The Other Shoe

JoAnne has been in the hospital since Monday AM undergoing tests and treatment. Her customer status must have been upgraded as she now has a large room with enough space for a table and chairs. She is not up to doing much as she continues to have fevers and nausea.  Most of the cultures have come back negative, so infection may not be the issue. They scoped her stomach yesterday, took a biopsy and also took two skin biopsies today.

Although the doctors are hesitant to say anything until the test results are back, all signs point to a case of acute graft vs host disease, henceforth referred to as GVH. This is a common side effect of stem cell transplant when using an allogeneic donor. It is the "other shoe" we have been concerned about, but it is far too early to make any predictions as to whether this will be only a moderate inconvenience or more severe.

With a BMT, there is such a delicate balancing act that goes on between rejection and infection. The treatment of GVH usually includes long term doses of prednisone which reduces rejection issues, but increases risk of infection. At a minimum, the doctors are hinting that it will take 6-9 months of treatment. GVH can present in numerous ways. JoJo is so far experiencing nausea so her stomach is involved. She has also developed a rash on her chest, neck and shoulders, and may have some liver involvement as well.

We aren't going to get too far ahead of ourselves, as GVH is usually treatable over an extended period of time. At the very least, it would be fair to dismiss the notion that JoJo was somehow going to miraculously skate through this with little or no problems. It will complicate the treatment plan and require more patience and persistence on our parts, but it is something we were prepared for during the orientation work-up.  

There is plenty of information on GVH listed via Google Search. One of the better is entitled "What is Graft vs Host Disease?"  I will add the link to our list of references as well.

By the way, some of you are still trying to figure out what a pphhfffttt is from the title of my previous post. In urban language or on the internet it has come to be regarded as a disrespectful dismissal similar to "Whatever". I originally learned it when listening to my Dad read the old comic strip Pogo. I used it in the context of something quickly disappearing. My other favorite use of it comes in the dart throwing scene from Young Frankenstein at the 1:00 to 1:15 mark  http://www.youtube.com/watch?v=eXb_E6X6__0   Love that movie!

The tides, they do turn quickly. JoJo is comfortable for now and getting lots of sedative assisted sleep. If you all could reignite your prayers for her, maybe we can hold those nasty little T-cells at bay.

Cancer Sucks