips to the clinic three days a week (last week we had one extra with the bone marrow biopsy) normal weekly house chores and trying to keep Jody entertained. Jody is not one who sits and reads, she loves to cook, garden and clean. All of which she is not allowed to do. Yesterday I was doing the wash, I went upstairs to work on the blog and I heard her in the laundry room. We went out for our walk around the block and she tries to pickup the garbage people dropped in their yards and on the street. "What pigs they are, leaving trash in their yard." "Well OK, will you pick it up for me?" NO, I am not going around picking up other peoples garbage!

We had to go over that the doctor does not want her doing laundry because of bacteria, touching garbage and gardening because of germs. "I will wear a mask, and rubber gloves." NO, why take a chance? Let it be for awhile. "But you are not doing it right." Too bad, when you get better you can do it right... let me do it wrong for awhile. (I do not know how I was able to help raise four children, manage a business and live to be 60 all before I met Jody. I must have done it completely by accident.) This has become our biggest challenge. Chemo... no problem; a bone marrow transplant... gee that was easy; lost our hair... so what, it will grow back; let Tom take care of you... THAT IS IMPOSSIBLE, HE CAN NOT DO IT THE CORRECT WAY, LIKE I DO!

Jody and I sat down yesterday and had a discussion. We are going to try harder, both of us. I will try to do things the correct way (her way) and she will stay out of the laundry room and kitchen. (Do not know how long this will last.)

OK, let me bring everyone up to date. Jody s doing fabulous, according to her Dr. Gregory. All of her blood counts are in the normal range. Jody's ANC is now stabilized in the 3000 range (1500 to 7500 is normal) Her HCT is a little low at 32.2 (normal is 38.0 to 48.0) but Jody has never been in the normal range, this is high for her. Jody's WBC is at 4.3 (normal is 3.0 to 10.0).

Jody's big challenge is to rebuild her entire immune system that the chemo destroyed. Her diseased stem cells were not creating the cells she needed including the ones she needed to fight off the potential blood cancer known as leukemia. Jody's new donor stem cells now need to do the work. All of the cellular elements of blood, including the red blood cells that transport oxygen, the platelets that trigger blood clotting in damaged tissues, and the white blood cells of the immune system, come from the same stem cells in the bone marrow.

The cells that are a part of the immune system (white blood cells or WBC) are complex and different with specific functions. These cells come from two types of stem cells called Myeloid and Lymphoid.

Myeloid stem cells produce macrophages, which are found in the body tissues, play a critical part in immunity. Dendritic cells ingest large amounts of fluid upon encountering a pathogen and migrate to lymph nodes. Mast cells release substances that play a part in protecting mucosal surfaces like the nose, mouth and eyes against pathogens. Granulocytes are produced in increased numbers during an immune response and leave the blood to migrate to sites of infection or inflammation. Neutrophils are the most numerous and most important cellular component of the immune response and fight bacterial infection. Eosinophils are thought to be important chiefly in defense against parasitic infections. Basophils is probably similar to that of eosinophils and mast cells and work on allergic inflammation.

Lymphoid stem cells produce B cells, which secrete antibodies; and T cells, of which there are two classes; one, which kill cells infected with viruses and the second activates other cells such as B cells and macrophages. Lymphocytes are remarkable in being able to mount a specific immune response against virtually any foreign antigen. Another type of  lymphoid stem cells produces natural killer cells. These cells circulate in the blood and are able to recognize and kill some abnormal cells like cancer and virus-infected cells, and are thought to be important in the immune defense against intracellular pathogens.

The complicated process of bringing all of these cells back and testing to see if they are produced when a response is needed is the big challenge ahead. They are testing her blood cells three times a week to measure what is going on. In addition, they are monitoring her electrolytes to measure her reactions to the drugs she is being given and are looking for Graft vs Host Disease (GVHD).

Last week (Thursday) we went in for a bone marrow biopsy as well as a skin biopsy. The biopsy will tell us how well the transplant is doing. If you recall, on the 16th of August they sent a sample of Jody's blood off for DNA testing. One of the tests came back that she had 85% of the donor's stem cells and the other came back at 95%. The BMT team wants to compare the results of the DNA test to the results of the biopsy. We are expecting to hear the results of this comparison on Wednesday or Friday next week. On Monday, we hope to hear the initial report, which will tell us if they found any "blast" cells. This is the cell, which caused everything. If there are no more blast cells the disease is not growing. Future biopsies will determine if she is cured.

This should bring everyone up to date. Jody is doing well and adjusting to life at home with me. I know she would love to hear from everyone so call, write, or email. She can have visitors as long as you are not sick. Jody needs to be occupied at all times, so do not feel like you are bothering her. Call before you stop by, in case we are going to the clinic.

We love you all!

I am going to post things at random now, so be sure to check in...