transplant and hello

[squirrellypoo]

Hooray! Happy rebirthday Serkan!! I hope you can take the time to celebrate and reflect on how far you've come.

[Laura]

Serkan!!! Great to hear from you! Happy rebirthday!!!!!!!!! I hope you can do something great for your birthday.

Laura

[Ruth Cuadra]

Congratulations, Serkan. You are such a brave warrior to have pursued your recovery and won! Your counts look very good compared to a year ago. I hope the coming year brings you continued improvements.

Regards,
Ruth

[tserdogan]

Thank all of you,

Last tuesday i had apointment with my doctor.My last counts are very positive for me and my doctor.Nearlly 400 day has passed.

My hemo is 14.5
Plt is 100
Wbc is 3,7

But my doctor is a little bit anxious about my liver.My liver enzymes are high.He is thinking a gvh.And he wanted ultrason about my liver and gall bladder.They are clear thank God.

He added Cellcept.i have taken 1,5g daily cellcept one week.İf the enzymes are same,He may be, want biopsy.

Whatever one week later may be i can give you more info about liver enzymes.

[squirrellypoo]

Thanks for the update, Serkan - those number are great! You must be really pleased.

Have your doctors ruled out infections or drug reactions for your liver results? I had really high liver function tests that came out of nowhere last September, and they did everything from ultrasounds (with high-contrast dye), so many dye-assisted CT scans I lost count, plus a CT-assisted liver biopsy, and even a lung biopsy, plus months of a daily antifungal IVs after weeks of a strong IV antibiotic cocktail didn't reduce them.

They're only just approaching normal levels now, and they never did positively conclude what caused them to go so high in the first place. BUT as soon as I stopped the IV antifungal (Caspofungin), they immediately started to come down way quicker than they were before, so it may be that it was actually making things worse instead of better.

From my point of view, the ultrasounds and CT scans were painless, and the liver biopsy was just some needles being jabbed through my abdomen (so not too bad), but the lung biopsy was super painful with a full 2 weeks of pain before I could stop with the 24hr pain medication.

So it's worth asking why they automatically think it's GvH and not other things if it means you're spared some pain!

melissa

[tserdogan]

Yes Melissa,i am very pleased about counts.

i am scared about liver biopsy.i will try cellcept one week.if it solves the problem,great for me.Melissa, do you remember your liver counts.
My ALP score is 230(0-129)
ALT score is 240(41-89)

[Laura]

Hi Serkan,

It is so nice to see your counts so high. I bet that feels good?

Sorry to hear about liver. Are you on antifungals? Like Melissa (in a way) my liver enzymes sky rocketed when on a certain antifungal and dropped as soon as I was on it.

Laura

[tserdogan]

Hi Laura,

i dont use any antifungal medications.i only use sandumin 3*25 and ursofalk.
if you ask me i have fungus,i dont know i have to ask my doctor to check fungus...

[Laura]

Just wondering if you were on the med as it can cause high liver functions. But if you are not. Then not sure what is causing it?

Laura

[tserdogan]

Yes Laura,you are right.
next wednesday biochemical will show us if it is gvh or not.

[mnsnyl]

Serkan are you from Turkey?

[tserdogan]

yes,i am.istanbul.where are you from mnsnyl?

[Debbie W]

Gorgeous city, we were lucky enough to visit, but only for a day and would love to return. Continued success with your transplant.

Best regards,
Debbie

[tserdogan]

Thank you Debbie.i hope you will come again to İstanbul.One day is not enough.At least one week needed.Many places you have to see İn İstanbul....

[Debbie W]

We would love to come for a week! My sister has lived in the UK for over 20 years and Istanbul is one of, if not her favorite, city to vistit.

My husband is just starting the transplant process so we know it will be not be soon, but we would love to have a longer stay.

Wishing you continued success

[tserdogan]

Hi,

i am very anxious ,My last liver enzymes are thirty times more.i will visit my transplant doctor tomorrow,and i hope i will learn what is going on my enzymes(Ast;Alt)

[Laura]

Have they checked to see if it is GVHD? I would be anxious too! I hope everything is okay. Keep us updated.

Laura

[Debbie W]

You made me google elevated liver enzymes after stem cell transplant and I came across this recent article.

I'm also curious because I had just asked about my husband's elevated Ferritin level.

Good luck and let us know what the doctor says.

http://www.hindawi.com/journals/ah/2010/345756.html

Review Article
Iron Overload in Patients Undergoing Hematopoietic Stem Cell Transplantation
Vinod Pullarkat
Department of Hematology and Hematopoietic Cell Transplantation, City of Hope Medical Center, 150 East Duarte Road, Duarte, CA 91010, USA

The following paragraph is from this section ...

"5. Iron Overload in the Post-HSCT Period"

"...Iron overload is known to contribute to the etiology of liver dysfunction chiefly manifesting as elevated transaminases, a common chronic complication occurring in 50%–72% of patients [62, 63]. Iron overload therefore can mimic exacerbation of hepatic GVHD following HSCT, leading to unnecessary continuation or intensification of immunosuppressive therapy [64]. In a study assessing the role of liver biopsy in evaluating the cause of elevated transaminases in post-HSCT patients, 33% of biopsies had evidence of iron overload and no other pathologic findings [63]. Normalization in liver enzymes has been demonstrated with phlebotomy and iron chelation therapy [64, 65]. The role of persistent iron overload in infections that occur late after HSCT, particularly in patients with chronic GVHD requires further investigation..."

Originally Posted by tserdogan

Hi,

i am very anxious ,My last liver enzymes are thirty times more.i will visit my transplant doctor tomorrow,and i hope i will learn what is going on my enzymes(Ast;Alt)

[tserdogan]

thanks Debbie for the link,i forward it to my doctor.Laura,it looks like gvh.no hepatitis b has seen.Now i am starting prednol 64 mg daily.and for only three day.if it does not work,i will stay 15 day at hospital.everyone knows prednol has got side effects and it is scaring me again

[tserdogan]

Hello again,

İ have question.What is zona.i know it is virus called herpes zoster.and i have got it five days.pain and irritation is incredible.
my doctor gave me some medications,but still they are still reproduce.
is there any advice?

if it is not recover,i turn back to hospital for iv therapy

[Greg H]

Hi Serkan!
I think what you describe is known in English as shingles. It is a herpes zoster flair up, often of a latent virus population that was expressed in childhood as chicken pox.

The virus lies dormant in the nerve fibers near the spine. When it deactivated. It creeps up the nerve fibers to the skin surface where it erupts in a painful rash localized to the portion of the body served by the particular nerve cluster that is affected. Immunosuppression can allow the dormant virus population to expand. The flare-up generally does have a finite lifespan of two to four weeks.

Take care!

Greg

[Neil Cuadra]

Serkan,

I'm sorry to hear that you have this infection. Herpes zoster is more commonly called shingles, a skin condition caused by a virus. Shingles can infect anyone, but it's especially common in post-transplant patients while their immune system is suppressed. It's important to get treatment, which may be with anti-viral drugs.

You'll find more information about it if you use the word "shingles" when you search Marrowforums or other websites.

[tserdogan]

Thank both of you.Now i am searching it in shingles.
i use valtrex for five days.i suppose at least minimum one week is waiting needed.

[Laura]

We have not heard from you in awhile. How are you? How are counts? Laura

[tserdogan]

Thank you Laura.
25 months has passed from post transplant.Blood counts are very near to normal range.
Only PLt is under normal range(135.000)
Gvh at my liver.Enzymes are high.So i still use low dose prednol.