Thursday

Hello:

Today was a pretty good day. Jim's toe is finally feeling better. He actually walked 3 or 4 laps today, so that was pretty exciting. Jim's appetite is up, too. I drove a very long way to get him the best gyro in the world, and it was goodly. And he ate the whole thing.

Jim's blood is doing well. I mean it's very poor, but it's good poor. He's only mostly dead. :) He's not neutropenic which is good for infection purposes. He's getting his strength back, too.

I think this is day 7 post transplant, and they say day 10 is when GVHD can start. I mean it can happen anywhere from 10 days up to years later, so it's not like we are sitting around waiting for that. GVHD is actually 2 diseases, I have learned. Below is some info about GVHD if you want to know some.

• Acute GVHD usually occurs during the first three months following an allogeneic SCT. "T-cells present in the donor's bone marrow at the time of transplant identify the SCT patient as "non-self' and attack the patient's skin, liver, stomach, and/or intestines. The earliest sign of acute GVHD is often a skin rash that usually first appears on the patient's hands and feet."
• Chronic GVHD usually develops after the third month post-transplant. "Scientists believe that new T-cells produced after the donor's stem cells have engrafted in the patient may cause chronic GVHD. ""Chronic graft-versus-host disease (GVHD) is the most serious and common long-term complication of allogeneic hematopoietic stem cell transplantation (HCT), occurring in 20% to 70% of people surviving more than 100 days.

"Chronic graft-versus-host disease (GVHD) is the most serious and common long-term complication of allogeneic hematopoietic stem cell transplantation (HCT), occurring in 20% to 70% of people surviving more than 100 days.1,2 Approximately half of affected people have 3 or more involved organs, and treatment typically requires immunosuppressive medications for a median of 1 to 3 years. Because of higher treatment-related (nonrelapse) mortality, chronic GVHD remains the major cause of late death despite its association with a lower relapse rate.

The trial that Jim was a part of was not a trial of a new way to do a SCT. It is actually for the drugs that he is getting to eliminate the GVHD. Also, because Bob was a 6 for 6 match, that makes the chances of getting GVHD less, as well. MUCH LESS. So, we really aren't too concerned about Jim getting a severe case of this disease. Also, I have to say if Jim does get it, I can think of no better place for him to get treatment than here. It's amazing what I don't worry about any more. Seriously. It's so freeing.

Here's a brief description of what will happen beginning in 1 more week.

• After entering the blood stream, the stem cells travel to the bone marrow, where they begin to produce new white blood cells, red blood cells, and platelets in a process known as “engraftment.” Engraftment usually occurs within about 2 to 4 weeks after transplantation. Doctors monitor it by checking blood counts on a frequent basis. Complete recovery of immune function takes much longer, however—up to 1 to 2 years for patients receiving allogeneic transplants. Doctors evaluate the results of various blood tests to confirm that new blood cells are being produced and that the cancer has not returned. Bone marrow aspiration (the removal of a small sample of bone marrow through a needle for examination under a microscope) can also help doctors determine how well the new marrow is working.

It's weird to think of Jim's immune system taking 1 to 2 years to recover. What does that mean? I have no idea. Now of course the biggest hurdle of all is the cancer returning. But we are not worrying about that either. We feel good that Jim has made it through this. It's the one goal that he wanted to make, and he has.

Anyway. Theres SCT 101. I just wanted to post a bit of info and how it personally relates to Jim, and to also let you know what is up.

I spoke to a women whose husband had a SCT the day before Christmas, and he's still in the hospital. We certainly don't feel this will be the case with Jim, but yuk.

God has been so very good to us. I have often thought about rough times in life, and when we think or feel that God doesn't care or isn't there. In those feelings and thoughts, I've often thought about how worse it could actually be without His loving hand guiding us through all of it, and I think it could really be worse, even though I don't feel it could, because I have been at wits end so often. When I look at what we have been through, yeah, it's been tou.gh. The hardest thing I've ever walked, for sure. But I truly believe that God has been very kind to me throughout.

Anyway it's late, and I'm not able to properly convey what I'm trying to say, so, I'm just going to shut up and check on my cyber pets.