Day +18, BMT :: Engraftment!

I know it looks like Jade is just sleeping,
but she is actually engrafting! 

"Mommy, I can do it in my sleep." Diaper changes, (some) oral meds, and apparently engrafting. Jade officially engrafted this weekend.  What does that mean? While Jade has been sleeping nearly 18 hours a day, her new blood-forming cells have started to grow and make healthy blood stem cells that are showing up in her blood. The criteria for engraftment is to have an ANC greater than 500 for three consecutive days; Jade reached that milestone over the weekend.  Today, Jade's ANC is 1120. 

With all of the swabs and cultures finally back, and all negative, Jade was also taken off of contact isolation and off of droplet (airborne) isolation today.  (Now, the staff doesn't have to get all decked out with masks, gowns, and gloves before entering the room.) All of her antibiotics have been discontinued.  And we're going to begin to wean her off of the TPN (IV nutrition) and encourage natural eating with an appetite stimulant. We even have a tentative discharge date: Monday, July 28, 2014.  That's right!  Home is on the horizon.  Granted, we will have to come back to the hospital every other day as part of the intense follow-up plan for bone marrow transplant patients, and any sign of a fever, new pain, new rash, diarrhea, or inability to take liquids by mouth over the next three months will result in an emergency visit, BUT we can do that.  After all, look at what God's done already, look at how far Jade has come! 

We do have somewhat of a task list that needs to be checked off before we reach Jade's discharge date, but again.  We will get this done too! Just a little something to keep us busy. 

Jade's To-Do List
Achieve an ANC of 1,500 and maintain it for three days
Maintain platelet levels above 10 for at least three days
Maintain hemoglobin levels above 7.0 for at least three days
Have an unremarkable echocardiogram on Thursday
Take all daily medications by mouth (at minimum, she will be discharged taking amiloride, cyclosporine, voriconazole, periactin, bactrim, mycophenolate mofetil, ursodiol)
Complete her steroid regimen and remain fever free (after Jade spiked another high fever of 104 when the steroids were discontinued, the team decided to have her complete the typical seven-day regimen)
Have no active, uncontrolled infections or other serious problems. Increase eating and drinking

Our To Do List
Clean house (damp dust house, relocate plants to an area of house where child will not spend a lot of time, minimize clutter, etc.)
Clean carpets
Clean/change heating-air conditioning ducts and filters
Clean all washable toys with soap & water or in washing machine; put other toys away
Secure reliable transportation to outpatient clinic appointments three times per week and just-in-case for emergency room visits (remember when my car gave out on me just one week into her treatment plan... it was the transmission.)
Check for any mold, mildew or water damage. Remove mold if present; repaint any walls with peeling paint.
Confirm home care visits.

Thank you for checking in on Jade and for your continued prayers and encouragement in the weeks and months ahead.