Sunday +59 (9:30 PM)

Today was another one of those somewhat down days. Although Jackie felt reasonably well today, she had very little energy. Once again she was nauseated this morning and had one spell of vomiting. Fortunately this didn't last long and she had very little back pain today.

We met with the doctor this morning during her morning Ganicyclovir treatment. Of biggest concern is her continued decline in blood counts. Her WBC count has dropped to just-post-transplant levels. She is officially neutropenic. Fortunately she has no fevers. If she does begin to suffer from neutropenic fever they will place her on IV antibiotics as a precautionary measure. The doctor feels the Ganicyclovir, along with the high doses of Mycophenolate, are the contributing factors for her declining counts. Therefore they are decreasing her Ganicyclovir treatments to once-per-day. They decreased her Mycophenolate (pills) by another 25%. Of course the danger comes from an increased CMV viral load count, the onset of GvHD, or the possibility of Jackie's immune system rejecting the donor cells. The hope is that the reduction in immunosuppression by a reduction in the Mycophenolate levels will lead her own immune system to kill off the CMV virus without inducing any significant GvHD. Again, walking on the edge of the knife! Jackie continues to receive Neupogen shots, but these have failed to produce any significant results.

With regard to counts, her RBC (Hgl) count declined from yesterday's wonderful 10.0 to 9.4; therefore a decline in energy level. Her WBC count declined from 1.3 to 0.8. This is in spite of the fact that she is receiving daily growth factor shots. I didn't obtain her ANC (absolute neutrophil count) today. As a general rule you can assume the ANC will be about 60-70% of the WBC count. This likely places her below the .5 level which is the official starting point for declaring someone "neutropenic". Due to the low levels we have reverted to many of our super-hygenic precautions that were in place post-transplant; constant hand washing, spraying the apartment with dilute alcohol solution, countertop disinfectant, etc. Her platelets declined to 109 from yesterday's 133.

With a little luck these changes will re-ignite her immune system and counts will improve, CMV will decline, and there will be no significant GvHD issues. I don't think the doctors, nurses, or I will be too surprised if there are still a few bumps along the road.

Until later...

Bruce and Jackie
From Rochester, MN