Day 61: Biopsy, BMA, & Spinal Tap

Today, Chase is back at CHOA for a bone marrow aspiration, a spinal tap, and a biopsy of his esophagus, stomach, and lower intestine. We knew he would be getting the bone marrow aspiration and spinal tap at some point, but the need for the biopsy is due to possible GVHD.

GVHD or Graft versus Host Disease occurs when the donor's marrow begins to see the recipient's body as "foreign" and sends out cells that basically begin to attack the tissue. It can present itself via a rash on the skin, nausea, through diarrhea, loss of appetite, weight loss, and more.

With Chase, he has been dealing primarily with the last two. In the first week and a half after discharge, he lost 5 lbs. He lost a bit more weight after that, too and he really didn't have the desire to eat like he normally does. His appetite at this point wouldn't be anywhere near normal regardless, but his is about half of what I would expect it to be. They expect him to consume over 2000 calories a day. The most I have managed to get him to consume is 1600 to 1800.

Last Thursday, they sent Chase to a GI specialist who basically decided it would be best to "scope" him. The only true way of determining GvHD is through tissue samples. They scheduled it for today, April 19th, so he could have his bone marrow aspiration and spinal tap at the same time.

Over the weekend, his appetite further decreased. He has complained in the past about various foods and drinks irritating this throat, and this seems to have gotten worse.

We went to the Aflac Clinic this morning before heading over to Day Surgery. His blood counts have risen, which is great news. Last week almost all of his counts, his white blood cells (WBC) and his neutrophil count (ANC) in particular, had fallen quite a bit. The doctors were not alarmed by it, but when the numbers are low to begin with, I don't like seeing them slide. Today his WBC count is 3.31. It had been 2.86. This, along with the rise in his platelets going over 60 for first time on their own were a welcome sight.

His weight, however, was not a welcome sight. He dropped 3lbs over the weekend and is down to 105! I knew he had dropped weight. He just was not eating well and Sunday his stomach was giving him issues. He threw up and had diarrhea. My heart sank when these symptoms started since they also point to GVHD.

Let me say it is NOT uncommon for a transplant patient to get GVHD. In fact, it happens in about 80% of patients if I am recalling what I read correctly. You do want a bit of GVHD because it can help the new marrow fight against any possible new leukemia cells in the future. My heart sank because I hate seeing Chase feel like this. I hate feeling like a nag trying to get him to eat. Most of all, I hate not being able to do anything about it.

Dr.Chiang is having us come back in on Thursday with the hope we will have the results back and can begin treatment if he does in fact have GVHD. They will start by giving him a steroid. Beyond that, I'm not sure what they will do. At least a steroid might kick start his appetite.

What we are praying for is that Chase can be diagnosed and treated quickly. I pray that should he have GVHD that it will be mild and not further compromise his health and recovery.

Please send up prayers! I'll let you know the results as soon as I have them.

And just to leave you with a smile, I'm including this picture. Chase gets an arm band every time he comes in to clinic and for some reason never takes them off. A couple of these are from three weeks ago! There are 8 total but I have a feeling they may cut most of them off while they have him sedated.





- God Bless :)