Journal entry by Leslie Cavanaugh

Day +17

Alyssa’s big news, as of Tuesday, Day 14, is, she is 100% engrafted!! This is very exciting news and way earlier than expected.  Her blood counts continued to rise this week, but we had a little setback last night when she spiked a 103 fever.  Tylenol brought it down fairly quickly and the doctors were not concerned.  This does delay her Day Pass, as they want her fever free for at least 24 maybe on Sunday.  Her blood counts this morning dipped a little from the rise she had been getting from last 5 days.  Perfectly normal, we are told.  There will be ongoing fluctuations for many weeks to come and no reason for concern.  Alyssa has been able to leave room for PT since Wednesday and yesterday actually did 1.5 miles on the stationery bike.  Pretty impressive considering where she was at just a week ago! They are hoping to get her off her pain pump this afternoon. This is a big step.  She will still have the option of getting pain meds through her IV as needed, but getting off the pump means that she is not hooked up to monitors 24/7. Her IV nutrition (TPN) is also being reduced again today.  Which means she’s got to start taking in calories by mouth.  She is eating a little more each day, but still it’s a battle.  She doesn’t really have an appetite and nothing tastes the same anymore.  She is forcing herself to eat only because she knows that’s what she has to do to get out of here.

While Alyssa continues to improve, I want to stress that she still has a long road ahead of her for recovery.  I think it’s been a bit misleading to some, that as I’ve reported all this good news, that she’s almost back to normal. Bone Marrow transplant is a grueling procedure.  The conditioning process (total body irradiation and extremely high dose chemo) she went through prior to her transplant can literally be fatal to some people. The mucositis, fevers, diarrhea and GI issues land a lot of patients in ICU. The excellent physical shape she was in prior to transplant has played a major part in how she’s handling everything now. With that being said, it can take up to 1-2 years for her to be fully recovered.  It will take at least 6 months for her immune system to be fully functioning again.  In the meantime, she will remain suspectible to infections. Hospitalizations after discharge are very common, which is why we need to stay in Cincinnati until late May.  And they will ALWAYS remain vigilant regarding relapse of her cancer.  She will have her first post-transplant biopsy done right before she’s discharged to confirm there are no cancer cells.  Blood work will be done, probably several times a week at first, and ongoing biopsies will be spread out over the next year.  She will also need something called IVIG.  This is a drug that will help boost her immune system while she’s recovering.  The doctors decided earlier to do something called T cell depletion on Eric’s stem cells...that, combined with the ATG she took prior to transplant, has greatly reduced the odds that she will get something called Graft vs.Host disease (GVHD), which can be life threatening. This is when the body sees the new cells as invaders and attacks them, almost like an organ rejection.  She went through hell for the 3 days she was on ATG, so now that that is behind her, it’s going to pay off going forward.

I certainly don’t want to end this entry being all doom and gloom, because the reality is, she is doing everything right and this has been a textbook case for BMT. Her doctors are ecstatic with her progress. BUT I need to be realistic; she’s going to have bad days along with the good ones.  I know she feels the love and support from everyone.  We want to thank everyone for all the kind words, cards, gifts etc.  They are greatly appreciated.

Journal entry by Leslie Cavanaugh

Day +14

On Friday, her BMT doctor threw down a challenge that she would get her ANC to 500 by Monday.  She was at 30 when he made this prediction.  Monday comes, she’s at 810.  Today her ANC was 1170!!  Her engraftment is really moving along nicely.  They are VERY pleased with what they are seeing.  The only setback she had was getting this Enterovirus last week.  Even though it’s fairly common and there’s nothing to do as far as treatment, it does prevent her from walking in the hallways.  The protocol is she has to wait 28 days to do that after testing positive, and hopefully we’ll be discharged by then. This is for the protection of other patients, not her.  People with normal immune systems would not even know they were exposed, much less show symptoms.  But because every patient on this unit is immunocompromised, they can’t take a chance of possible exposure.  There is a Plan B though...PT and OT can get her out of the room and take her downstairs to a workout room.  She has to have an ANC above 500 for 3 consecutive days.  So it looks like tomorrow might be the day.  

