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bpbullit Sat. 20 Mar. 2004 partly sunny 82°   727-898-7451 Room # 272 A

Welcome back to Billy's Page.Today is Day +16 on Billy's BMT calendar, and it is also Billy's Mom's (my Wife...*wink*) Birthday! Happy Birthday SweetHeart! We Love You!

I will see you'all later for Billy's Update !

Later it is ! Dr. Petrovic is "Amazed" at Billy's progress, and is "very pleased" with how well Billy's "New Immune System" is responding, and rebuilding. Todays Counts are: WBC @ 1.00, RBC @ 3.08, Hemoglobin @ 8.8, platelets @ 37,000. Billy will most likely need a platelet transfusion every other day or so, to keep his platelet counts up over 20,000, and will probably get a red blood transfusion once a week to keep his Hemoglobin up as well. When Billy's counts remain stable, the transfusions will end *wink*. Billy once again has an ANC count, and it is 640. The higher the ANC count, the better Billy's immune system is to fight for itself. We look for an ANC of at least 1500. Yes, Billy's WBC has more than doubled once again, and everyone involved in Billy's BMT process is just so excited at this response, as are we *wink*. Billy is experiencing some pain, and discomfort in his hips because of the G-CSF (neupogen). Billy's bone marrow is working "double time" in the white blood cell production, and it can be quite bothersome. Billy did ask for some pain medication to ease the pain some, this was the first time Billy asked for pain medication since the BMT process began over 4 weeks ago *wink*.

We would like to thank Maurine E., for the card Billy received today, We miss you too*wink*. Also, thank you to Uncle Tom and Aunt Vanessa for the card & gift Billy received today, it will surly come in handy when Billy is released to go home in a few weeks! Thank you, once again to Mary and family, from the "Soo" for the card billy received today, and thank you once again *wink* for your phone call, it was nice to talk to you again. Thank you once again to Gail L., from Alabama, for the card Billy received today. A very "Special" Thank you to Peggy S. for the package Billy received today containing all the "Diva" cards, as well as a copy of Billy's Star Chronicle! Now Billy can see them all from his Hospital bed! Please Thank the "Diva's" for us, OK!
We would also like to Thank Mrs. Govin and "our Southside Family", for all the cards Billy received today from Mrs. Gecans Math class ! Yes, Billy does know quite a few of the Kids, and misses you all!
Please Pray for Billy.........................
bpbullit Sun. 21 Mar. 2004 sunny 83°
Welcome back to Billy's Page.Today is Day +17 on Billy's BMT calendar. What a Beautiful day here in west central Florida. Sunshine, low humidity, and a WBC of 3.36! Yes, Billy's white blood cell count TRIPPLED again!, and no sign of fever! To see a jump like this over night, you would think Billy spiked a fever. That was not the case, Billy's body is responding to the G-CSF (neupogen), and producing HEALTHY white blood cells. Although Billy's counts are still quite low, they are trying to hold steady. RBC @ 3.05, Hemoglobin @ 8.6, platelets @ 26,000. Billy's ANC is at an incredible 2150!!

Once again I'll point to the "NORMAL" blood count levels, which are:
WBC: 4.0 - 10.5
RBC: 4.20 - 5.60
Hemoglobin: 12.5 - 16.1
Platelets: 150.000 - 450.000
Billy and Alicia had a good night last night, with only the normal interruptions *wink, Thanks Amy, for your company!
 Click here for a photo of Billy and his Buddy, Nurse Ed!
 Click here for a photo of Billy and his Buddy, Nurse Amy!
Billy did have a bit of vomiting when he woke up this morning though, and he is quite tired probably due to the low RBC. Dr. Grana was a bit concerned about the redness of Billy's eye's this afternoon, this is one of the things they look for in GVHD (graft vs host disease). But the redness was caused by Billy vomiting earlier, and Dr. Grana was relieved to know that. please read below, to learn all about this serious condition:

Definition:
Graft-vs.-host disease is an immune attack on the recipient by cells from a donor.

Description:
The main problem with transplanting organs and tissues is that the recipient host does not recognize the new tissue as its own. Instead, it attacks it as foreign in the same way it attacks germs, to destroy it. If immunogenic cells from the donor are transplanted along with the organ or tissue, they will attack the host, causing graft vs. host disease. The only transplanted tissues that house enough immune cells to cause graft vs. host disease are the blood and the bone marrow. Blood transfusions are used every day in hospitals for many reasons. Bone marrow transplants are used to replace blood forming cells and immune cells. This is necessary for patients whose cancer treatment has destroyed their own bone marrow. Because bone marrow cells are among the most sensitive to radiation and chemotherapy, it often must be destroyed along with the cancer. This is true primarily of leukemias, but some other cancers have also been treated this way.

