Day +103: back home again

A quick stay at the hospital this time. Mina Brigitta was actually quite excited to be back at the hospital, though she did ask to go back to the "new home" around bedtime last night. They gave her gancyclovir last night and again this morning. We'll be giving it via IV twice daily for at least a week. The other thing they wanted to do was have her see an opthamologist, which happened late morning. CMV can show up lots of places, but the most common are the eyes, lungs, liver and gut. He said her eyes looked fine. It's just a waiting game now, to see if she develops any symptoms. It is apparently very common for kids to become CMV-positive after BMT, and since the development of gancyclovir it doesn't cause problems most of the time. Especially if they catch it early, which they obviously did with Mina Brigitta since they only found one, single, solitary CMV cell.

The possibility of gut involvement is a bit of a worry at the moment. Mina Brigitta's stools have come back negative for c. diff. this week, yet her diarrhea and nausea has continued. The longer this goes on, the more likely it is that it's due to something like CMV. The other worry is that CMV is frequently accompanied by manifestations of chronic GVHD. We've been a little bit worried about her skin lately, although the symptoms are so mild we aren't convinced we're actually seeing them. The fact that these are all real possibilities now is kind of discouraging. But we probably need to expect chronic GVHD at some point, given the severity of her acute GVHD. Also, Keri finally got to meet with the bone specialist on Wednesday. Mina Brigitta does have a couple of small spots of avascular necrosis in her right femoral head (http://www.emedicine.com/radio/topic70.htm). The prognosis for this problem is pretty bad in older kids and adults, but I'm not able to find much information about how it affects kids Mina's age. The specialist said it could progress, stay where it's at, or resolve, and it's just too early to tell which. They'll watch it, and probably repeat the MRI every six months or so.

Kari and Carmen fly out tomorrow night. It was nice that Mina Brigitta got to come home and be able to spend some more time with them here. I'm looking forward to a full day of family time tomorrow.