Even though last week I mentioned the diversity of the group of patients I observed, this week surprised me even more! And that's mostly because I got to observe inpatient rounds with Dr. Noel and the Hem A Team, as well as seeing patients with Dr.Sproat. A huge thank you to everyone for letting me tag along!!!
So last week I got to a bone marrow biopsy and this week I actually got to see an actual stem cell transplant! I was warned it would be a bit anticlimactic but I think it was a must for me to watch. The stem cell transplant looks pretty much like a blood transfusion. The patient usually gets a few pre-medications (Benadryl, Tylenol, steroids), the stem cells are given through the trifusion catheter (long-term catheter, used to give IV fluids, and chemo), then the nurses check their vitals and monitor the patient closely. The actual amount of time the transplant takes depends on the volume of the stem cells but I think it averages around 60-75 minutes.
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| Peripheral Blood Stem Cells in a bag |
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| Trifusion Catheter |
I think seeing both inpatients (during rounds with Dr. Noel) and seeing outpatients (with Dr.Sproat) has been really helpful. I mean these are drastically different patients. On the outpatient side, you mostly have people who are at least six months out, more likely years out, who have overcome the hump of transplant. Most of these people are dealing with side effects of the transplant (e.g graft versus host disease) and are on lengthy drug regiments (immunosuppressants for GvHD, antiviral, antibacterial, antifungal, etc.) but for the most part these people got their disease under control. On the other hand, inpatients are in the process of undergoing chemo or have just had their transplant done. In other words, people are pretty much in their worst state at this point. Seeing both of these kinds of patients has given me a better understanding of my study and why people might lose weight.
Anyways, still waiting on the data analysis which should be coming shortly. See you guys next week!
I'm looking forward to the results Justin. Not many students your age get to witness and partake in both of those settings so I bet you feel pretty awesome to get to do that.
ReplyDeleteYeah. I heard the results should be back at the end of this week or latest, early next week!
DeleteHi Justin! I think that it is awesome for you to watch a stem cell transplant, even if you said it was somewhat anticlimactic. I am looking forward to seeing the data analysis in the next few weeks!
ReplyDeleteYup. The results should be back soon!
DeleteHi Justin! Wow seeing a stem transplant must be awesome! When transplanting a stem, are the doctors aware of the side effects that could take place after? If they are is there any possible way it can be done without such terrible after effects?
ReplyDeleteLooking forward to your data analysis! :)
Hi Sruthi. During the time immediately after stem cell transplant, nurses are constantly monitoring the patients vitals and making sure they don't have any sort of allergic reaction to the stem cells (given steriods pre-transplant for this purpose). But given that our current typing system is pretty advanced, this sort of thing doesn't really happen too often. The biggest, most common three side effects post-transplant, from what I've observed are gastrointestinal problems (nausea and vomiting), infection, and GVHD. These side effects are sometimes inevitable but are monitored and treated. For nausea, patients are on anti-nausea medication (e.g. Lorazepam, Ondansetron). Because chemo leaves patients with no virtually no immune system, patients get anti-viral/ anti-fungal medication (e.g. Acyclovir for prevention of shingles and Fluconazole for prevention of a variety of fungal infections). And finally, the biggest side effect of transplant is graft versus host disease. There is medication for GVHD, such as Prograf and Cellcept, but most patients still get some GVHD, whether it's acute or chronic. GVHD can effect really anywhere on your body, including skin, GI tract, mouth, etc. Sorry for the super long response but hope that helped!
Deletethank you! that was long but it really helps me :)
DeleteHi Justin! It's so exciting that you got to do inpatient rounds and observe the patients this week! What specifically did you observe from the patients that helped you have a better understanding for the weight loss? I am looking forward to see your results. See you next week!
ReplyDeleteI think it's their overall state post-transplant. Many of the transplant doctors who I've shadowed have told patients to try and walk around in their rooms after transplant and eventually go through some physical therapy but for many patients, it's really painful. Also, keep in mind that the patient population I'm observing is already on the older side, so fatigue, osteoporosis, and other pre-existing conditions worsen the issue. On top of that, many patients reveal that chemo and the large amounts of drugs (first given intravenously as an inpatient, then as oral pills as an outpatient) have killed their sense of taste and their appetites. Again this could also contribute to weight loss.
DeleteInteresting...What other symptoms did you see in post transplant patients?
ReplyDeleteHey Aditya. I think you and Sruthi were asking the same thing. I gave a pretty in-depth response to her so please see my response to her above!
DeleteHey Justin. It seems that this week was a quiet one. Does being an inpatient or outpatient affect weight loss in a person? Keep up the good work.
ReplyDeleteOf course! Patients are only discharged from the hospital once their blood counts (RBC, WBC, Platelets, etc.) have recovered, meaning the new stem cells have started to engraft. Additionally, you have to be comfortable enough to get around and your medication is given as pills, not intravenously. Most inpatients are bedridden, and some are too weak to even move around. For an inpatient, you can't eat the foods you want and you are being woken up regularly to check your vitals and be given post-transplant medication. So I think the majority of weight loss occurs as an inpatient, and patients slowly gain their weight back as an outpatient.
DeleteWoohoo! That's super great Justin! I'm glad you got to tag along and watch the whole process in action again this week! Keep enjoying your last 2 weeks!
ReplyDeleteI will thanks!
DeleteHi Justin! Glad to see you're enjoying your experience. Were there any specific factors of the patients that affected weight loss for each? Thanks and see you next week!
ReplyDeleteI think that specific factors that effect weight loss really vary from person to person. Some people feel more nauseous and fatigued than others. Even the side effects of post-transplant medication really varies from patient to patient. I think the three big culprits of weight loss are infection, GVHD, and nausea. I talked about these three things in depth in my response to Sruthi so please check that out if you would like to know more.
DeleteHey Justin! Its so cool that you are getting experience actually seeing these transplants in action since you have been researching them for so long now!
ReplyDeleteYup! I think so too!
DeleteHi Justin. Can you explain the negative aspects of chemo. Why do people have to do chemo?
ReplyDeleteMany chemotherapy drugs are cytotoxic and to be honest, chemotherapy drugs are toxic for different reasons. But I'll use a helpful analogy Dr.Sproat told me. If you drive a car in Arizona (versus a state with less extreme heat), your tires will burn out faster because of the heat. That's essentially what chemotherapy does to your body: it accelerates your bodies aging in a way. As for the reason behind chemo, it kills the cancerous cells in your bone marrow (or inhibits the growth of cancer cells). Because chemotherapy also kills your healthy bone marrow cells, you need a stem cell transplant to replace them.
DeleteHey Justin. So if stem cells were put into a healthier patient, would this change the results of weight loss, and would there be any way to account for this in your data? Would it be necessary at all for the patient if they were recovering, but at a slow pace (basically does it just accelerate the rate of growth of cells lost from chemo, and how willing are doctors to use it?)
ReplyDelete