Its been 4 weeks since Ryan's bone marrow transplant and we are still in-patient at Texas Children's.  We did not get to go home last week as we hoped.  Ryan developed a few common side effects from his 4 years of chemotherapy, radiation, and most recent transplant.  I will attempt to summarize below:
  • 4/16 - 4/19:  Ryan received a drug called GCSF to help with the engraftment process.  As a result of receiving this drug, Ryan started to develop high fevers and back pain. 
  • 4/21 CT scan:  Since Ryan's stomach pain, back pain and fever did not go away after we stopped the GCSF, TCH did a CT scan of his stomach area to see what was going on and it revealed that Ryan had a colitis/typhlitis (or better know as a gut infection).  As a result, Ryan went back on all medication via IV and a liquid diet.
  • 4/23 Ultra Sound:  Due to to the amount of pain Ryan was in, TCH did an abdomen ultra sound.  The ultra sound was reassuring as it showed the amount of free floating fluid in his gut decreased and it only showed a moderate amount of ascites, hepatomegaly, and gallbladder wall thickening.  All of which can be seen with venoocclusive disease but the portal venous flow was normal.
  • 4/25 CMV Positive:  When someone suffers from a CMV infection, it simply means he has been transmitted the Cytomegalovirus, a virus similar to those that cause herpes, chicken pox and shingles. And much like these other viruses, CMV will be with a person forever, going through intermittent periods of dormancy and reactivation.  Prior to 4/26, Ryan's blood work showed that the virus had been dormant, but its active.  TCH started Ryan on a new drug to help fight the virus.  Unfortunately, this drug can only be given in-patient.
  • 4/26 MRI:  Due to Ryan's persistent lower back pain, TCH performed an MRI of the back to make sure nothing was going on prior to his scheduled spinal tap and bone marrow biopsy.  MRI showed local inflammation on the right iliacus muscle and the psoas muscle likely from the previously diagnosed colitis/typhlitis.  As a result of the inflammation, Ryan's spinal tap and bone marrow biopsy have been postponed.
  • 4/26 BK Virus:  On Thursday night, Ryan started to pee blood.  The blood in the urine is most likely caused by the BK virus and is treated by making sure Ryan's platelet count stays above 50,000 and hydration.  The bleeding comes and goes so the doctors are not concerned as long as Ryan can continue to pee.  TCH performed an ultrasound of Ryan's bladder on Friday and everything was normal so we just have to wait and let Ryan's body heal.
Despite the above issues, the doctors think Ryan is doing great and although it sounds like Ryan has had a lot of complications this past week, all of the issue are very common and the fact that Ryan was still in the hospital, the doctors were able to act quickly on each issue.  

Now for some good news....Ryan's blood test from earlier in the week came back 100% DONOR BLOOD which is great news.  There is still a chance in the next 75 days that Ryan's blood cells can start to develop but the fact that his ANC count has stayed high on its own and his is 100% this early in the process, the chance is slim.