What We Learned in Transplant Class

We checked one more thing off our list today by attending the required Transplant Class that's meant to somewhat prepare us for what to expect. Most of it we already knew from previous meetings with numerous doctors, social workers, psychologist, nurses, etc. but it did give us more opportunity to ask questions.

Many things we were told left me shaking my head in amazement. Basically the goal of transplanting donor stem cells into one's body is to replace all of the patients problematic stem cells that are causing all the problems with good ones from the donor. So they kill all of Ray's stem cells with powerful chemo & then inject the healthy donor's stem cells. If everything goes well, those stem cells will go to work spreading through Ray's blood & multiplying into good fighting healthy cells. This is called "engraftment". But unfortunately there is a danger of this process not working the way it's meant to.

One's immune system normally keeps us healthy by destroying anything in the body it sees as foreign, such as bacteria or viruses. A working immune system recognizes cells from other people as foreign, too.If the tissue type match between donor and recipient is not close, the patient’s immune system may see the new stem cells as foreign and destroy them. This is called graft rejection, and it can lead to graft failure. This is rare, because the pre-transplant treatment (chemo and/or radiation) mostly destroys the recipient’s immune system, and donor matching is carefully done. 

Another problem that can happen is that when the donor stem cells make their own immune cells, the new cells may see the patient’s cells as foreign and turn against their new home. This type of attack is called graft-versus-host disease (GVHD) and can cause a multitude of problems. Most transplant patients experience at least some of these problems but to what extent varies from patient to patient.

Because of the non-existent immune system that results from the chemo plus the possibility that the new donor stem cells could try to attack Ray's body, the precautions we must take to avoid germs & disease seem extreme but necessary. As you know, Ray's immune system is already greatly compromised & we've been trying to be extra careful in many aspects. But after the class today we realize that we probably haven't been careful enough.

Sure, we wash our hands constantly & use sanitizing gels when out. Ray often wears his mask when he feels it's needed. We refrain from eating out at certain places & avoid eating from common/shared snack bowls, etc. He doesn't drink soda from fountain dispensers or use condiments from fast food places. If we know someone is showing signs of illness, we stay away from them. Ray uses paper towels to dry his hands so he's not sharing towels. So yes, we take precautions now. 

Anyhow, today we were given handouts listing many Do's & Don'ts that we never considered & forced us to look at things differently. Yes, we can eat out but with many precautions; things we never would have worried about before. No KFC chicken cause one can't know how long it's been under the warmer. No water or ice in restaurants unless it's bottled. Nothing that has garnishes on it, like a leaf of lettuce or parsley, etc. Of course NEVER eat food in a restaurant prepared by someone that wasn't wearing gloves. Truthfully, how would you know if it was or wasn't? Never eat raw fruits or salad items in a restaurant either. So after class we stop at Bob Evans for lunch & the potatoes were sprinkled with bits of parsley & the little cranberry relish was sitting on a leaf of lettuce! In class they told us that once a food item even touches the garnish, it's contaminated & shouldn't be eaten. Oh my. So much for eating out!

And then there are personal hygiene things in the home. I learned that I do something that is definitely a No-No & I would never have thought of it. After washing dishes the dish cloth must be washed each time! What! I can't use the dish cloth to wash my dishes for at least a couple of days? They said absolutely not. Never hang it over the drainer or faucet to dry & use it for another sink of dirty dishes. So many other things to be careful of too.

We learned lots of side effects that may or may not happen following the transplant. They spoke about typical daily routines in the hospital & it sounds like Ray isn't going to get much un-disturbed sleep because at least every four hours around the clock they'll be doing things with him. They have a pull-out bed for me if I choose to stay with him all night but it sounds like that will be up to us to decide if it's necessary. I've promised Ray that as long as he feels he wants and/or needs me there, I will remain. I'm sure I'll come home occasionally to fetch things & to get rest if I find I can't get any there. We live only 11 miles from the hospital so if I'd go home, I could quickly return if needed.

There was a LOT more covered today in class. So much information that my head is swimming. But we are handling it & doing the only thing one can do; take it one day at a time & cross whatever bridges we come to...