Thursday +56 (10:15 PM)

I wish I had better news to report, but Jackie's counts continue to drop. I am not certain why, other than the long course of Ganicyclovir and perhaps the CMV it is working against. They began growth factor shots today. They use Neupogen which a subcutaneous injection in the stomach. It is usually fast-acting and will hopefully increase her RBC and WBC counts.

Her RBC (Hgl) level dropped to 9.0 from 9.1 yesterday. For this reason she has almost no energy. She spent much of the day in bed. We were able to go for a 2 hour drive while they cleaned our apartment today. Most of the time she was asleep in the passenger's seat. Her WBC count dropped to 1.1 from 1.55 yesterday. More concerning is her ANC (absolute neutrophil count). This count determines how susceptible to infection she might be. Her ANC count is .65 down from .78 yesterday. Below .50 she is likely to suffer neutropenic fevers (again) and require additional IV antibiotics. You may recall that the body has a way of saying, "Hey...something is wrong here. We don't have any white blood cells and the neutrophil level is very low. We might get an infection! Why don't we just raise the body's temperature to help fight off anything that might happen to come along?" In most cases there is no infection, just a fever. But to make certain they will (again) do frequent blood cultures and start IV antibiotics if her temperature rises above 101.3. So far no fevers, so that is good. Her back pain was also better today. I've also failed to mention that her hearing is nearly back to normal. You may recall she lost quite a lot during one of the IV antibiotic treatments. I'm not certain her hearing is completely normal, but it is certainly much better.

Jackie's platelets continue to hang in like troopers! The decreased to 142 from 155 but that is still good. As you may recall this is the area that caused the most problems last year.

The doctors and nurses (again) don't seem concerned. They all feel these sorts of things are simple "bumps in the road" and "if it wasn't this it would be something else".

I think as the Neupogen shots kick in she will feel better soon. I also think as her levels of Mycophenolate (the anti-rejection drug) drop it will allow her own immune system to recover and fight off the small amount of CMV that remains. Of course the most dangerous and troublesome part of the transplant still lies ahead - the possibility of GvHD. If the anti-rejection drugs are tapered too quickly it will give rise to GvHD. As the doctors often point out, "They are walking on the edge of a knife".

I've included a couple more photos of the subway and the Mayo Clinic. The sculpture you see is quite large. It hangs on one wall and is probably about 30 feet tall. It appears to be made of bronze. Below the sculpture is a grand piano that is played by volunteers every day.

Until later...

Bruce and Jackie
From Rochester, MN