Month 7 Plus: Another Interesting Month

 And we thought last month was interesting. Ha!

All is good here in post-SCT land. We are now just past 7 months post transplant and everything seems to be going well, but it's been an eventful month in the family. We'll get to that, but first the health update.  My white cell counts have returned to normal as mysteriously as they had dropped. Do we know why? Nope. Are we concerned? Nah.  The rest of the bloodwork looked good, too, including the results of my Epstein Barr Virus test. We paid particular attention to that test this time around, he said, foreshadowing.

I continue to slowly taper off my two anti-rejection drugs (both the general one - tacrolimus; and the more targeted anti-GVHD drug that I was taking to address mild GVHD in my gut.) So that's good because less drugs are always better. And since the anti-rejection drugs are immuno-suppresant, less drugs are definitely better. It also means that I have been cleared to have the occasional beer or glass of wine. 

I'm also only seeing my NP or MD every four weeks, give or take and so that's good, too. 

And I was able to get both the Covid and Flu vaccine this year!  Of course, I got the Covid booster two weeks after Stacy and Matt got Covid, but fortunately through a lot of isolation, precautions, and a week by myself at a hotel, I managed to avoid Covid while the family recovered.  

So in general, except for the need to avoid crowds (particularly indoors), certain foods (soft cheeses, cold cuts, sushi, soft serve ice cream among them), and things that kick up dust and other particles (mowing the lawn, blowing leaves, vacuuming, etc.) life is returning to a mostly normal kind of pace. Even work, which was wildly busy for about eight weeks has returned to a normal busy kind of pace. 

Sunset on Sabattus Pond

That's why I'm able to write this from our temporary home away from home, up on Sabattus Pond  in Maine, where Stacy and I were finally able to go for a short getaway. We were supposed to be up here about three weeks ago, but instead Stacy was down with Noah at Lehigh, while he enjoyed a three-day stay at the local hospital. 

The diagnosis that finally came back was a severe case of mono (thus the relief of my negative Epstein Barr Virus test) complete with enlarged spleen and liver. The diagnosis was a huge relief. After the year and half of my health experiences, just the idea of my youngest headed to the ER was enough to crank up the PTSD meter.  Throw in a hematologist and oncologist consult, and it was a stressful few days, to say the least.

He had a rough go of it for a couple weeks, but Stacy was able to help him get back on his feet, and now he's pretty much back to his normal self.

And I'm happy to say, day by day, month by month, I'm getting there, too.

--Michael

Day +6 months (give or take) - It's Been a Month!

It's Sunday night and I'm sitting here on my nice sectional sofa here at the Residence Inn in Needham, MA. It's very nice. Spacious. Clean. And a nice place to spend a few days. We thought it was the safest option. Safest option, you might be wondering. 😕😕 What's that all about?  How did we get here?

Lest I bury the lede, I feel fine. But  it's been an adventurous couple of weeks. Last we checked in, I was waiting on CT results and confirmation of bone marrow scans. And after meeting with my team in early August, we confirmed that the bone marrow was clean, the scans looked good and the mutations we had seen pre-transplant - particularly the troublesome TP53 mutation, which is implicated in many cancers -- are no longer there. There's even the potential that I have a new mutation, from my donor, that might actually confer some benefit. Interesting. This swapping of genetic mutations amazes me a bit -- and it also confirms why we went with the donor-based transplant instead of my own stem cells. (I wrote about this when we first made the decision to do the donor transplant back in November. )

So all good, right? Well here's where things got interesting -- or stressful if you're actually going through it. 😟 After going in for the usual blood work and appointment on Monday, the 28th, the labs showed that my white blood cells had dropped unexpectedly, and we found out later in the week that my neutrophils were also very low. More labs on that Wednesday showed not a whole lot of improvement and my neutrophils were basically zero. So we got a little shot of neupogen,  which is supposed to give a shout out to my bone marrow to go ahead and do your job and start cranking out the WBCs. That seemed to work... or I just naturally recovered because by Sunday, when we tested again, they had recovered enough that we didn't get another neupogen shot. That was last Sunday and I continue to feel fine... even with a little houshold drama going on, which I'll get to later.

The question you are now asking is why?  My red blood cells, platelets, were all  fine, so why this singular dip in WBCs?  There are  ideas, but there is nothing definitive. I continue to feel fine. Energy is good, even as I work through what has turned out to be very busy period at work. Some prevailing theories: long-term use of Bactrim causing this rare-ish side effect (so we paused taking it for bit); or my favorite, the new mutation I picked up is causing a transient drop in white blood cells, something that has been seen before in other transplantees (although I don't know if that's one transplant recipient or many); or my least favorite, it's just some random insult to your immune system, which if we weren't drawing blood, we wouldn't even have noticed. 

