Last but not least We spotted this right outside of Winnie Texas and is priceless. If you find yourself completely lost while driving and happen across a sign like this, it's a safe bet that you can narrow your geographic location to the deep south. I've got no idea what "Gatorfest" is but your imagination is probably just as good as mine.
Suddenly before you know it the southern rural landscape that I-10 cuts through, turns into a spaghetti bowl of concert ribbons that leads to Houston. It's like discovering civilization again. Trip totals: 4 hours (give or take) and 289 miles.
At MDA Ann had her follow up with her transplant doctor and subject number one was her dry and itchy skin. Doctor Kebreai had begun to strongly suspect chronic systemic GvHD, based on the dry skin, bumps, occasional dry eyes, reduced white blood cells count and slightly elevated liver enzymes. Normally she would have treated Ann with oral steroids but because her symptoms were so minimal, she didn't want to jump to conclusions. So she set up a appointment with the dermatology and melanoma center.
There we meet Doctor Hymes who is MDA's expert on skin GvHD. She gave Ann the once over and made her diagnosis pretty quickly. Based on the dry skin, hive like bumps, little blisters, and alopecia she though it was a pretty clear but "unimpressive" case of chronic GvHD. Both Doctor Hymes and Kebreai conferred and agreed that they were not going to start with oral steroids until we return to MDA next week to see ophthalmology and give the liver enzymes a chance to return to normal. The liver enzymes could be due to an increased amount of Valtrex that Ann was taking through last week and over a week the medicine should have a chance to work it's way out. If not then it could be chronic GvHD of the liver as well.
So Ann's treatment, for the moment, is steroid creams and gels. They also halted the Prograf taper and have restarted her Anti-fungals. That suites us fine because oral steroids would mean immune suppression which could mean a chance for the PTLD to return. Once was scary enough thank you very much! Overall I think this is good news though. Transplant patients with chronic GvHD are statistically less likely to relapse and unlike Acute GvHD, chronic GvHD is usually a very treatable condition for most who have it. I'm also hopeful because the transplant team has remarked on how mild Ann's symptoms are, which implies that treatment could be mild as well.
I just hope the little baby stem cells know how precious and wonderful their new home is and take it easy while they are rearranging the furniture.
Since returning to Baton Rouge, Ann has started using the steroid cream and is very happy to report that her skin feels "so much better".