Not so bad – Yet

I got the first bag of Melphalan today at 9:15.  Just before it, I got a bag of something to ward off nausea, and so far it has been totally successful. The Melphalan itself took about a half hour to infuse.  Then an hour later they gave me a dose of Lasix.  Lasix is a diuretic that causes you to flush fluids from your system.  In other words, pee like crazy.  They want you to do this to make sure the Melphalan does not accumulate in your kidneys and bladder, where it might do damage.  I am also on a continuous drip of saline solution, so I have lots of liquid flushing through my system.  So far, so good.

I am actually feeling quite well.  They say it takes 5-7 days for the effects of the medicine to take hold.  Melphalan is a derivative of mustard gas.  It causes fast-dividing cells to be unable to continue dividing.  According to Wikipedia it adds an alkyl group to DNA, thus interfering with cell reproduction.  So things that need to be replaced fast, show the effects first.  Your white blood cells live in your blood stream for 3-4 days.  So if their production is cut off, in 3-4 days your existing supply runs out, and your white blood count plummets.  That will happen to me.  Your blood platelets are also short lived.  According to Wikipedia, they last 5-9 days, so they will run out fast as well.  They are involved in blood clotting, so their reduction will make it so they no longer give me Lovanox to prevent blood clots.  Red blood cells, in contrast, live for about 3-4 months, so a lack of new blood cells will not become apparent as fast.  But (again according to Wikipedia), 2.4 million new red blood cells are produced per second in healthy bone marrow, so your red blood counts do drop as well.

Presumably the first dose of has wreaked its destructive effects already.  I just have not yet felt them.

I am learning the ins and outs of being a prisoner in my room.  My particular room does not have a shower.  So to get clean, I lather up a washcloth with soap and do a sponge bath in the bathroom.  Barbie helped by doing my back.  I didn’t do much to the right side of my chest, as the sub-clavian line is still tender.  The meals available from the low-bacteria menu have been surprisingly good.  They have you take something to reduce the possibility of infection in your mouth and throat every 4 hours.  You suck on a tablet and the medicine goes all down your system, keeping the bad guys at bay.  Apparently mucus membranes (which make up much of your GI tract) are fast-dividing cells as well, and they take a hit from Melphalan.  They have special toothbrushes that are extra soft because normal or hard-fiber tooth brushes can puncture your gums, leading to infection.  Similarly, you are prohibited from using dental floss, as normal flossing leads to a spike bacteria in your blood stream, as the teeth are a major source of bacteria, and inevitably you cause bleeding in your gums.

So all is well – for now.  Nurses, interns, & doctors are all monitoring me closely.  Presumably they are doing so for a reason.  I am curious to see what are the first reasons that show up.