What does the recovery process look like for a child after a bone marrow transplant?

What does the recovery process look like for a child after a bone marrow transplant? 

So after the transplant, typically there's going to be a period of 2 to 3 weeks where their body is not able to heal. And we're seeing the cumulative effects of the chemotherapy. And this is when our blood counts are very low and we're needing frequent transfusions. This is where our immune system is at its weakest. We're on a lot of preventative medicines to help prevent infections with viruses, funguses, and with bacteria. We see this mucositis where we get pain in the mouth and throat and through the digestive tract, the appetite often goes away. We have nausea, we have vomiting, we often have diarrhea as a result of this. And so patients are either going to be getting feeds through, you know, many, many more unable to swallow medicines are not able to swallow nutrition. So in some centers they will place an NG tube in order to bypass the need to swallow medicines that we can't give through the IV. And it's a way to be able to give some nutrition into the tummy to help promote healing and get some nutrition in that way at other centers. They will, instead of that, just put them on IV nutrition when they don't eat. And each center is a little bit different in how they do this. And IV nutrition tends to be available at all centers as well, even in those where we try to use the tummy first. Sometimes if the tummy is just not tolerating the feeds will give the IV nutrition, because the IV, nutrition or nutrition in general is important for the body to have. What it needs to heal back up from the chemotherapy. It's usually somewhere between a week and a half to two and a half weeks after the transplant, where we start to see the white blood cell count start coming up, and we call this engraftment. It's typically at this time that we start to see the other toxicities of the chemotherapy start to heal up as well, particularly, this mucositis, which is one of the common things that we see that is really a major reason that patients are in the hospital. So we can make sure that we keep them safe, make sure they're getting nutrition and hydration and keep them comfortable. And many patients will need IV pain pumps called PCAs, where they're getting continuous pain medicine can push the button to get additional medicine as well. So all of this will be happening. And as the white blood cell count starts to come up, this starts to heal. And as they start to heal, we start to be able to back off and some of the pain management, we start transitioning medicines that we have IV that they're going to need to go home on to taking them by mouth. We see their needs for transfusions becoming less and less frequent as they start to heal. And we also want to make sure that physical therapies continue to work with patients during that time to make sure that any weakness that we've gotten from not being able to be as active as we'd like, because we feel lousy from the chemotherapy, to start regaining that strength. So that way we're ready to do things at home, like be able to walk from our bedroom to the bathroom to the kitchen for meals and things like that. Whereas when we've been in the hospital, we haven't had to walk more than 15 to 20ft to a restroom and our food is being brought to us, we have to be much more active and also be able to go from the car to the clinic and from the clinic, back to the car afterwards. We have to be able to do this walking when we're doing our close follow up in clinic, and patients when they first leave the hospital are typically coming anywhere from 2 to 3 times a week to clinic. For us to be managing medicines, to be checking blood levels of drugs, to be checking our blood counts and our chemistries, to make sure that that transition home as well it goes well, and that we're not seeing any of the early complications of transplant that we have to actively look for.