Well we have been back here for the week now and Daniel is just finishing up his chemotherapy. He had kind of a tired day today and that is okay since I had a very bad night last night. I was up all night with a migraine and it has pretty much wiped me out for the whole day too. The nurses and doctors have been just as attentive to me as to Daniel which has been very nice. Rob has been in and out trying to be here for us as well as take care of work and Matthew and is kind of running a little ragged if you ask me. Although we made it through the worst of the immediate side effects of intense chemo again with our strong Daniel we will now wait for the drugs to do their thing. And that thing is making his numbers drop before they come back up again. What this means (as a review) is that it will begin to push out all of the white blood cells from his marrow which it is already doing. He will become neutropenic as his white blood cells drop and the hemoglobin and platelets drop along with it. This is when he will be tired and weak and susceptible to infection. He really didn't feel sick at all last time so let's hope for that again. If he stays feeling good we would like to have healthy visitors as much as possible since once he goes to transplant he won't be able to see anyone for a while. This brings us to our next news. We received our pending schedule for Daniel's transplant if all goes well. All going well is a big one but so far so good. If he goes through this cycle with no infections or complications then it should be expected that he will be finished this round after 30 days EXCEPT Daniel's 30 days is more like 35 or 37 days and subsequent rounds sometimes take longer for count recovery so who knows...therefore well who knows. We don't really plan by the books anymore, however we hope to have a few days home at the end of this round before checking back in on the BMT side of the floor. That being said Daniel is on the books of the BMT side to start his outpatient work up starting October 13th. This involves several dozen appointments evaluating every organ, system and cell in Daniel before he goes to transplant. The trick is, he has to have his counts at a certain level before most of these assessments can be done. Then his official check in date to start his preparation for his transplant will be the 27th. Again with this schedule we hope he will be able to get a few days home before he has to check back in. Then beginning the 28th he will start what is called the conditioning phase which involves a very difficult round of special chemotherapy that will prep him for his transplant. During this time Daniel will begin being in isolation when none but us will be able to see him. He needs to have only a limited amount of people (set of germs) that he is exposed to until he is cleared to go home. This chemotherapy will be different from what he has had up until now. Up until now the chemotherapy's job has been to kill off the bad leukemia cells (to put it simply) but this type during the BMT will be much different an will clean out and kill off his entire immune system leaving it empty to be replaced in the transplant. That is what happens during the conditioning phase , This is harsh and tough on him and we are told there is no way he will escape it without side effects. Let's hope he will prove them all wrong, but regardless we will be here for him and they are the specialists that know what they are doing. Then the big day is what is called DAY 0 or INFUSION DAY and that will be November 6 (ironically it is 5 months from his day of diagnosis). Every day after this is called the supportive phase and is counted in + DAYS (+1, +2...) for the next 10 days especially we wait for the new bone marrow to find its way to where it needs to go. Even the doctors say they don't really know how it knows where to go or how it all works (very encouraging huh?) but it just knows. The new bone marrow 'grafts' or takes hold and just starts generating new blood cells in its new home. The next 10 days are crucial for Daniel to except and start making these new cells on his own. During this supportive phase the risk for infections and host vs. graft disease are high. This is our greatest fear but this is what the doctors know to watch for. We know that they have found the best donor match for Daniel and that they do these transplants all the time with great success and that this is Daniel's greatest chance for a cure. He will overcome great obstacles and the next 100 days of being watched closely for any risk of rejection or infection. Where we have been watching for the magic number of an ANC of 100 to go home form the hospital. This time he will need an ANC of 500 for 3 consecutive days. This could take a month or more from DAY 0 it is very hard to tell. During this time remember he will be in strict isolation. Once he comes home he will be able to leave the house but will be very compromised and need to wear a special mask for a full year. It is a scary thought but he will have no immune system and it will essentially be just starting to develop. This is why he won't be allowed to go back to school for a full year and spend more time going back and forth to appointments at the hospital during the year than he will be at home, but he will have a brand new clean and healthy immune system and hopefully no serious residual complications. There are some side effects he will have for the rest of his life but he will have a very long rest of his life to enjoy. Class dismissed.