Ryan Returns to the Keyboard

I haven't posted in a while.  The weeks haven't been kind to me.  Hopefully I'll be posting more in the future.

I'm feeling better now though and I hope to be home in the next 7-10 days.  We'll see if that date holds.

3 days ago I was started on some powerful steroids.  I don't know why I'm telling this story.  Anyhow, the doctors couldn't keep my glucose at a proper level.  So for two days, every two hours, they would prick my finger to check glucose level.  It was inevitably high every time, ranging from 190-250.  So five minutes after the finger prick I'd be giving myself an insulin shot. The first finger prick didn't always work either.  Thus ends the story of why I gave myself 24 insulin shots in 2 days, along with 28 finger pricks, and two lovenox shots.  It's day three or four today and I think we almost have things under control.  They've added 35 units of insulin to the TPN that drips into me all day.  I'm pretty sure this will temporarily give me adult diabetes.  Today I've already given myself two more insulin shots, one while writing this post.

In the past two days I've been out of the hospital for walks.  It's been nice, apparently my white counts are good enough for outdoor activity.  That is, as long as I don't get any exposure to sun, wear a mask, wear a gown, and wear gloves.  Still, this is much better than being in the hospital all of the time.  Emily and I did 1 lap around the hospital two days ago, we did two laps yesterday, the goal today is three laps.  It would be nice to know the distance.  Either way, it takes us a long time.

They are moving me to ice chips today.  This is thanks to the steroids and other drugs doing their job with my gut based GVHD.  If the ice chips don't make things worse I'll be allowed to drink some water.  If that doesn't make me sick I'll be allowed to have half a soda followed by the same amount in water.  And, finally, if I handle all of that well I will be allowed to eat rice or cheerios with soy milk.  It's a good thing I'm not hungry, this is a depressing list.  After graduating through all of the previous levels without relapsing I'll be allowed to eat food you could live on.  That's when I really start to eat.  They won't let me out of here until I'm putting down 1745 calories a day.  Let me tell you, that is a staggering amount of soy milk and cheerios.  So, everyone keep your fingers crossed, I could be out of here in a week or so if everything goes perfectly.

What else is moderately interesting.  My general health, perhaps.  Strange leg pain between foot and leg.  Dry eyes.  Odd thick mucous that must be sucked out with the same tool dentists use.  Persistent general fatigue.  Chemo brain.  Nominal emotional control, that's the roids for you.  Stomach pain, GVHD.  I'd like my hair back.  All-in-all I feel well.  Everything really could be so much worse.

I'm optimistic.  I think I'll be home soon.  I think I'll feel better soon.  I think home life will be mostly normal shortly after I return.  I'm excited about the future, regardless of quantity.  I don't care about percentages.  I'm going to do  everything I can to enjoy the rest of my life.  I realize much of the next year will have me tied up in clinic visits.  That's alright.

I have wonderful friends and family.  Did I mention that the steroids make me emotional? I'm taking life one day at a time and enjoying it.  This is an easy proposition when Emily is your best friend, helping you in any way she can.

My love goes out to all reading this.  Have a wonderful day and a wonderful life.  I believe this is your one shot, make it count - live a happy life.

The picture of the day - what happens when Tim and Emily conspire to hook me on a children's game while I'm fatigued.

Return of the Steroids

Ryan's doctors put him on steroids yesterday to try to control the GVHD (graft versus host disease) that they confirmed from those biopsies. Ryan was pretty disappointed. He was hoping to be able to kick the GVHD without steroids. But the doctors thought this was the best option- try to hurry and get it under control and not risk having it really take over. We don't want a coup here. Steroids cause a whole host of problems for Ryan. He has severe muscle wasting if he's on them for very long. He doesn't like the way they change his personality/demeanor (roid rage is no joke, people). They throw his blood sugar level through the roof. Since yesterday morning Ryan's blood sugar level went from low 100s (very normal and consistent for him) to 270 last night. So they're pricking his finger every couple hours and giving him insulin shots. No fun.

