Sunday, January 22, 2017

HSCT Complete! - Health Update

Wow, it felt good to type that title.
The last two months of my life have been absolute, and utter hell. All the alumni patients warn you, but nothing on earth could prepare someone for a stem cell transplant (aka bone marrow transplant). I have never experienced such pain, such nausea, or the wish to just slip away in my sleep. It's so hard to fight when you're that weak. It was a emotional, and physical roller coaster for everyone involved.

After a total of 7 days of chemotherapy, 4 blood transfusions, 5 platelet transfusions, and one stem cell infusion, I am happy to say I am recovery at home with a new immune system slowly growing inside me. The process was in two grueling phases that spanned over many months. To type everything that happened would be to write a novel - honestly, don't want to relieve many of those terrifying days. I did try my best to document the transplant through Live Facebook videos which can be found here:
Phase One Videos consists of the first chemotherapy, the harvest, and some pre-testing, while HSCT videos are the actual transplant procedure. They go from Day -5 to Day +10. Upon viewing these videos please remember, this was a live, raw, and unfiltered journey - some of which is very unpleasant, and emotionally upsetting.

I learned so many incredible things while in Chicago. The care I received there is unlike anything I have experienced. They actual helped clarify so many of my diagnosis, plus all of their physicians are on the same page so I never felt flung between two care providers opinions... I have such a hard time with that at home and it can lead to some confusing coordination of care! lol After thorough evaluation of my organs, the transplant team noticed minimal fibrosis. Many of my physicians in Seattle just kind of blame everything on fibrosis without really taking a look since Scleroderma is my main diagnosis. As it turns out, fibrosis was not the reason my digestive tract was paralyzed - and the reason I was always short of breathe is even more surprising!

The start of chemo.
Let's start with the digestive tract, all of my esophageal manometries, barium swallows, and gastric emptying studies preformed in Seattle have always shown, "classic Scleroderma findings." I guess I had always figured that meant fibrosis, but as I was explained in Chicago - that is not always the case! Their amazing GI did a head to toe scope of my digestive tract and found little fibrosis or strictures, meaning my paralyzed digestive organs were caused by something else. He explained to me that Scleroderma damages the vascular system resulting in nerve damage that causes weakness or paralysis of smooth muscle tissue; this leads to decreased digestive ability among other things. So from my understanding Autonomic Neuropathy (aka nerve damage caused by a lack of blood flow in my case) is what caused my digestive paralysis. AN is damage to the autonomic nerves as a result of an overactive immune response to connective tissue. Yes, even nerves consist of connective tissue! The autonomic nervous system aids in everything from digestion, to respiration, to heart rate, to blood pressure! You can imagine how damage to these nerves would cause mass havoc on the body. The smooth muscles in my digestive system atrophied due to the nerve damage, and eventually become severely slowed, or even paralyzed. This lead to my inability to swallow, or digest food that did make it to my stomach; It was also the reason I would soil myself multiple times a day. The muscles too weak, and the nerves too damaged to function. I honestly had no idea that my illness affected the nervous system in this way!

