I promised a better explanation tonight. Unfortunately I am just about to miss the deadline on my promise. The day got away from me… or maybe I got away from it. Either way, as so often happens, things didn’t go exactly as planned. But I am not complaining – where it really counts, things are going exactly as planned. So this is the end of day 3, and Jim is doing great! By “great” I mean that he is overcoming the expected nausea, indigestion, and schizophrenic bowel behavior, and managing to keep moving and keep his meals where they belong. The meds to control those things are keeping their promise, which means lots of extra zzzzzzzzzs. That’s a good thing -Building a new immune system requires way more rest than Jim’s body is used to getting! There’s the basics… want the rest of the story? I promise it will (hopefully probably) be less long than usual. Actually I take that back… one broken promise is bad enough!
Today, as both expected and promised, Jim’s “counts” began to drop. This means that the number of red blood cells, white blood cells, and platelets circulating in his system is starting fall. This is a good thing. Or, more accurately, this is a necessary thing. Therein lies the missing link in my explanation from the other day. Jim woke up on day one and asked the question, “if I still have all of these blood cells from my own system… is the new immune system going to kill them all?” And the answer is… drumroll please…. sort of. So it works like this:
Cells have a regular life-cycle -every day your oldest cells die, and your system replaces the dead ones with fresh new cells. Every cell type has a different life cycle, so the number of days a cell lives, and the number of new cells of it’s kind you have to make every day varies. When it comes to blood cells, all of the newbies are produced by stem cells in the bone marrow. But even amongst the blood cells there are variations in the cycle. For example, red blood cells live for about 120 days. Every day all of your red blood cells that are around 120 days old will die. But also every day little baby stem cells in your bone marrow are developing and maturing into real functioning cells of all types, and each day your bone marrow magically releases just about exactly the number of red blood cells you need to replace the old ones. Even if something goes wrong, and your red blood cells start dying faster than usual, or you lose a lot of blood because of a wound (or because you are a woman :P) your bone marrow will do it’s best to accommodate the need by working overtime to grow and release replacements as fast as possible. White blood cells, on the other hand, only live 3 or 4 days. But the process is the same… each day the 3 or 4 day old cells die, and each day your bone marrow releases enough white blood cells to replace them. If you have an infection, your bone marrow will ramp up production and release of white blood cells quickly, because those are the ones in charge of fighting the enemy.
Now imagine something destructive, like a chemotherapy drug just for example, got into the stem cells waiting to mature and be released into circulation. When the circulating cells die out on their regular schedule, there would be nothing to replace them with. The body says “WE NEED MORE CELLS!” but the production house remains closed because all of the little stem cell seedlings were zapped by the chemo.
So that is the first half of the story…
Jim got chemotherapy in moderate doses last week. Those drugs made their way into his bone marrow right on schedule. The stem cells in that marrow absorbed the drugs… and tapped out. The drugs exited his system quickly, leaving a path of destroyed stem cells in their wake. This is how we do it (this is how THEY do it, but the song got stuck in my head, and I couldn’t resist). At first the effect is silent, because the circulating cells are still out there doing their thing. But when the circulating cells die off per the usual schedule, the zapped bone marrow simply does NOT step up to the plate and replace those cells. That’s when you notice! Red cells, white cells, platelets… the levels all fall because the “dying” part of the cycle is intact, but the “replacing” part is gone.
Enter the OTHER half of the story in the form of those bags of cells sitting on the counter. Those new baby German cells (does that make them German germ cells?) were not in Jim’s system when the chemotherapy was administered, so they were not affected. They poured in and found their place among the destroyed stem cells in Jim’s bone marrow. And right now they are starting their normal process of ramping up production for release. But it takes stem cells several days to mature even in a normal setting. And these little guys have to figure out how to do it fast in an all new body. Not to mention that they will have their hands full when they find that not ALL of the old stem cells have cleared out. Taking care of the old cells will be a high priority for the new kids on the block. And this is where we encounter that tricky balance I mentioned before -We can’t have the new cells fighting everything they don’t recognize, because that would mean fighting… well… everything. So until they get used to their new surroundings, the docs have to hold them back quite a bit. Immunosuppressive drugs are the defensive weapons of choice. And Jim will be on those for a while.
Let’s sum that up and get to the bottom line: Day 4 has begun. Days 3-4 are where we enter the gap between the old cells dying off and not getting replaced by the old system; and the new stem cells gaining a foot hold, maturing, and stepping out into Jim’s circulation. Real “count recovery” (end of the gap) will happen around day 10. So days 4-10 are when we watch cell counts get low low low, give transfusions of blood and platelets to bridge the gap, and (impatiently) cheer the new system along. It’s also where we stay up obsessively blogging and listening to the patient breathe all night. Oops, no, that’s not a “we” thing. TMI.
As for how the patient feels during that time, well it depends on the patient. I’d say Jim is doing much better than expected, but I expected that so if I said it I’d be cancelling myself out. Or something. Anyway, let’s just say he is doing well enough to further the mission…
Three smokers, 5 legs, and more profanity than I ever heard on the streets of LA (yeah yeah I know I was never really “on the streets” of LA… but valley girls can come up with some surprising profanity when someone like totally messes with them at the mall. Omigawd!)
That really happened! He obviously wasn’t missing any fingers. And yeah that is the no-smoking “on the entire campus” sign planted right next to them.
But don’t worry, Officer Happy Lungs called in his posse and got the problem resolved.
YER OUTA HERE, BUDDY!
AND YOU TOO, MISSY GIRL! You can’t hide behind the giant blue rectangle with a crossed out cigarette in a circle. NEIN! RAUS HIER! (Technically she is already out, so saying “get out” is probably incorrect in any language, but it’s 3am and I can’t get inspired to research a more appropriate phrase)(And also It’s 3am and I must be lonely. I REALLY tried to resist that one, but it’s one of my very favorite songs)
It’s officially day 4! Jim is good, the kids are good, and we are a whole day more grateful for them, for you, for smart and dedicated medical people, and for everything.
Gute Nacht (goodnight!) Sleep tight, and keep the good healthy and loving energy coming Jim’s way. You can’t even imagine what a difference it makes, and how much we both appreciate it! THANK YOU!!!!