Yesterday day 19, and things were continuing to improve slowly. The diamorphine dosage was lowered and the throat was still getting better. It is now possible to eat all the meals, although care still needs to be taken when swallowing the food. If I'm eating anything bulkier than a soup I need to gulp it down with some fuild to prevent the pain in the throat, but atleast I was able to have lunch, breakfast and dinner without painkillers.

When the morphine was lowered from 2.2 to 2 ml per hour there was a notable difference in the way the mouth felt. The discomfort from the ulcer on the tongue became more apparent since it had been masked by the morphine. I also noticed that my hands especially the palms were becoming even more sensitive particularly around the base of the thumb on the webbed skin there and between the base of the forefinger. I looks like that is a sign of the graft vs host disease (GVHD) which is a characteristic of bone marrow transplants when the engraftment occurs.

The blood results did not show any increase from the day before, but it is quite common to experience a small change on one day followed by no change the next. However, the platelet and haemoglobin (red blood count) counts were almost the same, whereas the platelets would normally fall by a significant amount were there no engraftment as occured previously. It would be a case of waiting for the next day to see if the bloods stayed the same or moved hopefully in an upward direction.

The nutritionist/dietician was happy to see that I was eating, which meant the feed through the hickman line could be halved that evening, and if my eating progress continued would be halved again the next day, and that would be the last feed.

Today, once again, I am feeling just a little better than yesterday and sleeping more at night. Eating as you would expect is getting easier. The doctor also commented on the reduction in size of the ulcer on the tongue which only occurs when the white cell count starts to notably increase. The pain from the ulcer too is definately less than yesterday. The rash on both hands is still there, and very sensitive in places which also ties in with start of engraftment and hence GVHD.

Sure enough the blood results today confirmed this showing nearly a three-fold increse in the neutrophil count from 0.04 yesterday to 0.11 today. Although the neutrophil count is normally in the region of 5 - 12 this step seems to be significant enough even for my consultant to be pleased to suggest that engraftment is starting. The neutrophils form the majority of the white blood cells, around 95%, which explains why the haematologists always view increases in the neutrophils as a good sign.

I should have my last bag of the neutritional feed tonight provided I can maintain a good appetite. The only problem now is finding food on the menu that agrees with the stomach that you haven't eaten ten times, because the dishes soon become bland and tasteless. Maybe part of the reason for this is due to the chemotherapy that alters the taste for sometime. I've noticed water now has a funny taste to it, whereas tea still seems alright. I have been told that the taste will eventually come back, but my main concern is to keep the GVHD at a minimum.