Tuesday +27 5:45 PM)

This morning started out with clouds and drizzle and ended with some nice sunshine.

We spent most of the morning in the hospital. As with most mornings lately Jackie was very weak. The trip to the hospital had to be made in the wheelchair. And, again, she was very shaky and unsteady on her feet. Her nausea was as bad as ever. Yesterday she ate almost nothing. Her liquid intake was better than her solids intake. Any solid food instantly nauseated her and she would try to vomit. Even the smell of food did the same thing. She spent a lot of the day sleeping due to the constant stream of anti-nausea meds.

I discussed this with the doctor this morning and he ordered one unit of fluids to make certain she was well hydrated. He also ordered a unit of IV Kytril. I also discussed the possibility of prescribing either Fentanyl or Scopolamine for nausea. In the end he went with the Scopolamine. It is most commonly used for seasickness and comes in the form of a transdermal patch. It took most of the morning to get fluids and meds infused. She was a little better this afternoon and was able to eat a few solid foods and more liquid.

We believe the reason for the new round of nausea is due to early stage GvHD. At this point the new cells are beginning to engraft in other areas besides the bone marrow. Most often these changes first take place on the palms of the hands and soles of the feet. It can also manifest in the GI tract and cause nausea due to changes in the stomach lining. That is likely what is happening.

How long will it last? Hopefully not long! But, GvHd can be more problematic than the original disease. The hope is that the GvHD will not be severe and will not last long. They hope to have it mostly under control by day +100. The perfect situation is to see some moderate GvHD that will effectively kill off the CLL cells and then subside by day +100 with no anti-rejection drugs needed. GvHD can become chronic and need management for years, however. There is no way at present to estimate the level of GvHD a patient will experience. It is known that a good donor match usually shortens the process - but it is not a guarantee. Of course Jackie's match was a 10 of 10 molecular match.

Jackie's counts were mixed today. Her RBC (Hgl) was 9.8 down from 10.3 yesterday. Her WBC counts was 4.1 down from 5.2 yesterday. Her platelets were 114 up from 110 yesterday.

Until later,

Bruce and Jackie
From Rochester, MN