Okay- so Day -1 is what the clinicians call it, but it is actually the most important day in the transplant process. On Day -1, which for me was Thursday, July 11th, I got my 200 mg/m2 of Melphalan. Melphalan is an old chemo, invented back in the 1950s, and is a derivative of nitrogen mustard (yes the same stuff they made mustard gas out of). It has a lot of nasty side effects, including nausea, vomiting, fatigue, hair loss, mouth sores, and it is profoundly myeloablative–which means it targets the bone marrow and pretty much wipes out everything there. That is why it works so well against myeloma, because of course the malignant plasma cells hang out in the marrow. I already lost all my hair last week from the stem cell conditioning agents they gave me so I’m not too worried about that . I chewed ice and sucked ice water down for about an hour ahead of time and an hour after to try to prevent the mouth sores (also called mucositis). The coldness constricts the blood vessels and can help keep the melphalan out of those cells to an extent. Got the poisen at about 1pm- kind of anticlimactically I felt just fine afterwards. Probably all the steriods and antiemetics they infused into me helped. Mom and I did some grocery shopping in the early evening, had some frozen meals at the apartment and took a steamy post rain walk through Duke Forest. Its been so wet, it felt like a Pacific Northwest forest, all full of fungus, mushrooms, falling sodden dead trees- very interesting. Was pretty tired but managed to stay up til 10pm. Dr. Giralt at MSKCC says during a transplant “the bed is your enemy during the day and your friend at night” so I have to try not to crash too early. Off to sleep now though after my nightcap of a protein shake with peanut butter and banana.