Sunday - Day 46

Trish's is feeling sleepy, the steroids haven't had the anxious "energy" effect that they are known for with her, nor have they increased her appetite which would have been a welcome side effect.

Her skin is peeling like crazy and the new skin looks pretty good. Her skin had become so "sun burned" she looked like she had African-American legs on a white body yesterday. Her billirubin count is still elevated and her eyes are yellow. I have never seen yellow eyes before. I have always heard about it and never seen it. In fact, according to Trish's nurses she has had yellow eyes for over a day before I noticed it and went to tell them. She likes to keep her room dark and in her room I couldn't see it,, but when we walked, it was obvious in the bright hallway lights.

The plan currently is to wait 48 hours, till Tuesday. The levels of prograf (FK506, Tacrolimus) in her blood have reached its therpeutic level in the last 24 hours. By Tuesday, we should know if the steroids and prograf will control her GvH. While the skin is improving we haven't seen a major improvement in the billirubin count (her liver function). So the thought is at this point that the GvH is in her skin (which is getting better) and in her liver. The first three places that GvH is seen are usually in the skin, liver and gut (digestive tract). The good news is that she has no signs of GvH in her gut. I found out yesterday that there are four levels of GvH and Trish was diagnosed with level 2. Level 3 and 4 are pretty severe. Level 1 and 2 are still very treatable.

On Tuesday, they will decide if things are getting better or if we need to start a chemo regimen of cytoxan. If they do start cytoxan, it will be at the same dose she received post transplant (which is about half the dose of the pre-transplant series). She could be an inpatient for a while.

Again, folks, she could use some perking up...send her a card, write an email or pick up the darn phone and call her. The best address for mailing is the Hackerman House address listed below in a recent post. The phone number and email addresses are listed in the left column. Thanks as always for your continued prayers and support.