Causes and symptoms:
Even if the donor and recipient are well matched, graft-vs.-host disease can still occur. There are many different elements involved in generating immune reactions, and each person is different, unless they are identical twins. Testing can often find donors who match all the major elements, but there are many minor ones that will always be different. How good a match is found also depends upon the urgency of the need and some good luck. Blood transfusion graft-vs.-host disease affects mostly the blood. Blood cells perform three functions: carrying oxygen, fighting infections, and clotting. All of these cell types are decreased in a transfusion graft-vs.-host reaction, leading to anemia (lack of red blood cells in the blood), a decrease in resistance to infections, and an increase in bleeding. The reaction occurs between four to 30 days after the transfusion. The tissues most affected by bone marrow graft-vs.-host disease are the skin, the liver, and the intestines. One form or the other occurs in close to half of the patients who receive bone marrow transplants. Bone marrow graft-vs.-host disease comes in an acute and a chronic form. The acute form appears within two months of the transplant; the chronic form usually appears within three months. The acute disease produces a skin rash, liver abnormalities, and diarrhea that can be bloody. The skin rash is primarily a patchy thickening of the skin. Chronic disease can produce a similar skin rash, a tightening or an inflammation of the skin, leisions in the mouth, drying of the eyes and mouth, hair loss, liver damage, lung damage, and indigestion. The symptoms are similar to an autoimmune disease called scleroderma. Both forms of graft-vs.-host disease bring with them an increased risk of infections, either because of the process itself or its treatment with cortisone-like drugs and immunosuppressives. Patients can die of liver failure, infection, or other severe disturbances of their system.

Treatment:
Both the acute and the chronic disease are treated with cortisone-like drugs, immunosuppressive agents like cyclosporine, or with antibiotics and immune chemicals from donated blood (gamma globulin). Infection with one particular virus, called cytomegalovirus (CMV) is so likely a complication that some experts recommend treating it ahead of time.

Prognosis:
Children with acute leukemias have greatly benefited from the treatment made possible by bone marrow transplantation. Survival rates have climbed by 15-50%. It is an interesting observation that patients who develop graft-vs.-host disease are less likely to have a recurrence of the leukemia that was being treated. This phenomenon is called graft-vs.-leukemia. Bone marrow transplant patients who do not have a graft-vs.-host reaction gradually return to normal immune function in a year. A graft-vs.-host reaction may prolong the diminished immune capacity indefinitely, requiring supplemental treatment with immunoglobulins (gamma globulin). Somehow the grafted cells develop a tolerance to their new home after six to 12 months, and the medications can be gradually withdrawn. Graft-vs.-host disease is not the only complication of blood transfusion or bone marrow transplantation. Host-vs.-graft or rejection is also common and may require a repeat transplant with another donor organ. Infections are a constant threat in bone marrow transplant because of the disease being treated, the prior radiation or chemotherapy and the medications used to treat the transplant.

Prevention:
For recipients of blood transfusions who are especially likely to have graft-vs.-host reactions, the red blood cells can safely be irradiated (using x rays) to kill all the immune cells. The red blood cells are less sensitive to radiation and are not harmed by this treatment. Much current research is directed towards solving the problem of graft-vs.-host disease. There are efforts to remove the immunogenic cells from the donor tissue, and there are also attempts to extract and purify bone marrow cells from the patient before treating the cancer. These cells are then given back to the patient after treatment has destroyed all that were left behind.

Key Terms:

Anemia:
Too few red blood cells, or too little hemoglobin in them.
Immunoglobulin:
Chemicals in the blood that defend against infections.
Immunosuppressive:
A chemical which suppresses an immune response.
Inflammation:
The body's immune reaction to presumed foreign substances like germs. Inflammation is characterized by increased blood supply and activation of defense mechanisms. It produces redness, swelling, heat, and pain.
Lesion:
Localized disease or damage.
Scleroderma:
Progressive disease of the connective tissue of the skin and internal organs.

Of course, we are not crossing "that bridge" yet, and we really hope we never come to it *wink*
Please Pray for Billy......................


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