Looking Forward

23 September 2007. It’s just two days from now and Yam celebrates the first year anniversary of her bone marrow transplant. Sounds remarkably good? It is.

Two days ago, she was discharged from a five-day hospitalization at the Asian Hospital in Muntinlupa after 13 days at the San Pedro Hospital, Davao City. She had intermittent fever and persistently low blood counts. Relapse was ruled out while still at San Pedro. Infection with the dreaded cytomegalovirus was ruled out on her third day at Asian. She still has low blood counts which she needs to recover from before going back to school, perhaps in a week.

Setbacks are not uncommon to patients like her. After transplant, she bounced back fast. She engrafted two days earlier than usual, was discharged a week earlier than most, and was cleared to travel back to Davao three weeks earlier than the 100 day mark. It was generally smooth sailing from here with few setbacks. These included the need to administer valganciclovir to control cytomegalovirus two days after her initial discharge last October, an involuntary muscle contraction due to ion imbalance last February, hives in July, a bacterial infection in August, and this period.

Looking forward to the first year anniversary, was it really worth all the risk? We considered two views. First, that of medical science:

"The hope with a transplant is to cure the underlying disease," says Christopher Bredeson, M.D., M.S., assistant professor of medicine at the Medical College of Wisconsin. "Chemotherapy, on the other hand, is not a cure..." Relapse rate in chemotherapy patients is very high, while in the transplant patients it is much lower. That would seem to make a transplant the treatment of choice -- no question. But there is another factor to consider: there is up-front mortality with BMT. Between 20 percent and 40 percent of patients die of complications directly related to bone marrow transplant. One of these is Graft-vs-Host Disease (GVHD) which occurs when the cells from donor bone marrow attack the host cells it considers foreign.

"It's a balancing act," Dr. Bredeson says. "In a young patient, a transplant may be worth the risk for long life. In an older patient who says 'I just want to see my grandson get married in the fall,' it may not be."

Our view when we were in the maelstrom of decision-making was perhaps typical of parents. We just wanted to do everything and anything for our daughter. We didn’t leave things to chance, we didn’t relish the thoughts of, “what if…”, “why didn’t we…”. We confronted the situation like it was war, and we were determined to win. Or if we were to lose, then we lose with our boots on.

Now, more than a year after deciding on the transplant, we feel secured of our decision. The setbacks, preventive measures, periodic check up and treatment our daughter needed to go through after the transplant are but integral consequences of that decision.

Today, we are looking forward to relish our daughter’s long, meaningful life, and to better appreciate the "why" of all these things. These, to us and the countless good Samaritans who helped us, is the heart of the matter.