Day +17: More White Cells

Our days have been up and down since Thursday, with Brianna's bouts of coughing subsiding and then picking up. As long as we stay on top of the pain in her side with her pain medication, she's okay. But at least once a day now, it seems we get behind in keeping her pain down. The pain meds have been increased steadily during the day and at night since that awful day on Wednesday when she was hurting terribly. I just hate to see her this way and the doctors are doing all they can to keep her comfortable.

For the last several days, her white count stayed at 0.2. But today, they've increased to a whopping 0.4! We know it's not much, but it's a huge leap to us!! This means her new marrow is starting to pick up its production of white cells. The other lines, red blood cells and platelets, will take several more weeks before we see signs they are starting to come in. But we're happy about this bit of news.

Unfortunately, her pnuemonia has not gotten better. It doesn't look like it's gotten worse, either. But it would be nice to see some improvement. Brianna had another x-ray this morning, and the film looks pretty much the same. However, she didn't take as big a breath when she had the one done on Thursday, so it's a bit difficult to see if there are any subtle differences.

At this point, it's still not clear whether it's viral, bacterial or fungal. But the docs are guessing it's fungal. She's been on some heavy antibiotics and antiviral drugs and all of the cultures they've taken have come back negative for either of these. We are still waiting on the results of two tests, both of which will come back on Monday. One of them is a blood test to see if it's a fungal infection. She is taking an antifungal drug, just so all the bases are covered. And, it's been decided that on Monday she'll have a CT scan of her sinuses, chest, abdomen and pelvic areas. Fungal infections have a very distinct look on CTs, and since they'll be doing one of her sinuses and lungs, they decided to make sure nothing was going on in her stomach or intestines while she was under the microscope, so to speak.

Normally, we all have an immune system to keep any viral or fungal infections in check. We have antibodies to certain viruses, and most of us carry aspergillus in our lungs. Its a fungus that is found in the soil and is everywhere, blowing in the wind. But because Brianna's immune system has been nil for the past two months, any virus or fungus would have the opportunity to erupt. Add the fact that she's on a steroid, which suppress all immunities, and it makes a good environment for opportunistic growth.

So she is being weaned off the steroid and will be put on another immune suppressive drug - sirolimus. The steroid was being used to avoid graft-versus-host disease. She still has to avoid GVHD, so this new drug does the same thing. But it does not suppress the part of her immune system that fights fungal infections. So some of those new white cells can do their job. Of course, there's always side effects with many of these drugs. Sirolims is hard on the kidneys. She'll be checked often to ensure that it does not build up and cause any problems.

I just pray that we'll have a clearer picture of what's going on in her body and of the best course of action. Send some of those thoughts and prayers of healing. I know this is just one more bump in our long journey, but we'd sure love a little more smoother sailing.