Today the doctors started talking of discharging Harvey from the hospital in a couple of days if things continue to look as good as they are right now. The potential discharge date is Wednesday, April 9th, exactly two weeks since the day he was transplanted.
I am feeling pretty confident things will continue on the same trend and Harvey will come home on Wednesday. How sweet is that! Below is his latest WBC chart. For the first time his white blood cell count has reached 1.0K and fully 0.7K of it are the precious neutrophils. Harvey has now had absolute neutrophil count (ANC) above 0.5K for three days running, the official definition of neutrophil engraftment.
The other things they look for before discharging patients from the bone marrow transplant clinic are stable liver, kidney functions (ALT, AST, Creatinine, Bilirubin, BUN), patient is able to take a shower, change clothes etc with minimum help, able to take all medications orally (mucositis can be a real problem and make it hard to swallow large pills), no fevers of any kind, able and willing caregiver to take care of the diet, medications, hygienic living arrangements etc. Harvey passed with flying colors on all counts. Frankly, I have never seen his liver and kidney scores better than this in the past 7 years!
Getting patients out of the hospital and into home care is a good thing. No matter how hard they try, it is not possible to keep patients as comfortable in an institutional setting as they would be at home. There is also the ever present concern of hospital acquired infections (MRSA and pneumonia spring to mind) and infections are a much smaller risk in a well kept apartment. Fairview Hospital tries hard to give patients many good choices when it comes to diet. But Harvey is still nursing a sensitive stomach and the only foods that do not seem to trigger nausea are things I cook and bring from home. I suppose people revert back to childhood comfort foods when under stress. Feeding him would be a lot easier when he is back in the apartment and I do not have to carry little Tupperware containers of food back and forth. He has lost quite a bit of weight in the past few weeks (64. 2kg to 60.9kg), but has now started to climb back. His weight today was 61.5kg and he is eating better.
The nurses here tell me he is doing very well, most patients take longer than this to get discharged. I cannot be happier about how how smooth things have been since our very traumatic DAY ZERO. Now all I have to do is keep my fingers crossed that some level of chimerism is seen when they do the bone marrow biopsy on Day +21 and that he has potent GVL with minuscule GVHD. Since the time is approaching when GVHD is likely to become an issue, I had better hurry up and write my article on some interesting perspectives on GVHD management.
We will have to stay close to the hospital and outpatient clinic until Day +100. In the first few weeks after discharge from the hospital Harvey will have to make daily trips to the clinic so that they can check him over and take care of any medication changes etc. It helps that our apartment here is just a couple of blocks away, in good weather it is a very pleasant 6-7 minute walk. They also have a 24/7 door-to-door shuttle service. Since we do not have a car here, we use an online grocery ordering service that delivers to our apartment. All in all, a nice little home away from home.