12/7

This is some tough sledding.  John was readmitted to the hospital last night after our weekly doctor appointment.

He is dehyrated and has graft v host disease.  Since John's cancer first showed up in the skin and the therapies, chemo and treatments all affected the skin, John's doctor said if anyone was ever going  to develop gvh as a complication of transplant, it would be John.  He was right; looking for something positive about this, the gvh may well improve the graft v cancer effect in the future.

Dehydration affects electrolyte balance and kidney function.  That's reflected in his dropping sodium, rising potassium, and elevated creatinine levels.  He has been working very hard to drink more but hasn't been able to get rehydrated on his own.  GVH adds an additional challenge.  The new immune system is "attacking" the "John" proteins in his skin - he looks like he has a terrible sunburn and now his skin is sloughing off.  Skin is a barrier to infection and helps trap moisture so losing it makes rehydration even harder.

John is getting IV fluids and steroids in the hospital.  The steroids should help get the gvh under control; maybe he isn't absorbing the oral steroids and the IV therapy might kick start a recovery.  John's blood sugar is high; his doctor says this is most likely a result of the steroid therapy.  That is being treated with insulin; finger tip pricks 5x/day have been added to his list of treatments/procedures.

The first 24 hours haven't been restful.  A picc line was installed because it was too hard to find a vein to draw from for the many blood tests.  He has had 2 chest x-rays; the first one revealed a coiled up portion of the picc line. The line was forcefully flushed to try to straighten out the kink; the second x-ray results show it was a successful maneuver. Yay! Since the pic is straightened out, the IV line can be removed and the picc line can transport the meds, fluids and be used for blood draws.  John has had a kidney function test - all is good; hydration should take care of the electrolyte and creatinine problems.  A cat scan shows the lungs are stable or even a little improved.  No temps and no infections. 

John has gained 4 pounds in the past week (which still leaves him about 15 pounds below his high school weight).  He has been a little nauseous in the hospital although he is doing his best to eat and drink.  Zofran reduces the nausea but we haven't gotten the timing just right yet so he can eat without discomfort.

We'll be here for at least the weekend.  If you're looking for something to do this weekend (because everyone has so much free time at this time of year...) rent the movie A Cat in Paris.  We guarantee you'll love it.