As her cells start start coming in, she’s going to feel kind of crappy.  This is normal.  She is having more flu-like symptoms (no fever) but just general muscle/joint aches and pains and low energy.  Dr. Nelson said she will feel like this a few more days.  There is a good possibility that she may even get a “Get out of Jail Free” card, otherwise known as a 4 hour pass from the hospital.  Lots of things need to happen fever, weaned down on pain meds, and able to eat some solid food.  So, not 100% sure all that will happen, but it’s out there as a goal for the weekend.

They will be doing a blood test tomorrow to see what percentage of her cells are Eric’s.  If everything goes according to plan, as time goes on, each day more and more of her cells will match Eric’s DNA until eventually all her blood/cell DNA will match Eric’s.  For all you CSI fans, yes, if one of them commits a murder and leaves blood traces at the scene, the police will not know which one of them did it (As I’m reading this back, I’m imagining myself as the murder victim, and honestly either one of them could be a strong suspect.  Just a random thought as I enter Day 23 in this 10x12 room 🤔)

Keep the prayers and good vibes coming!

Journal entry by Leslie Cavanaugh

DAY +12
....And we have engraftment!  4th consecutive day of positive cell growth.  ANC is at 380! (48 hours ago it was at 30) Her main BMT doctor stopped by late Friday afternoon and predicted she would be at 500 by Monday.  We looked at him like he was crazy, but I guess he knows what he’s doing because 500 by tomorrow seems pretty likely.  The doctors are happy with everything they are seeing.  She did catch a virus (Enterovirus) which is causing some GI issues.  It’s a very common virus, nothing they can do to treat it and it’ll just have to run its course. They only other thing that’s bugging her, is she’s having some type of allergic reaction to something...very itchy skin.  She’s going through tubes of hydrocortisone cream to try to help.  They really don’t want to put her on an oral steroid at this point. They’re going to try another antihistamine to see if that will help.

They have already started reducing the nutrition through the IV, and will continue with that.  She actually asked Eric to get her some fried rice last night.  That’s the first time she’s asked for food in over a week.  Granted, she only had a few bites (taste buds are ALL screwed up) but hey, it’s a start.  Pain from mucositis is most definitely improved and they are continuing to wean her off pain meds as well.

All in all, a really great weekend.  Everything is going just like they hoped and I can only pray that this will continue.  We got moved into our rental and it feels great to spread out a bit.  It’s a very charming older home and perfect size for what we need.  I even cooked dinner for the first time in a month.  Felt wonderful eating something besides takeout and hospital food.

Journal entry by Leslie Cavanaugh

Day +10:
Things are going as well as can be expected with Alyssa.  The big news is, she does have some white blood cells coming in!!  This is the first sign that “something’s cooking in there”. It is still early, and they could drop BUT she’s had cell counts for 2 days in a row now.  They also look at her ANC (absolute neutrophil count).  That is another way of measuring neutrophils, which are a type of white blood cell.  Normal ANC is above 1500.  A “safe” number is above 500.  Alyssa’s was 60 yesterday, it was only 30 today.  But at least there was a count...she had been at zero since transplant day on February 19th. Her ANC needs to be above 500 before she will be allowed to leave her room.  We’ve been told that once engraftment really takes hold, that number can jump significantly in just a matter of days.  

Alyssa has labs drawn every morning at 4am.  They are posted online in her My Chart account around 5:30.  So it’s the first thing I look at when I wake up.  We have all her lab reports before the doctors even do rounds, which is awesome.  The timing of rounds varies betweeen 8:30-11:30 every morning.  I would be going crazy if I had to wait that long to find out what her counts were.  So for last 2 mornings I’ve been arriving at the hospital with a huge smile on my face.  The doctors are a bit more poker faced...they don’t want to get too excited yet since it’s still early, but if I prod them enough, I can get them to admit, that yes, this is all good news.

