Dawn had a restful night. She still hasn't been awake since they put the trach in. Her bilirubin count is up again, to 18.4. I think at some point this morning they're going to decrease the sedation and see how she does. They wanted her to get a good nights rest and try to get on a "normal" day/night sleeping schedule. The trach also bleeds occasionally, which is normal for the first few days, and they wanted to give that time to heal more before awaking her. Her temperature has been normal all evening. They plan to do dialysis today again, her swelling is up just slightly from yesterday. You can see some swelling mainly in her left hand but overall she looks pretty good. Her blood counts are still ok. Her white count has fallen to 3.55 but her neutrophil percentage is very high at 86% putting her ANC at 3.373. Hemoglobin 7.9.
I am so happy in the midst of all this to share some good news. They did a Fluorescent in situ hybridization (FISH) test to see if she had the BCR/ABL gene. This would indicate some leftover or new cells with leukemia. The test showed that 100% of her cells were cells from her donor. That means they're clean leukemia free cells. This doesn't necessarily mean she's cured, but as of now they can't detect any leukemia cells. This is excellent news.
She's in the middle of dialysis right now, they've so far removed 3.6 liters of fluid and are targeting for 6. Her fever is still stable so they've stopped one of her antibiotics. This is good news because when they started her on the antibiotic it coincided with her bilirubin counts rising so it's possible that drug is, or is part of the cause. The good news with her liver is that it appears to still be working. All of her liver enzyme counts are normal except the bilirubin. Her lungs look better on the X-ray and her breathing is doing pretty good. She wanted to sit in a chair today. She got as far as the side of the bed before tiring out. We may try again later but to get as far as she got and to sit up after being in the same bed for 22 days was amazing. I think when it's time, she's going to get up and walk out of here!
Dawn sitting up out of bed for the first time in 22 days
She's still smiling
She's continued to have a pretty good day. She's been nauseous this afternoon and evening. She's had some blood in her stomach which may be part of the cause. The liver specialist came by today. He said her bilirubin counts are elevated but not her other liver enzymes which means the liver is still working. He's going to bring the liver team by tomorrow for another consult. They may do a liver biopsy in a few days. They still think the liver is reacting to all the meds she's on. If that's the case, then as soon as she can get rid of some meds, the liver should return back to normal. I think this is what everyone is hoping for, but I think everyone's thinking about what else it could be.
Tuesday, December 23, 2008