Tuesday, July 30, 2019

Look out the window, oh how scenic, you can't go anywhere if you are Neutropenic

What is neutropenia? 
Neutropenia (noo-troe-PEE-nee-uh) is when your blood has too few neutrophils, a type of white blood cell. All white blood cells help your body fight infections, the neutrophils are important for fighting infections, especially the infections caused by bacteria.

Why would one become neutropenic?
Neutropenia, is a side effect of the chemotherapy given during critical conditioning regimen for HSCT. Thus, as opportunistic infections, including those caused by foods, can occur in the period during which patients are immunocompromised. Ivy will remain neutropenic until engraftment or bone marrow recovery. Once engraftment occurs her new immune system will start making WBCs including neutrophils.

I often take care of neutropenic patients who are febrile in the emergency department. Cancer patients who are neutropenic are instructed immediately go to the ER if they have a temperature >/= 100.4. This is because they are at increased risk of becoming septic and to be deathly ill due to the lack of immune system. These patients are treated with great concern because their condition is often tenuous and they are on the brink of death given their immunocompromised state. A neutropenic fever is no joke. 

Ivy is starting to show a slight increase in her neutrophil count and will hopefully be out of the dangers of neutropenia soon. Her neutrophil count will hit 0.5 which will mean she is no longer neutropenic and will be ok to be discharged home. Her count today in 0.1 which was positive as she has been too low to count or register a number for the past several days. Today is a good day and I predict that she will be above 0.5 tomorrow. 

A lonely neutrophil 

Tuesday, July 23, 2019

Stem Cells, What the &%$# are they and what do they do?

In order to explain stem cells we can start with bone marrow. Bone marrow is the soft, spongy area found in the center of some of the larger bones. The marrow makes all of the different cells that make up the blood, red blood cells, white blood cells (of many different types), and platelets. 

For Ivy's stem cell transplant we are dealing with the cells of the immune system. The cells of the immune system are also produced in the bone marrow. These cells develop from a specific type of cell found in the bone marrow, "hematopoietic stem cell."
The body signals the hematopoietic stem cells to create or differentiate into the different blood components needed at any given moment. This process is very active / busy, the bone marrow produces millions of different cells every hour. The stem cells stay in the marrow until they differentiate into mature blood cells, at which point they are released into the blood stream where they perform their specific functions such as carrying oxygen, providing protection from infection, and helping blood clot. There are small numbers of stem cells, however, that can be found in the circulating blood, this allows them to be collected under certain circumstances. Often medication as in Ivy's case she was given daily Neupogen injections the week before they harvested to increase the number of hematopoietic stem cells in the blood prior to collection. 
These stem cells that will go on to differentiate into mature adult blood cells of the immune system are what they harvested from Ivy. After the stem cells are infused into the patient’s bloodstream, they find their way to the bone marrow and begin the process of forming new, healthy blood cells including white blood cellsred blood cells and platelets. This new immune system will not remember to attack Ivy's myelin as they will not recall that the previous cells had mistakenly been programmed by Ivy's immune system to attack her myelin. The old immune system was wiped out by chemo and no longer exists so these new cells differentiate  into a brand-new immune system which also explains why Ivy will need to get revaccinated as her new immune system will no longer carry the memory of her previous vaccinations and she will no longer be immune to many of the diseases she was previously immune to by her past vaccinations she received as a child. The good news is that her immune system will no longer remember that it used to mistakenly attack her myelin as it thought it was a foreign substance that needed to be killed and removed from the body. 

Ivy is forming a brand new immune system that has forgotten that it was programmed to attack myelin and this is how the stem cell transplant stops MS from progressing allowing the body to repair the damage already done by MS and going forward her new immune system will ignore myelin and not try to destroy it anymore.

The actual treatment responsible for stopping MS the chemo which killed off the immune system and the stem cells that get transplanted will just help her new immune system grow quicker and help her recover in a more rapid fashion, without the chemo the stem cells would just differentiate into the same broken immune system and still attacks the myelin. Now that the broken immune system has been destroyed the stem cells will differentiate into an immune system that is no longer broken it will be like the immune system that was there before the MS developed effectively making MS just a bad memory that has been erased. 

My Stem cell poem 
Stem Cells, New Stem Cells,
So much potential have you.
reproduce, renew.

Friday, July 5, 2019

7 new Lesions are not very pleasin

Ivy had a new MRI recently of her Brain and cervical spine. We were wondering if she has had any relapses since her the MRI's she had when she was diagnosed. Since being diagnosed she had been feeling pretty good but has had some numbness that would wax a wane in different areas of her body but these symptoms would resolve and were not very severe at all. She had some facial numbness and some skin sensitivity to her chest was on her right side. She has not had any significant deficits or symptoms that were severe in nature like she had when she was diagnosed and she was seeing double due to the attack on the myelin of the  6th cranial nerve.

The good news is that she will has already received aggressive treatment to stop this flair in its path of destruction before it could do more damage and then her chemo and  stem cell transplant will facilitate termination of her MS and then allow her body to heal and repair the damage her body has already sustained from the MS attacks she has had up to this point. The goal is that she stops MS in its tracks and prevents it from coming back and then heals the damage that has been done and ultimately makes MS a distant bad memory never to return.

That is the update.

Today Ivy is have her stem cells harvested. I will write another post to explain the process soon.

Harvesting stem cells 

Ivy gave MS the boot now there is an updated article woot woot!

 A follow up article on Ivy and her HSCT treatment was just released online and will be printed in Monday’s 5/17/21 Chicago Tribune newspape...