High dose chemo

The high dose chemotherapy regimen included Zac receiving a combination of carboplatin, etoposide and thiotepa over 6 days.  The stem cell transplant would take place 3 days after the chemo had finished.  The aim of this chemo is to completely obliterate rapidly dividing cells, such as cancer cells.  Unfortunately, this is a blunt tool, so it obliterates rapidly dividing healthy cells as well, such as those found in the bone marrow that go on to become red and white blood cells, and platelets.  Zac would require multiple blood and platelet transfusions and would be highly susceptible to infections as his white blood cells became non-existent.  He would be on a cocktail of drugs to mitigate the risks, including antivirals, antibiotics, antifungals and anti-sickness meds. 

One of the chemotherapy drugs, thiotepa, is secreted in the sweat and, if left, can lead to a painful, blistering rash on the skin.  For that reason we were told to bathe Zac 3 times a day and to change his clothes and bedding frequently.  The bathing initially took a lot of coaxing, he absolutely hated having a bath since the central line went in, but we found a little baby bath in the hospital that he tolerated.  We would see the return of the hyperhydration, although even more so during the thiotepa.  During the day he would often need to wee hourly and through the night we had him in nappies, aiming to change him every 2 hours.  Even so, there were many times that he would have completely soaked through the bed, resulting in multiple changes, bed disinfections and new bedding though the night.  Those nights were tough but, as we were still alternating, at least you knew you could head home the following night to sleep.  I can only imagine how brutally relentless those nights would be for parents on the ward doing it alone.