My Stem cell Infusion!
My recent breathing issues are actually somewhat similar, as in they are also a consequence of damaged autonomic nerves and smooth muscle tissue. As a brief back drop, in summer 2015 small amounts of fibrosis and heavy inflammation were found on my CT scan, my DLCO dropped dramatically, and I started de-saturating during 6 minute walk tests. As a consequence I was put on supplemental oxygen. After 9 months of chemotherapy the fibrosis had dissipated from my scans and the inflammation was all but non existent. I was off oxygen for many months when suddenly I started becoming short of breath again post chemo, my heart would pounded right out of my chest. I was placed back on oxygen without proper follow up. I begged my doctors to do another CT to see if the inflammation & fibrosis was back, but due to my age they decided, "I didn't need to the radiation." Basically, they pulled a 'we don't need to know what the problem is if you already have the answer: oxygen.' I spent months frustrated, and unable to breathe, even at my 2LPM. Chicago did all the proper tests, and even some that Seattle had never preformed! (Always, always get a second opinion!) The team found that my lungs were still clear of inflammation & fibrosis after a CT scan, but when I did my six minute walk test I lost consciousness suddenly, even though my 02 stats stayed within normal limits just before the incident. Obviously my lungs weren't the problem at this point in time, and neither was oxygenated blood! Meaning I didn't need the oxygen - also meaning I probably never needed it after chemotherapy. (Again, always, always get a second opinion!) The wonderfully docs in Chicago ran a test called a CPET which looked at how all my systems function together, not just one system at a time. This test gave us a wealth of knowledge regarding my odd condition! Turns out my Autonomic Neuropathy was more wide spread than just my digestive tract, heavily effecting my heart, and brain! In a nutshell the damaged nerves caused a condition called POTS which left my body unable to cope with any exertion. Basically, it didn't remember how to adjust blood pressure, heart rate, or blood flow when I was talking, walking, standing, or basically using an effort besides just lying down. All that oxygenated blood ended up pooling in my lower body and not going to my brain which would cause Cerebral Hypoxia. My brain in turn would freak out from not getting proper blood flow, leading to a starvation of oxygen, and tell my heart to pump more blood causing it to overwork. Beating upwards of 150BPM by simply walking, causing serious hyperventilation as I gasp for air my brain is telling me I don't have. Eventually my body would just shut down by passing out. Luckily, this was not an oxygenation issue, it was a blood flow issue. The doctors who figured all this out (a team of three to be exact) prescribed special waist high compression garments to keep blood from pooling in my lower body, as well as a few medications to slow the heart rate. It also doesn't help that I have such a poor working diaphragm due to smooth muscle tissue damage. (My body hates me! lol)

Basically I went to Chicago, and everything I thought I knew about my diagnosis changed. It's incredible what new sets of eyes can do for a patient that fell into stagnant care. While I talk mostly about Scleroderma on my blog, it is only one of many clinical manifestations of Mixed Connective Tissue Disease, my full diagnosis. MCTD is a rare autoimmune, connective tissue disease with features of three distinct diseases, paired with the findings of high U1-RNP antibodies. The three distinct diseases are Scleroderma, Lupus, and Myositis. This is why MCTD patients are extremely unpredictable, and extremely hard to treat - we are made up of so many illnesses, what do you treat first?! While we have manifestations of all three diseases, we are also our own separate entity with our own quirks. Chicago had actually never treated a patient on an MCTD protocol for this reason; however, after reviewing my case, especially with the severe history of scleroderma in the vascular system and digestive system, I was approved to be the first patient treated specifically for MCTD!

The researching physician!
I won't keep you in anticipation, while I barley survived the transplant, it seems so far to be super successful! While fibrosis cannot be fully reversed, nerves can be repaired, inflammation can be removed, muscles can be rebuilt, and the body can begin to finally heal! Why is this? The high levels of chemotherapy completely wiped out my old immune system (bone marrow) essentially erasing disease. The new immune cells transplanted were just babies, not programmed with disease like my old cells. This new immune system, created by my hematopoietic stem cells, is no longer attacking my connective tissue - meaning locations like the autonomic nervous system have time to heal themselves, instead of being contently beaten down. As my cells began to en-graft, we started transitioning to food in the hospital, and I haven't had a tube feed since! I CAN EAT AND DIGEST FOOD!!
I never, ever thought I would say that again! I can practically feel the peristalsis move down my esophagus, and it's incredible! Food no longer stays stagnant in my stomach, and I no longer soil myself! It's not perfect, but it's enough to sustain a human life! I truly feel like I received a miracle - a miracle I worked my ass off for! lol ;) My shortness of breath has also decreased, and so have my POTS symptoms which is amazing - though that may be attributed to the waist high compression garments as well. There are still things I feel have yet to changed, such as my joint swelling and pain, but I am told I'll start to notice more and more improvement over the next few years! For now I recover, and grow my new immune system!

I am extremely grateful to my Scleroderma Specialist who referred me to the HSCT program, and of course the team of researching physicians in Chicago that just added so many years to my life! I am also humbled, and overwhelmed with love, by everyone who supported me on this journey through their beautiful comments, kind messages, fundraising, or simply quiet prayers.

For the first time, in a long time, I am so excited for what the future holds!