His stomach is still really hurting, but they're hoping if they can get the GVHD under control then that will get a little better. Still no food for Ryan, although I can tell he'd like to eat. I'm under strict orders to not talk about food. That's tough because food is one of my favorite topics of conversation. They're talking about letting him eat a tiny bit today and see how it goes. There's a detailed eating plan when you have GVHD. You start with one thing (just one!) and it can be half a cup of white rice or mashed potatoes (no butter!) or a slice of white bread. And then depending on how that goes, you can add one new thing the next day. It's slow going.

His counts are looking awesome though. His white count is 1800, platelets are at 79, hematocrit is almost 30. One more day like that and they'll officially say he has engrafted. That is really exciting. Even with the GVHD, the bright side is that maybe he'll experience the GVL effect to a greater degree (graft versus leukemia effect, which is a good thing.) Oh, two more pieces of good news- the polyp biopsy came back and it's not cancerous AND they found a medicine that helps a lot with the burning feet problem. Super nice.

This post is kind of late because I keep waiting for Ryan to do a post and I know he really wants to. He says he picks one of his better times, opens the laptop, gets ready to start typing, and then instantly falls asleep sitting up. (He really does do this, I've watched him.) I think the mental energy it costs him to write is just too much for him.

We had a good time playing Name That Tune last night. This is Ryan's trickiest way of getting me to stay awake longer (and now he knows I know). I got "While My Guitar Gently Weeps" and "Can't Get No Satisfaction" and "These Are Days" super fast. I failed on a bunch of Ani DiFranco songs ("Slide" and "Make Me Stay" and "Dog Coffee". Son, I am disappoint.) Ryan didn't sleep a whole lot during the night, what with all the finger pokes for his blood sugar levels. I slept better than I usually do here. I'm trying to let Ryan get some sleep this morning, but it is a steady stream of hospital people this morning.

Picture for the day: Ryan holding a green tea from our most recent trip to San Francisco (May 2009). This green tea is easily the worst thing I've ever tasted. Kind of makes you never want to eat again. Maybe they could use a mouth rinse of this for Ryan. Help him get over the idea of wanting to eat.

Define Irony

Let me tell you a story of irony. It's a double-feature. Friday during the day, Ryan and I were talking about life and how sometimes things can happen that come out of nowhere and completely throw you off balance. Ryan likened it to a car accident (because he is the master of analogy). He talked about how you're happily driving along and BOOM! You get hit. It shakes you up. You're shocked, you're skittish around other drivers, you're sore. It takes awhile to calm down, it takes a few days to drive around and feel somewhat safe again, etc. It runs its course, you deal with it, life goes on and pretty soon you're feeling pretty good again.

So on the way home from the hospital that night, I got rear-ended. It was not a big hit, the car's fine. But the first thing I thought (well, right after "What the heck just happened?!?!") was "How ironic." And that's what I texted Ryan.

So I went home and decided that instead of working, I would just veg in front of a chick flick. A time-honored remedy for stress, right? I got set up with some ibuprofen and cold cereal and settled in to watch my run-of-the-mill romantic comedy about a funny, beautiful, and successful woman that can't open herself up to love until she meets the right man, etc. etc. etc. Pretty standard stuff, which is all I wanted. Then the movie takes this major turn. The girl goes to the doctor, the girl finds out she has colon cancer, the girl quits the chemo treatment, the girl says a slow and painful goodbye to her family and friends, the girl dies. Holy crap! That is not what I needed in my chick flick. Sheesh.

So the next day they do an endoscopy and colonoscopy on Ryan and find a polyp. How. Ironic.

Enough about me and irony. I want to give you all the details on Ryan. I've been told I don't give enough detail. Since the last post, they found out Ryan has another virus called the BK virus. It's a similar story to the VRE virus- they won't treat it unless it starts to cause a problem. Hopefully his body (with its climbing neutraphils) will be able to keep things under control. We're not going to worry until there's actually something to worry about. His platelets climbed another 10 today, his white blood cell count is climbing as well, his hematocrit is almost at 30. Things in his blood are definitely headed in the right direction.

