I’m going to break this down by symptoms.

Taste and Appetite: Somewhere around the middle of conditioning chemotherapy my taste got messed up in the all to familiar way that comes with chemo. Water starts tasting like dirt and becoming unpalatable. Other foods become bland. Sweet tastes seemed to be preserved best. My appetite bottomed out around days T+4 to T+6. On those days I was only really getting nutrition from Ensure Clear supplements and Naked Juice protein smoothies. Fortunately I did enough that tube or intravenous feeding never became a real consideration.

Nausea: Overall my nausea was relatively well controlled. I threw up twice during conditioning chemotherapy and twice in the days post transplant — always in the evening and usually when I was trying to force down pills. My stomach felt unsettled frequently but I was rarely hit with intense waves of nausea. The medications seemingly did their job.

Fatigue: In the early days of my hospitalization I was walking up to a mile in the hallways over the course of the day. After transplant doing 2–3 laps of the unit a couple times a day was all I could tolerate. My fatigue was worst the days I spiked fevers. On those days I was lucky to get out of bed. The fatigue significantly improved once I engrafted.

Mental Fog/Chemo Brain: It’s honestly hard to pinpoint when this was at its peak. The entire process already seems like a blur in retrospect but there definitely were days where I couldn’t watch more than 20 minutes of a movie at once. Fortunately it seems to be improving significantly now that I’m out of the hospital.

Mouth Sores: Oral mucositis is one of the chemo effects I dreaded most, as for some people it significantly limits the ability to eat and can necessitate pain medications to control. Thankfully, I never developed any mouth sores. I was very diligent about keeping ice in my mouth 30 minutes before, during, and two hours after Melphalan on day T-2.

Diarrhea: I may have dodged one bullet with Melphalan, however the other hit me squarely in the chest (or should I say intestines). I was warned ahead of time that Melphalan tends to cause some awful diarrhea. What I wasn’t prepared for was how awful. As in 20+ trips to the bathroom some days kind of awful. As in having to diligently use baby wipes after each trip kind of awful. As in taking the dignity hit of having to wear Depends on the worst couple of days kind of awful. The symptoms did significantly improve once I engrafted and I’m getting closer to normal now, but symptom wise it might have been the worst of the whole stem cell process.

Mental State: Overall I think I weathered the entire process about as well as could be expected. That said when I spiked fevers up to 103 on day 6, I not only felt pretty miserable, but I also got pretty anxious/depressed. At that time, my neutrophil count was zero and I was significantly concerned that an infection could interfere with engraftment and potentially be fatal. Fortunately that proved not to be the case, but for those 24 hours I was in a pretty dark place.

Also the days from transplant to engraftment seemed to crawl by. It’s demoralizing looking up at a neutrophil count of 0 for seven consecutive days. Conversely though you get an incredible morale boost when those numbers finally start climbing back up to normal.