Waiting for ‘Day 100’

Women’s hockey forward Mandi Schwartz ’11 left the hospital Wednesday after a 31-day stint for a stem cell transplant.
Women’s hockey forward Mandi Schwartz ’11 left the hospital Wednesday after a 31-day stint for a stem cell transplant. Photo by DSPics.

After a crucial stem cell transplant, 31 straight days of hospitalization and six days in intensive care, women’s hockey forward Mandi Schwartz ’11 is finally on the mend.

Schwartz, who has battled acute myeloid leukemia since December 2008, departed the Seattle Cancer Care Alliance at the University of Washington Medical Center for an apartment in downtown Seattle last Wednesday. Doctors green-lighted the Saskatchewan, Canada native to leave the hospital once the transplanted stem cells engrafted in her bone marrow, beginning to manufacture new blood cells and her health improved. But with her immune system still low and susceptibility to disease and infection high just 36 days after the transplant, Schwartz’s recovery will not be over until she reaches “Day 100” — the point at which most transplant patients are healthy enough to return to their homes.

“It’s really exciting and I’m very thankful that it worked,” a weary-sounding Schwartz said of the transplant Tuesday from the apartment she shares with her parents in Seattle. “[I’m] still praying every day that it keeps working.”

‘IT FELT LIKE A YEAR’

After more than 18 months of treatment, Schwartz’s cancer returned for the third time in early August. Doctors fought to push the cancer into remission again so they could perform a potentially life-saving stem cell transplant, and they reached this goal by the end of August.

Schwartz’s most recent stretch of hospitalization — which began in mid-September as doctors readied her for the stem cell transplant — was a trying time for the forward and her family.

Preparation for the procedure, or the “conditioning process,” as her father Rick Schwartz called it, started on Sep. 15. Mandi received three days of radiation, followed by three days of chemotherapy and one day of rest. On Sept. 22, doctors carried out the stem cell transplant, changing Schwartz’s blood type in the process.

The procedure took 32 minutes and there were no complications, Dean Forbes, a spokesman for the Seattle Cancer Care Alliance said in late September. But Mandi’s recovery has been far from smooth sailing.

“The whole time in the hospital wasn’t pleasant,” Rick said. “It was a lot of pain and suffering over this period of time, there’s no question about it. It wasn’t easy.”

Mandi’s mother Carol Schwartz said her daughter had a white blood cell count of zero and no antibodies of her own immediately following the transplant, putting her at high risk for infection.

Mandi experienced reactions to antibiotics that made her delirious and caused her to hallucinate for nearly three days before doctors traced the symptoms to her medication, Rick said. The forward’s health declined, Rick said, with mucositis (painful inflammation in the intestinal tract), fevers and nausea racking her body. Because of kidney damage sustained during chemotherapy and radiation, Mandi started to retain fluid. When the fluid retention began to impair her breathing and cause lung inflammation, doctors moved Mandi to the intensive care unit on Oct. 4. At one point during her six-day stay in the ICU, Mandi had about 30 extra pounds of fluid in her system.

Rick said Mandi spent most of her time in the hospital sleeping. When she was awake, Rick said, she was in pain and vomited frequently.

“We had some very stressful times in that year — or in that month,” Carol said. “It felt like a year.”

But in time, Mandi’s condition improved, and a bone marrow biopsy conducted 28 days after the transplant showed that the stem cells had engrafted and started to manufacture new blood and immune cells in her body.

With the go-ahead from doctors, Mandi Schwartz moved from the inpatient unit of the University of Washington Medical Center to a Seattle apartment with her family last Wednesday.

‘NURSES AT HOME’

Mandi and her parents are currently staying at an apartment in the Pete Gross House, a facility affiliated with the Fred Hutchinson Cancer Center and Seattle Cancer Care Alliance that houses only transplant patients. The hockey forward goes to a clinic every day to receive blood and platelet transfusions, her father said. She often stays there for four to five hours at a time.

“It feels really good, but it’s very tiring,” Mandi said of leaving the hospital. “I haven’t had much time to do anything but sleep and walk slowly around again.”

When she first left the hospital, Mandi said she tried to begin exercising again. She rode a stationary bike, but had to stop because her muscles became “really sore” and left her barely able to walk. Now, a week later, Mandi walks about 15 minutes to and from the clinic each day. While she is still weak and sore, Mandi is “feeling much better” on the whole, her father said.

“Right now it’s a lot better because after 31 days in the hospital and finally getting out and seeing a light at the end of the tunnel, her spirits have improved,” Rick said.

Rick said he and Carol are like “nurses at home,” administering saline and antibiotics to Mandi. In addition to the treatment she receives at the clinic, Rick said his daughter takes about 30 pills a day.

Carol said Mandi’s bone marrow has started producing white blood cells, but her red blood cell and platelet counts remain low. The hockey player is also at risk for graft-versus-host disease, a potentially fatal condition which occurs when transplanted cells attack the body. Acute graft-versus-host disease can set in up to 100 days following a transplant, according to an update on the Yale Athletics website.

Mandi had her transplant 36 days ago today, and she will undergo another bone marrow biopsy in Seattle 80 days after the initial procedure, Carol said. One hundred days after a transplant, she addded, the average patient has recovered enough to return home. In the long term, Carol said the family plans to go back to Saskatchewan. It will take about a year for Mandi to fully recover from the transplant and rebuild her immune system, Carol said.

“We’re holding up,” Carol said. “Every time [Mandi] takes a step forward, we lighten up by about ten years because it’s like she’s on the right track. But then every time she has a setback, we have a setback.”

ON THE HOME FRONT

Despite her prolonged absence from campus, Mandi’s teammates continue to make sure her presence and story are not forgotten at Yale.

Hilary Witt, who served as the Bulldogs’ head coach for eight seasons before departing in July to pursue other interests, said she has kept in touch with the Schwartz family and visited them in Seattle in early October.

“It was just a constant reminder of how hard [Mandi] fights,” Witt said of her visit. “She’s got good days and she’s got days that aren’t as good, but she continues to battle and fight through and, knowing Mandi, you don’t expect that to stop.”

The women’s hockey team has dedicated its first home conference game, against Rensselaer Polytechnic Institute on Nov. 12, to Mandi. Called a “White Out for Mandi,” the team is encouraging fans to wear white and pack Ingalls Rink. The squad will collect donations for the Schwartz family instead of charging admission.

Aleca Hughes ’12 said the team has lined up individuals and organizations to pledge a donation for each spectator that attends, with contributions ranging from 10 cents to one dollar for each fan.

Mandi still appears on the 24-person team roster — listed as a senior forward, number 17. All members of the hockey squad sport her number on back of their helmets, said Bray Ketchum ’11, and a dedication to their teammate also hangs in Ingalls Rink.

“When you walk out of our locker room it says ‘You will never walk alone’ on the back of the door with [Mandi’s] number on the bottom,” Ketchum said. “We’re always thinking about her when we enter the rink and when we leave.”

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