They did six biopsies during the procedures yesterday. The GI doctor was very good. She said we'd have results back on Monday. It will tell us everything we need to know about whether Ryan is having GVHD symptoms, and also about that pesky polyp. They didn't remove the polyp because they were worried about bleeding and infection risks. Tony (our nurse yesterday) said that the bone marrow patients make the surgeons really nervous, and they're very reluctant to do much work on them.

Ryan's mouth and throat have improved a lot. It no longer hurts much to swallow. His stomach is feeling less upset the further he gets from that unfortunate bowl of Cheerios. He hasn't eaten anything for two days now and it's going better. He has found ways of dealing with his burning feet. Leaving them out of the covers, not letting them touch each other, ice packs, putting them on the cold floor in the middle of the night, etc. He looks a lot better than some days I've seen him. The pain pump is helping control his pain quite well.

Ryan's friend Travis dropped by last night with a smoothie for Ryan. Very thoughtful and it went straight to me. Ryan really liked talking with him. Travis actually had an autologous bone marrow transplant about a year ago I think. He looks good, is doing well. Scott and Melissa visited for awhile after their anniversary dinner in Salt Lake. It was so good to see them. We talked about all the black-and-white shows we watched as kids. (Loved The Donna Reed Show, hated The Andy Griffith Show, felt neutral about Mr. Ed, etc.)

Today's plans are to get Ryan to walk around a bit and do some exercises and stretches. Also to finish watching Spies Like Us, which I've never seen before. Ryan decided now is as good a time as any to make me watch all the movies from the eighties that I missed (which is most of them). I wouldn't say I missed them, Bobs. Finally, here's a picture of Jonas on his first ever fishing trip. Jenny & the Porritts treat him like the world's only and cutest kid, and frankly, spoil him completely. I think it's exactly what he needed. Thanks so much Jenny and all the Porritts! Jenny says Jonas caught 15 fish at Strawberry Reservoir. Ridiculous!

Titles should not be the hardest part of a post

Ever feel uninspired? Well, that's how I feel, so this update will be short and dull. You're welcome. Ryan ate a small bowl of Cheerios this morning with some soy milk. As he set the bowl aside, his nurse came in and let him know that he's NPO again (he can't eat food anymore, he'll have the TPN dosed at full strength again). Apparently they suspect GVHD, given all Ryan's stomach pain and other issues. So the hope is that if they back off on the food, maybe his body will calm down and we won't have to get into a serious GVHD situation. 

About ten minutes after that, we found out that Ryan has VRE. This is a bacteria that many people can carry. If you're healthy and have a normal immune system it rarely causes a problem, it just kind of camps out. If you're immune compromised, it can turn into an infection that is hard to treat and can cause some real problems. VRE is short for Vancomycin-Resistant Enterococcus. Vanco is one of the antibiotics Ryan is already on, so obviously that won't work to treat a possible VRE infection. So if it becomes a problem, they'll have to break out the big guns, antibiotic-wise. What I love is how the doctors and nurses come in and let you know you have VRE and that it's no big deal, don't worry, they won't treat it. At the same time that they say this, they're all getting hazmat suited-up and hanging a warning sign on your door. You have to laugh because it's kind of funny. I can picture a fantastic Andy Samburg skit about this. 

Other than that, Ryan has mostly slept and pushed the pain pump. So there's the update. Now here's one of my favorite pictures of Ryan- it always makes me smile.

First signs of engraftment

Some great news! Ryan's neutraphils are at 200 this morning. That means that the process of engraftment is beginning. The doctor said he expects Ryan will have fully engrafted within about a week, then we'll be hanging out waiting for his counts to come up and get past that window of accute GVHD. Still no signs of GVHD, so we're hoping for the best. The week has been a stressful one, but we're really happy about this morning's news. We love you all and appreciate your continued caring and concern. 