Her throat pain is getting better, but she is still on her pain pump.  She will probably need that into next week.  She’s also had some GI issues that are causing her a lot of distress.  All normal side effects of the transplant, we are told.  They are going to slowly start weaning her off the TPN (IV nutrition). She’s able to swallow liquids and pills, but still doesn’t seem interested in actual food (have no idea what THAT must feel like). She’s awake more now during the day and her physical therapist that comes every day has been awesome about getting her up and doing something. It’s just hard when she is stuck in one small room.

On a side note, we are leaving the hotel today, which has been home for the last 19 days.  We get into our Airbnb this afternoon; it will be nice to be able to spread out a bit.  The house also has some outdoor space. I’m assuming at some point in the next 3 months, the sun will actually shine again and it will start to warm up.

One thing I have learned over the last few months, is not to get too excited about potential good news.  But, it’s hard NOT to be excited when you see the lab reports and for once her body is doing something it’s suppose to be doing to get her healthy.  Please continue with prayers and positive vibes, they are helping!

Journal entry by Leslie Cavanaugh

Day +4 
There’s really not much going on right now...her WBC is down to zero which it will remain at for awhile. She did finally have to say goodbye to her hair on Thursday night. It was literally falling out in clumps after the radiation and chemo.  She was miraculously able to keep her hair after 4 previous rounds of treatment, but this dose of chemo was extremely high, and then add on Dr. Nelson told her, he’s never had a patient keep their hair going through BMT.  So, no shock she lost it and of course she took it all in stride.  

The mucositis has taken its hold on her gut, mouth and throat.  Think of the worst strep throat pain you’ve ever had, and then multiply it by 10.  She’s on a continuous pain pump that she can control, but each day they come in to adjust the dose higher.  It’s becoming impossible for her to eat, so they are going to put her on IV nutrition for now until this clears up, probably when her cells come in.  She spends most of the day sleeping, which is good.  When she is awake, she is coherent and watches an episode or 2 of Grays Anatomy before drifting off again.  This will pretty much be her pattern for next 2 weeks.

Eric and I are adjusting to this schedule as well.  The days are all starting to run together and I guess it’s a blessing the weather has been so crappy.  The boys are on their way up today, so I know Alyssa will be happy to see them. 

Journal entry by Leslie Cavanaugh

Dear friends and family...I have a request.  For next 2 weeks or so, please refrain from calling or texting Alyssa.  She feels like total crap right now.  Her words “I know they love me, but I just don’t feel like responding but I don’t want to hurt anyone’s feelings”

Feel free to text me during normal hours if you’d like an update, but there’s not going to be much going on for at least 2 weeks.  I’ll be sure to put anything significant on here.
thank you!  Prayers are ALWAYS welcome!

Journal entry by Leslie Cavanaugh

Today is Day 0.  Her new birthday really.  The transplant process itself was straightforward.  It was about 20 ml of Eric’s stem cells that they had in a large syringe and just put through her central line. (I will upload new pictures in the gallery) The real excitement will happen in about 2-3 weeks, when her new cells start growing in her marrow.  We will start obsessing (again) about her counts.  Strange that in just 5 short months, every waking thought begins and ends with blood counts.  While Eric and I are both terribly anxious about this transplant, I know he feels the extra responsibility of being her donor.  As if he has the power to make this cancer go away.  Or not go away.  The loss of control over this situation is so maddening.  You have to trust the doctors, the nurses, the lab reports, the clinical trials that said this is the best route to take, the chemo drugs and radiation that’s suppose to clear out the last bits of cancer cells, and last but not least, I must learn to trust GOD.  The daily devotional that I started reading when Alyssa got sick has been so spot on.  Today’s entry was no different....”You need to remember who I am in all My Power and Glory.  Then, humbly bring Me your prayers and petitions.  Your problems will pale when you view them in the light of My Presence.  You can learn to be joyful in Me, your savior, even in the midst of adverse circumstances”.

