How can I prevent infection after transplant? How long will I be immunocompromised?

[Music] what is the process of stem cell transplant what does it like my name is John Perry I live in Austin Texas and I was transplanted at st. Davids South transplant center with dr. Ramakrishnan I first had MDS and then all of a sudden my numbers after two years went up drastically he put me in the DAR Touma map study and I did that for four months and then the conversation of stem cell transplant came up after my numbers got down and he just suggested that I go and talk to dr. ramakrishna who was this stem cell transplant doctor and so my husband and I went over talked with him and we both decided that the stem cell transplant was the best option for me as much education as possible is important when I counsel patients I spend at least an hour and a half with them telling them about the process of what happens during the procedure what they can expect we give them calendars that basically map out exactly when we expect certain side effects to happen we tell them about what to do at home who they need to stay with if the procedure can be done as an outpatient or it can be done in the hospital transplant can be done inpatient or outpatient most of the time where we do it depends on medical factors social factors insurance sometimes age is an issue but as long as patients have social supports and they have a caregiver that can bring them back and forth to the clinic they're healthy they don't have lots of comorbid medical conditions almost every patient can have this procedure as an outpatient well we scheduled the transplant my particular insurance actually wanted me to have more tests and they wanted me to stay in the hospital for at least 15 days I really liked being in the hospital that felt more comfortable to me if they start getting sick where they need continuous IV fluids or some more support for IV antibiotics we can always admit them but we try to do as many outpatient procedures as possible and the best place to heal is at home the best place to sleep is in your own bed not a hospital bed your infectious risk is also lowest at home as opposed to the hospital some patients don't have that availability of caregiver support they don't have anyone that can drive them to the clinic every day while the patients are going through transplant they can't drive so for those patients they end up in the hospital there are support groups and online resources that help patients get educated about the process talking to other people who've gone through it is always helpful because it gives you a first-hand perspective of how someone else felt when they went through the procedure as well what was really good for my husband what they had at the hospital was a support group for the caretakers so my husband went to that support group and he learned a lot about that and he also met people that were caregivers that helped supported him and what he was going through and they did that at the hospital as far as the process of the transplant many patients can undergo the procedure as an outpatient the first part of the process is harvesting stem cells and freezing them away at our Center we typically do that with just something called growth factor these are injections that we give under the skin these injections mobilize bone marrow stem cells from the bone marrow out into the blood and then we can suck them out of the blood using a machine and a process similar to dialysis and this is entirely an outpatient procedure it sometimes requires a special type of catheter to be placed into the jugular vein so that the machine can process enough blood and collect enough stem cells I went in there and they before the transplant what they do is they put a central line in they gave me a drug to push the stem cells out of my bone marrow which was no big deal some people say it hurts the bones start hurting it aches mine never did that then I went in for collection day as what they call it and they hooked me up to the machine and from the central line my blood went through it they pull out the stem cells and I had wonderful pink lots enough stem cells for three transplants it took a day like maybe six hours maybe and then I was done once those stem cells are collected they're frozen away we typically try to collect for at least two transplants in most patients and once the cells are frozen then the patients are ready to move forward with the chemotherapy and transplant procedure so again typically we place some sort of IV catheter that is semi-permanent so that the chemo can be administered before the transplant then they give you a a week to relax and you know and they during that time what they do is then they put a central line in your arm because I never had a port so they put a PICC line in and then I was in the hospital and the first day I was in got to know people got settled into the hospital setting the chemo that we typically use is a drug called melphalan we give it at very high doses it's a very short infusion goes very quickly we give lots of medications to prevent nausea vomiting in patients usually tolerate it very well we wait for about a day for the melphalan to go in and do its job kill all the myeloma cells and it'll also kill some of the bone marrow stem cells and once it's kind of processed through the body and eliminated then the frozen stem cells are thawed and infused into the patient usually that infusion is very fast over a period of five to ten minutes the first day they started with antibiotics and and a fungal type resistant drug the next day they put the Machine up they put the muffling in to my arm and then they had the machine and and then they just put my stem cells back in they suggested that the whole time I'm getting mouthful and and going to that procedure that I suck on ice because that prevents sores in your throat in your esophagus and so I was able to do that I never got the source so I highly suggest that people do that also I never got neuropathy of what people said that they would get then there is a period for about a week where patients are experiencing some of the side effects of the chemotherapy the chemotherapy damages the guts and people have some mild diarrhea and also their bone marrow goes into failure because the new stem cells that we put in are typically like seeds they need some time to go into the bone marrow and develop and grow and that process usually takes about 11 to 14 days so there's a period where they sometimes feel like they have a bad flu don't want to get up very much not eating as much or drinking as much and we support them with intravenous fluids and support and antibiotics to prevent infections and almost everybody gets through that period without any major complications and then once those stem cells kick in everything starts getting better patients recover this procedure is so well-oiled at this point at most transplant centers it can be done entirely as an outpatient over a period of three weeks and then patients can return to their physician for further care and maintenance therapy overall I would pretty much say my stem cell transplant couldn't have gone any better than what it did and so if I had to do it again I would do it again the only problem that would bother me is that I will have to regrow my hair again because the mouthwash does take out your hair and the that was the most struggle I had was growing back my hair [Music]