Ryan has been mostly out of it today. He's still having quite a lot of pain. He is doing his very best to get out of here though. He's trying really hard to eat so he can get off TPN. He's trying to use his pain pump less. They definitely won't let you out of the hospital if you're on TPN or a pain pump. He's also trying to move around, walk, etc. This gets pretty tricky when you're a falls risk, but we're doing the best we can. I'm trying to be up here as much as I can so he has help in staying awake for even part of the day in order to do some of these things. I'm sure he'll want to give a more complete update when he feels up to it, but I wanted to give a brief update while I had a minute. 

Highlight of my day was giving the grocery store sushi a try. Surprisingly delicious. Also scored a free latte from Einstein Bagel. I go buy my $1 whole wheat bagel and there's a free coffee coupon on the receipt if you fill out their online survey. So I do. Then I go buy my $1 bagel and get my free coffee. Rinse and repeat. This can't last. 

Well, you should get back to work or your kids or your life. I will get back to Ryan.

Yes, Everything Still Hurts

My Emily has gone home.  She's the best part of my life.  Sure, some people believe co-dependance is a bad thing, and they're probably right.  However, knowing that there is a person out there who cares as much about me as I do about them brings me peace and gives me the will to fight.

My everything continues to hurt rather seriously.  This is day 20 here at LDS Hospital for the bone marrow transplant process.  Everyday has been a little bit worse in one way or another.  Today and yesterday are exceptional in that both days my throat improved.  My body compensated for that by increasing joint, muscle, and bone pain.  I think it overcompensated.

Time is passing quickly enough.  Hopefully the next week will be a harbinger of good things.  Since I don't have much in the way of good news this will be a short update.  Also, my head keeps slumping into semi-consciousness.  I don't want to take any new injuries while writing a post.

I'm sure that soon enough my posts will regain some of their entertainment value.  Until then I recommend re-reading all of the old Peanuts books, Snoopy is hilarious.

Thank you to everyone for your help in this process.  Jenny, those bruise pictures look terrible.  Thank you for the bone marrow.  I owe you one. ;p

As for visitors, it depends.  I sleep all hours of the day but I've still managed to have a few drop by and it's been nice.

The picture of the day, my monkeys enjoying the bunk bed:

Constant Short-Lived Naps

I think I'm honestly posting this just to have two days in a row of posts and not feel the need to apologize at the beginning of a post for once. Also, I'm probably posting because I have time and I don't know what to do with myself in a small quiet room. Ryan has been pretty out of it this afternoon. He's getting almost no good sleep. He's at the point where he's hallucinating, drifting in and out of sleep constantly, etc. Tacro (the immuno-suppressant medicine he's on) has a side effect of making your hands and feet feel really hot, like maybe you're holding them over a hot burner. It makes it really hard to sleep. Also, anytime Ryan sleeps for a bit, he wakes up in a lot of pain. His mouth, his head, his stomach- they all wake him up and he's miserable for awhile, then he kind of falls back to sleep. It sucks. I wish I could help. I can't really. I massage his legs (that helps a bit with the bone aches) and I hand him things (tissues, saline rinse, urinals, pillows). Not a lot I can do right now. Ryan did drink a ginger ale today. He thought it sounded good and he wanted to test out his throat to see if it felt any better. He got through the whole thing and said it was about a 6 on the pain scale. So what does that translate to on the Clydesdale scale, you ask? I believe it's two mules. I'm not great with that scale though, so don't take my word for it.

I believe the plan for the rest of the night is to keep Ryan as comfortable as possible. Maybe listen to some more Bossypants. Maybe make a list of my top ten movies. Maybe get Ryan to take a short walk in the halls. That's always a goal, it doesn't usually happen. Dang- Ryan was sleeping pretty nicely just now and the CNA loudly came in to do vitals. Maybe I'll make a DND sign. Or at least a "Be Stealthy" sign.