Journal entry by Leslie Cavanaugh

OK...apparently we are back on for transplant today! She finished the ATG around 5am and is feeling much better.  Hives are under control and they have given her a PCA pump for her to be able to control her pain medication.  I will update later, after she gets her new stem cells. 

Journal entry by Leslie Cavanaugh

Alyssa tolerated her 2 days of high dose Cytoxin (chemo drug) pretty well. Unfortunately, the second drug she is getting, ATG, is kicking her butt.  She has had a pretty severe allergic reaction...entire body covered in hives.  Also temperature is spiking and blood pressure keeps dropping. She has finished 2 days (2 bags) already, with one bag left.  The doctor has decided instead of the bag running over the normal 8 hours, they are going to half the rate, which doubles the time to 16 hours.  Then he wants a day in between before transplant day. So, bottom line, Day Zero, just got moved back to Wednesday.  A bit disappointing but rather safe than sorry on this. Alyssa is hanging in there, tough as nails but the last 48 hours has really been hard on her.

Eric spent about 5-6 hours at the infusion center today.  He will most likely be needed to go back tomorrow for addional donation.  Everything has gone pretty smoothly on his end.  Just some aches and joint pain from the neupogen shots.

Journal entry by Leslie Cavanaugh

This week has been both uneventful and remarkable at the same time.  She finished a total of 12 rounds of radiation (4 on her brain and 8 total body) and got to “ring the bell”. For those of you who don’t know, in the cancer world, anytime a patient hits a milestone in treatment, they ring the bell to mark the moment and celebrate.  So her first bell ringing in regards to finishing radiation was a big deal.  Today (Saturday) also marks the start of her last ever round of chemo 🙏🏻🙏🏻.  Today and tomorrow she will receive extremely high doses of a drug called cytoxin.  She will also receive over the next 3 days a drug called ATG.  ATG is given to patients to help prevent something called Host vs. Graft disease (HVG)  that is when Alyssa’s body would attack her new stem cells, thinking that they are a foreign body.  The condition is fairly common for BMT patients, but it varies in its severity.  With the last radiation treatment, that was also her last chance to leave her room for probably 3-4 weeks.  Her care here has been fantastic and the nurses are as awesome as the ones on 5east at Norton’s back home.  What kind of sucks is the actual room.  Very basic hospital room, on the fairly small side with one small window that looks directly into the side of the building.  If you’re only here for a couple of days, no biggie.  But when you are literally captive in a room with no natural light for almost a month, it can start to wear on you (well, on me at least) I did make a request to get her in a room on the other side of the hall where you can actually see daylight.  The nurse just came in to tell us they might have one available later today.  I got all excited and Alyssa just looks at me and tells me I’m high maintenance.  Oh well.  

She did get to see a new face yesterday (and today). Taylor made it up here around 4pm but she kinda of slept through his visit.  He’s on his way back up to her room shortly, so hopefully she can stay awake for this visit.  Ben is suppose to be here tomorrow. I think some new faces will cheer her up, if she’s not feeling too sick.  God knows she’s sick of my face lol.

Keep the prayers coming. We are on Day -3.  Transplant Day (Day Zero) is on for Tuesday February 19th.

Journal entry by Leslie Cavanaugh

First round of chemo in the books and Alyssa did great.  No signs of any nausea or extreme fatigue. She decided to go public with her fight and the outpouring of support has been overwhelming.  Please keep the positive messages coming, especially if you or someone you know is a leukemia survivor.  
Alyssa’s Story

Site created on September 7, 2018

Our beautiful 22 year old daughter was diagnosed on 9/5/18 with Acute Lymphoblastic Leukemia (ALL). She is a recent WKU grad where she played volleyball for 4 years, leaving WKU as their  most decorated female athlete ever. Alyssa is a fierce competitor and fighter.  We know with God’s grace and her tough attitude, she will see her way through this journey.