Monday, July 25, 2011

Jacob Is Home! ... For Now

Let's start with the good news: Jacob came home from the hospital on Wednesday! He has been enjoying spending time at home with both of his parents and his big brother. In fact, we've all been enjoying spending time together as a whole family, which we hadn't been able to do very much for about 3 ½ months.

Jacob still has his central line and his NG tube in, and he's still on his regimen of medications throughout the day and nutritional supplementation at night via the NG tube. Kylene and I are basically Jacob's nurses now; we have been trained in administering his medicine every four hours during the day and operating his automatic feed machine at night, changing the dressing over his central line site and replacing the tape holding the NG tube to his face as often as needed, flushing his central line daily to keep it functional, replacing the caps on the central line lumens weekly, etc. Of course, we're also responsible for constantly reminding him to be careful not to be too rough or careless with his central line since we don't want it to pull out, and throughout the day we try to encourage him to eat. He's been doing better at eating since he's been home, although he promptly spits out much of the food that he tries—often onto the new carpet.

With all of the medical knowledge and training we've gained in recent months, Kylene and I joke with each other that we could practically be MDs or nurses. Now maybe we could add carpet cleaning specialists to our repertoire. But I digress.

On Friday, Kylene took Jacob to CHLA for a follow-up appointment with a BMT doctor, where we received the bad news: the latest sorted chimerism report shows that while the percentage of certain donor cells is very high (79.2–85.5%), the percentage of certain other donor cells has dropped to almost nothing (1.55–3.25%). According to the BMT doctor, the type of cell that has dropped to 1.55% donor DNA must be higher for Jacob to be effectively cured of CGD. This seems to contradict the 30% coverage against CGD-related infections from the last NBT test, which was done prior to the last sorted chimerism. They drew blood for another NBT test on Friday, but we found out this morning that they made a mistake when doing the test and will have to redo it (this is not the first time this has happened with that test at CHLA). Now we apparently have to wait until Jacob's next CHLA visit on Friday for them to draw blood for another NBT test.

In any case, the BMT doctor indicated that they would be contacting the donor to try to get him to donate stem cells from his blood that can then be infused into Jacob to boost his donor cell count. The donor would just have to agree to take GCSF (the white blood cell boosting drug that Jacob took for one day prior to a test once) for 5 days prior to the stem cell extraction, which should be painless unlike the bone marrow aspiration that the donor went through before. If the donor agrees to donate cells, Jacob would have to be hospitalized for an extended period of time again. If for some reason the donor refused (probably unlikely), Jacob would have to find another bone marrow match and go through the entire bone marrow transplant process all over again, chemo and radiation and all (although I'd guess that they probably wouldn't do the reduced intensity treatment this time). It was very frustrating to find this out just two days after Jacob got home. We already wondered whether they might have been in too much of a hurry to get him home given that the last sorted chimerism results were still pending and there was another C. diff test that needed to be done.

Speaking of which, we also found out this morning that after two negative results for C. diff after finishing his Flagyl treatment, the third test showed that he does currently have C. diff. Both Jacob and Ethan have been having C. diff-like symptoms, and we know that C. diff is highly contagious, so we're trying to figure out some way to get Ethan tested (they won't just prescribe Flagyl based on Ethan's symptoms and the fact that his brother has C. diff, and Kylene can't just bring in Ethan to be tested because she can't take Jacob out in public, and I work during the day so I can't take Ethan in either).

On the bright side, at least we get to have Jacob home for a few weeks or however long it takes before the donor can donate cells.

On the less bright side, my academic leave of absence ends August 14th, which means I have to get back into my Ph.D. studies just three weeks from today, and Jacob could be in back the hospital around then. I have no idea how I'm going to maintain my sanity and fit everything into my life; it's been stressful enough without having school studies and assignments on top of everything else. My next class covers statistics, so if anyone reading this is a statistics expert and would be willing to help me occasionally, please get in touch with me.

We continue to be in need of your faith and prayers as we go through this extremely stressful and trying time in our lives.


Kaci Uipi said...

I'm glad you have him home at least for a little while. Hope the donor agrees to do whatever is necessary to help Jacob be cured. Salesi would joke about becoming a doctor or nurse after spending 3 weeks, both days and nights in the ICU...but you guys know much more from your experience... maybe the knowledge will come in handy. (And to think, there is a reason for all this madness) God bless your family and prayers go your way.

Laurie said...

Just read about Jacob and realized he is YOUR son. Wow, what a lot for your family to be going through. Please know that our good thoughts and prayers are headed your way. Best to you all, Richard and Laurie West