For my own entertainment, here's that movie list. Most are good solid shows you can be proud to call your favorites. The rest are more the "I don't care what you or all the critics think" variety. I'm sure you'll be able to differentiate.

1. Castaway
2. Out of Africa
3. Meet Joe Black
4. The Royal Tennenbaums
5. Forgetting Sarah Marshall
6. Amelie
7. High Strung
8. O Brother Where Art Thou?
9. Shawshank Redemption
10. When A Man Loves A Woman

Picking just ten is too hard. Pelican Brief, Dan in Real Life, Gattica, High Fidelity, and Field of Dreams didn't make the cut, and that doesn't seem right. Don't hold me to these. But please do post your own list in a comment. Entertain me for the night.

Hospital Bed Transformed Into Day Bed

Can five days really have gone by since the last blog post? That's shameful. Time flies in blog land apparently. It's not going quite as fast in hospital land, but we'll get through it. Ryan wanted to write a post with me two days ago, but he really wasn't feeling good enough and it never got done. Then he insisted he would write a post himself yesterday, but that was the drugs talking. He spent a lot of the day sitting up in his bed with his eyes closed, saying he didn't want to lay down or he'd fall asleep. This is cute and sad at the same time. 

The update on how he's doing physically is a little bleak. The mucositis is progressing and is extremely painful. I know the kepavance probably prevented it from being worse, but it's still plenty bad. He has a suction tube so that he literally never swallows. He had one medication that doesn't have an IV form so he was still trying to swallow that in pill or suspension form, but it is agonizing so they decided to ditch it for awhile. His liver will have to fend for itself for a few days until he can swallow again. Today a nurse told us a lovely story of a patient with mucositis in the pre-kepavance days that coughed up his own uvula. I thought I'd share that pain with you all. Sorry, I feel bad about it already but I'm not going to delete it. We're really grateful the mucositis isn't worse, but it's still the most painful thing Ryan is dealing with right now. To give you an idea, he says that swallowing is easily more painful than getting a bone marrow biopsy and even more painful than when he broke his arm a couple years ago. He has a very hard time sleeping due to the mouth/throat pain, aches in his leg bones, digestive tract issues, and headaches. The pain pump helps. To me, he looks a bit better than earlier this week. Here's to hoping it won't be worse tomorrow. That is our dearest hope right now. It will be really exciting when his counts start to come up and things start improving. Starting tomorrow (Day 8) they will be looking very closely to see if there are any signs of engraftment (a good thing) or acute GVHD (a bad thing). 

I don't know what else he wants me to give an update on. We've been working our way through the audio book Bossypants by Tina Fey. It's a perfect book to listen to right now because it makes me laugh and it doesn't matter if Ryan sleeps through half of it- it's not one continuous story that you'll be confused about if you miss a part. He still enjoys the parts he hears. This afternoon we rearranged his hospital room. This is a much bigger deal than you realize. The room is a positive pressure room with a hepa filter running all the time. This is great for keeping out germs but it constantly blows cold air right where the hospital bed was. It was Ryan's biggest complaint about the room. So now we rearranged the whole thing and it's much better. The bed isn't in a wind tunnel anymore, the room feels bigger, I have room to stretch my legs out, Ryan has a great view from his bed (this is reminding me of that O. Henry story about the last leaf for some reason)- anyway, it's all very pleasant. I got the idea from a seventy-year-old guy across the hall. I feel like all we need is a rag-tied oval rug for the middle of the room and we'd have ourselves a stunning sitting room. That rug is probably against hospital policy, so never mind.

We really love Jessica. I feel that this can't be said enough. She is loving, smart, hard-working, generous with her energy and time, and an amazing friend. She and Elliot are taking such good care of our boys. We deeply appreciate what they are doing for us and it means so very much to us. 

