6 Months Post-Transplant

I just celebrated my 6 month post-transplant milestone with a visit to the BMT clinic to see Dr. V. Good news: I didn't have to have a bone marrow biopsy-- just lots of blood work. (Well, that's more like awesome news for just for me.) Better news: Only 3 of the 8 medications I currently take are related to the transplant. I have had almost thirty different medications since transplant. Dr. V has been slowly taking me off the Prograf-- the anti-rejection medication. I am down by 80% now with no evidence of GVHD. Best news: DNA (STR) testing continues to show that greater that 95% of my blood cells are donor cells (Tracy's cells). The lab will never report 100%-- but this is basically saying just that. My old blood cells can no longer be detected. My bone marrow transplant continues to prove successful. A TRUE MIRACLE!

Day + 35 - Anything but routine

Yesterday’s short visit to the clinic has turned into a rather long trip from home. At least for Courtney anyway. After checking her lab results and seeing her platelets drop significantly, and seeing that her nausea was getting worse instead of better, they decided to admit her back into the hospital to run some tests. Dr. V said there was a chance that her symptoms and lab results could be due to Graft Versus Host Disease (GVHD). So, they wanted her to go to the hospital for a CT scan of her upper abdomen, where she’s been feeling pain the past couple of weeks, and an endoscopy to check her upper GI tract for lesions and to perform a biopsy to check for GVHD.

Her latests lab results:

Date	Platelets	RBC	HGB	HCT	WBC
1/10	65000	3.22	10.4	29.5	5.0
1/15	25000	2.58	8.2	23.8	5.5
1/16	23000	2.18	6.9	20.4	3.7

This morning Dr. V came in and shed some light on her suspicions. Apparently, the GVHD manifests itself in many ways and could be causing her to feel the way she’s been feeling lately – more nauseous and fatigued than before. She also said the drop in lab counts and the increase in nausea could be due to the Foscarnet. I asked why, if she’s been on the Foscarnet since she left the hospital, would her counts suddenly drop. She said that it can have a cumulative affect and cause symptoms and side effects after a couple weeks of being on the medication.

Her plan was to have the Esophagogastroduodenoscopy (EGD) (officially the longest word I’ve ever written or used), today and start her on a relatively low dose of steroid (prednisone) pending the results of GVHD that could take 2-3 days. Unfortunately, the doctor overseeing the procedure didn’t want to do it because her hemoglobin was too low. He said she needed to get blood beforehand. Even more unfortunate was the fact that there was no way to get blood in time to still be able to get the EGD done today. The GI doctor who visited her this morning said if it was him he would have done it today regardless. This is really frustrating because Dr. V. said that she expects Courtney to be feeling better almost immediately after getting the steroid. But now we have to wait another day before starting it.

So, after a long morning of waiting to find out when the EGD would be (she couldn’t eat until after the procedure) we finally got word that it wouldn’t actually be done today and she could eat. The rest of the day went pretty smooth as she had a nice long visit with her friend, Melissa, and had a routine CT scan. No results yet.

She did finally get her two units of blood this evening, so all should be clear for the EGD tomorrow morning. We’re hoping that if everything is good tomorrow and she’s feeling up to it, that Courtney could go back home tomorrow. Otherwise, she may be here for one more night.

We’re just hoping and praying that they find some answers and get her turned around in the right direction towards recovery. She’s really tired of feeling nausea and pain, especially when they prevent her from getting out of bed. So, while the visit to the doctor didn’t quite go as expected, we know that she’s back in the hospital for a good reason – to help get her back to her routine as quickly as possible.

Oh, one more thing. Aidan made a dramatic recovery at about 9:00 yesterday morning. When we left for the clinic at 8:45 he still felt warm and looked a little lethargic. Half way to the clinic my mom called to tell us that he was downstairs (he hadn't come down once on Monday) begging for food and acting as if he'd never been sick at all. He's been himself ever since. Thanks again for the prayers.

D 0 – Out with the old, in with the new

After a relatively good night of rest, Courtney woke just in time to greet the girl from Carter Blood bank who arrived just after 10:00 AM with a bag of stem cells. It basically looked like a bag of blood. The bag was hung from the IV pole with care, and a long tube connected to the bag was connected to Courtney’s Neostar catheter. At 10:30 AM the tube was unclamped and the stem cell transplant began with gravity doing the work.

There wasn’t much to it, however it was quite an emotional moment. These were the cells intended to help ensure a long life for Courtney.

Tracy arrived just a few minutes later, after having the straw removed from her neck. She and Courtney were able to share some time together, cherishing a new beginning.

Today marks the day that Courtney’s blood will gradually fade away as Tracy’s stem cells slowly take root in Courtney’s bone marrow and begin the process of making more blood – blood whose DNA matches Tracy’s blood. Blood that is leukemia free.

At 11:45 the bag was empty and the transplant was done. Just like that. And now we wait. We wait for Tracy’s stem cells to make their way to the bone marrow where they will mature, engraft and seed the process of producing her own cells. In case you were wondering just how the stems cells find their way to the marrow and do what they’re supposed to do, no one knows.

Currently, Courtney’s white and red blood cells are dropping just like they did during the last round of chemotherapy. This is due to the fact that her bone marrow, where the cells are produced, has essentially been shut down by last week’s chemo drugs. In about five days or so, we expect to see the last of her remaining white blood cells die and her counts hit zero. By this time her red blood cell and platelets will also be significantly depleted and she may need transfusions. We then will wait for another ten to fourteen days for the bone marrow to start making enough cells to be released into the blood stream and her counts to return to normal.

Courtney will go home once her white cell counts are back to normal and she isn’t experiencing complications such as graft versus host disease (GVHD). That’s something we don’t want. So now we pray that the stems cells do what they are supposed to do and kick start her bone marrow. Sometimes they don’t. And we pray that her recovery is quick and as painless as possible. And we pray that she doesn’t have to deal with GVHD or serious infections. And we pray that Courtney continues to have the courage and patience to endure these next few weeks and months.

Thank you for your thoughts and prayers. Each and everyone one of you is in ours!