Day 20

Thursday my doctors gave me a goal to drink 3L of water that day in an effort to keep my kidneys hydrated and my creatinine low.  I did, but by Friday morning my creatinine had jumped back to ~1.8.  The decision was made to take me off the cyclosporine, since functioning kidneys trump anti-rejection (I am still on the MMF so I am not completely off anti-rejection meds).  I have an appointment with Dr. Oran Tuesday morning to assess my medications and, I am assuming, add another anti-rejection med.  The problem is, I was told by the doctor I saw on Friday, that the next common anti-rejection drugs have interactions with VFEND, the ever important antifungal I take.  So she did not substitute another drug for the cyclosporine for now.  This runs the risk of GVH appearing before I see Oran on Tuesday.  So far I have probably felt better off the cyclosporine than I did while I was taking it (the side effects of that drug were awful).  However, I think I am showing signs of GVH:  I have changes to the skin appearing on my head and my GI tract has become irritated.  The skin on my forehead and in my hair has an odd bumpiness to it.  It is not painful or even very noticeable unless you look closely, but I feel this may be how it begins.  We will see what Oran has to say about it on Tuesday.  My hope is that I am put on a new anti-rejection and, if my symptoms are because of GVH, they disappear without the need for further treatment.  Acute GVH is treated with high-dose steroids, and we all know how much my diabetes would love that.

I also have a bone marrow biopsy Tuesday morning...ugh.  Just thinking about it makes me depressed.  It will be a first look at what is going on in my marrow and how Mitch's cells are doing.  I am not quite sure what to expect, if there will still be leukemic cells present, or my cells present, or what.  Good questions for Oran I guess.