Day +26: a miserable little girl

Mina Brigitta had a pretty tough day today. She spent most of it either sleeping or just lying around lifelessly. Her rash has gotten quite a bit worse -- she now has raised bumps on her back, bright red palms, and small red dots on her face and head. Almost nothing on her legs, strangely enough. Her bilirubin was also much higher today than yesterday, indicating that her liver is quite likely also affected. With the rash, the high bilirubin, and the mucous in her stool, she's pretty much experiencing what's called the "trifecta" of GVHD effects: skin, liver, and gut. She spiked another fever at about 5 PM after almost 24 hours without one, and with the fever started throwing up again. They decided not to wait to up her dose of the prednisone, and the Tylenol and Benedryl have helped her get more comfortable. She did perk up a little after she got a dose of morphine today, so we're putting her back on a continuous morphine drip.

The hope is that the higher levels of steroids and cyclosporine will help these issues within a few days. If not, they'll have to look at riskier options like monoclonal antibodies, but they'll want to get a biopsy to confirm the diagnosis before they take that step. The risk from the GVHD therapy stems from immune suppression, specifically of the lymphocyte lineage of white blood cells. It's these cells that cause the problems with GVHD, but they also are the most effective cells at fighting off viruses and yeasts (candida). She'll be vulnerable as long as she's on these therapies, but that theoretical risk is definitely preferable to what she's going through now.