We also love the nurses, CNAs, and doctors here at the hospital. They are fantastic. We've had some visitors this week (and we've also cancelled on quite a few because Ryan just wasn't up to it), but we were really happy to get to see Becca, Elliot, my mom and dad, Angela, both the Scotts in our life (Bonnett and Ashby, henceforth to be referred to as Scott A and Scott B, grade-school-style), and Terri. We love them and we love all the people in our life- that is what it's all about.

Ryan is hooked up to six different lines at all times. The TPN for nutrition, the pain meds, fluids, Tacro, Invanz, Micafungen, Vancomycin, Acyclovir, Levaquin, platelets or red blood, an O2 sat monitor- he says he finally feels like he's getting his money out of the nursing care fees now. They're in the room a lot, switching out meds, changing dressings, taking samples, etc. Good thing we like them. Ryan used to be the easiest patient here, but he's definitely stepping up his game. He keeps them hopping. It is very nice though to walk into the hospital and know almost everyone's name. It feels like a home away from home now- so different than the first time we walked in last March. Even when they use the cleaning product that smells bad, I don't mind. It's just nice that it's familiar. Also, maybe I can't smell how bad it is anymore because I'm used to it. Probably like when I worked at a dentist office- pretty soon I didn't notice that bad dentist-office-smell. And I didn't know I smelled like it when I came home. Nice for me, not so much for Ryan.

Well, Ryan is napping. The room rearranging and shower have completely exhausted him. The medications are hitting him hard as well. They give him a dose of Benadryl before the Vancomycin because he has a reaction to it. The combination of Benadryl and Fentanyl (pain med) makes him really sleepy. I'm always glad when he can relax enough to sleep. I hate seeing him in pain. We're going to count moving hospital furniture and showering as his workout for the day. 

I'm rambling now, so I'm going to end here. Photo of the day is a few of my favorite people: Jessica, Valerie, Jacob, Jonas, and Annalisa. This was a New Year's Eve party a few years ago, when Jessica organized onsie pajamas to be worn by all.

Transplant Update

So sorry this update is a little late in coming. Ryan isn't feeling so good. And no, he hasn't started referring to himself in the third person (yet), this is Emily filling in again. Ryan thinks he'll dictate some at the end here. The transplant well smoothly for the most part. Jenny came in on Tuesday and Wednesday morning at 7am on an empty stomach. They poked I don't know how many holes in her arms. She'll have some fine bruises to show for all her trouble. They were able to avoid using a femoral artery to harvest the stem cells, which I know Jenny was really happy about. Jenny was pretty happy about most things the second day because they finally gave her the good pain meds. I felt so bad that she did the first day with no medication. Not cool. Since I don't know how to sufficiently thank Jenny for all she's done for us, I'm not even going to try. How's that for fair? Jenny knows how much we appreciate and love her, and we'll keep showing it year after year. That's a bit more fair. She's still very nauseated today. I'm hoping she can recover soon.

Ryan started receiving Jenny's stem cells about 6pm Wednesday night. We had one of our favorite nurses that night, John, who was very good to work with. Ryan started having a reaction about five minutes into it, but they backed way off on the rate they were putting the stem cells in and that helped. The rest of the transplant was uneventful, which we love. Call us boring, but we love ourselves an uneventful day. I believe Tim called me boring the other day. Hmmm. 

The day of transplant is officially day zero of the protocol. So now we're on day three. Ryan is not feeling good. The whole process of food is becoming too much for him. It hurts going in because his mouth and throat are getting more sore each day (thanks radiation!). Once the food hits his stomach, he struggles to keep it down. And then it goes right through him and is painful on the way out. I haven't managed to talk him into any food today. He dodges any questions I ask about his food intake yesterday. (I wasn't here yesterday- craziest day of work ever, but his brother Scott spent a lot of the day with him.) The doctor should come in to talk to us any time now, and I believe we'll talk about starting TPN (total parenteral nutrition, you can read more about it here: http://www.livestrong.com/article/374528-the-tpn-diet/). Other troubles are headache, body aches, ear ache, strong hiccups from the chemo, fatigue, (radiation and how hard it is to sleep in the hospital), etc. Ryan doesn't like to complain about all this, since it doesn't help. But that's the update. Even though he feels crappy, he is still working hard to stay positive, make jokes, and smiles (although they're sad smiles). I love him for trying.