Whatever the culprit, it'll be interesting to see what the lab results are this Wedneday, and hope to have a continued rebound in my WBCs so I can continue to fend off diseases... like Covid.

Because Covid is still a thing, y'all. Matt came back from a Labor Day weekend away with his friends and was sick from the moment his masked little face came into our house. He stayed mask on everywhere in the house and isolated to his room (and bathroom), which is good because he tested positive for Covid on Thursday and Stacy followed yesterday. The latter fact is crazy because she has been and was so very careful, but she was bringing him food and retrieving it, and they shared the same bathroom. I've fortunately had my own bathroom since coming home from transplant, so I'm thinking that helped. We're not out of the woods yet, but as they are feeling a bit better and able to fend for themselves, we thought isolating in a hotel for 4-5 days might be a safe option.

And safe options are what we want as we approach the six month post transplant date, which is officially next Saturday, the 16th. All this is a stark reminder of vulnerable I am, and how I have to remain very vigilant, particularly until my immune system grows up a bit. 

Day+ 142: No News is Good News

It's been more than a month since my last post and the old adage, "No news is good news" holds true. It's been a good month. While a month ago my taste buds were mostly back to normal, as Miracle Max might say, mostly normal is not completely normal.  These days, food tastes like it's supposed to, and except for the few restrictions that will remain for another six months or so (cold cuts, soft cheeses, raw honey, sushi, mainly), I'm pretty much eating like I used to. I've even managed to venture out to a few restaurants with outdoor dining. 

Even ice cream, which had been somewhat of a challenge for my system as I was, temporarily it seems, lactose intolerant, has worked its way back into my diet on a regular basis. And for me, that's about as normal as it gets.

While I've started running again, both pace and distance are frustrating. I realize I'm not even five months post transplant, but I look forward to the day when I can jog at something close to my pre-transplant pace for at least a couple of miles. We'll get there. Eventually. 

The big appointment coming up is on Wednesday when we go in for PET/CT scans. These are routine post-transplant scans. Today, I'm feeling pretty sanguine about it, but anytime we're looking inside me to see if there's anything growing, it's inevitably going to produce some anxiety. Two weeks ago, I had a bone marrow biopsy -- a little less fun than a PET/CT scan. The results seem like good news but I can't really understand the pathology report. We'll hear more about it on Wednesday when we see my NP after the scans.  The good news is that at Dana-Farber scan results are always available by the time you have your exam appointment. So between lab results, bone marrow results and scan results, we'll get a lot of info on Wednesday. 

Day +108 Give or Take

Colt State Park, Bristol, RI on a recent walk

I went to our local bagel store this morning. It was the first public indoor place I've gone to that's not a hospital in four months. It was a calculated risk: I'd be in the store less than five minutes, I would need to touch very few things, and I would be masked. But there would be maybe 10-15 unmasked people in a relatively small footprint. 

The transformation to normality happens in tiny increments, the progress of which can be hard to notice in the minute, like watching your kids grow up (pretty much there), or your hair come in (not yet). The past weeks have been good ones, driven largely by two related events. The GI issues that were affecting my daily life have subsided, and at +97 days, just shy of the advertised 100-day milestone, I was cleared for take out food. Together, this has meant more options for eating. In the last two weeks, we've had Chinese food, pizza, Thai food, and of course bagels. It's also given me the confidence to restore morning coffee to my daily routine. 

First Take Out Meal!

But it's not just the return of a more normal course of meals. I've been walking a bit more each day and noticing that the small inclines I encounter on my daily walks are no longer leaving me short of breath. I won't be running a 5K anytime soon (hopefully in 2024!) but I was able to slowly jog about a quarter-mile last weekend. 

As we come up on the four-month mark, it's tempting to accelerate the return to the way things were -- to begin to socialize more with friends and family, to do more around the house, to return to my office occasionally, to frequent non-crowded stores.  But on this marathon of recovery, we're only mid-way through the race. And I may be having a good couple of miles, so to speak, but there may be tougher stretches to come. My blood counts may wobble; we may need to make adjustments. 

So before we hit fast forward, we'll just pause and enjoy the subtle changes -  taking longer, faster walks; requiring fewer hours of sleep (in the first couple months, I needed about 10-12 hours a day!); having more energy; and of course, eating fresh bagels. 

Along the bike path in Barrington, RI on a recent walk