Right now he's trying to distract himself from all that by playing Fallout. His mouth is getting sore enough that talking just makes things worse. But we've still talked this morning about this strange life. How beautiful and unique and fleeting it is. My grandpa died on Wednesday. I loved him very much. He gave me his books to borrow when I was young (The Wizard of Oz, The Great Brain, lots of Beatle Bailey comic books) and then gave me his Alfred Hitchcock videos to borrow when I was a teenager.  I loved his sense of humor, the gleeful look on his face when he would tease babies, the way he always called me "little one" even though I'm thirty-five now, hearing him read poems at family parties, and the way he loved his hobbies and knew how to share them with people. I will miss him very much. 

The boys have essentially moved in with Elliot and Jessica. They are surrounded by family and people that love them. That makes it a little easier to cope with not being their full-time mom right now. I can't actually talk about this right now. But I'm told they're doing alright. Thank you Jessica, Elliot, Mom, Dad, Bethanie, Lily, and Cameron- for spending time with them and loving them. We're going to get through this and pretty soon we can be at home again with our boys and have our family back together. 

So the plan for Ryan is: keep doing what we're doing until his counts come back up. That's easier said than done. His body will continue to deal with receiving Jenny's stem cells. The hope is that they can prevent acute GVHD and that Jenny's cells will slowly take up residence without Ryan's body freaking out completely. That is achieved by using Tacro (an immune system suppressant) and methotrexate (a chemo drug to beat Jenny's cells down some but not all the way). Don't quote me on any of this by any means. Read something on the internet and quote that- it will be more reliable. The doctors and nurses are watching out for signs of GVHD- it can affect any organ of the body but most often targets the digestive tract, the skin, etc. If that starts up, they'll combat it with steroids, which Ryan is understandably afraid of. Another danger is any kind of infection. The guess (although each person has a different experience) is that he'll feel worse and worse each day for a couple weeks, then hopefully things will level off and maybe even gradually improve. They're watching for signs that the stem cells have engrafted (that Jenny's cells have won this battle they're having with Ryan's remaining marrow and leukemia). We'll know that's happened once Ryan's bloodwork starts showing a rise in platelets, hematocrit, etc. That engraftment process can take up to day thirty. Until that time, Ryan's body can't produce it's own blood stuff, so he'll be getting transfusions whenever he gets too low. Blood stuff- so technical, huh? 

That's the update. Let me know if I missed anything big. I want to thank a few people that have helped this week- Jeff, Mitch, and my other friends at OrangeSoda, that have gone above and beyond for me and Ryan. I can't even thank them enough for being so supportive and concerned and kind. My sweet neighbors Julie and Debbie, that were weeding my flower beds when I left yesterday morning. Tim and Scott, for being true friends to Ryan. Buffy, for sparing Tim and sending him out and for being a true friend to me. Gavan and Amy, for being there for us and making me laugh. My family and Ryan's family- we love you forever. Melissa, for having Jonas over Wednesday night and taking his mind off things. For so many friends and family that have shown their love and concern for us through calls, letters, texts, comments on the blog, etc. It means everything to us.  

Okay, Kelli, one of our favorite PAs, just came in to go over things. They are going to start him on TPN and more IV fluids today. Mucositis is starting to develop, and since he's just starting into this process and it's still a long way down (in her words), there's no need to power through with the eating. It will hopefully help him get the calories he needs and decrease his pain. Kelli is awesome. She knows her stuff, she's a good listener, you can tell she cares, and she gives us a lot of good information. Ryan is really hopeful that TPN will solve some of the biggest problems he's facing right now. Looks like Ryan isn't going to dictate anything today. Maybe next time. Below, a picture of better days.