D+50: Buy one get one free

WBC 2.9
ANC 2378

If you pay close attention to Ryan's counts, you probably have noticed that there have been three consecutive days of decline in his WBC and ANC. Looks like one of the main side effects of one of Ryan's antiviral meds is starting to kick in. Gancyclovir helps prevent against reactivation of a particular virus known as CMV (Cytomegalovirus) . CMV is bad news for a number of reasons, so it's definitely a good idea to try and keep it at bay. Now to the side effect --- bone marrow suppression. Yuk! As longs as we are on the Gancyclovir (and apparently for 1-2 weeks after) we can expect Ryan's counts to get hammered. I swear that every decision made here is of the "which leg do I shoot" variety.

To make matters worse, Ryan received a "bonus" dose of Gancyclovir today. Normally, Ryan gets it every other day, but the nurse made a mistake and gave it to him today. I didn't find out about it until the night shift and I was obviously really freaked out (see above paragraph). Apparently, the extra dose is not toxic or anything and shouldn't have a significant negative impact on Ryan. Be that as it may, I would prefer Ryan to get the correct dosage of medication (go figure). The weird thing is that the nurse that gave Ryan the extra dose is one of the most careful nurses on the floor. She is constantly making lists and double-checking things to make sure it all checks out. Given enough time and opportunity, I guess anyone here can make the same mistake.

Ryan's weight is up to 18.9 kg. This is not because he's eating steaks and ice cream all day long. Rather, it indicates that he is retaining a good portion of the fluid that he's getting on a daily basis. The fluid collects in all sorts of places -- some benign, some not so benign. Examples of the latter variety would include lungs and heart. We are keeping a close eye on Ryan's blood pressure and respiration to make sure that things don't get out of control (again).

The doctor ordered an optometry consult to check out Ryan's potential conjunctival GVHD. To make a long story short: everything checked out just fine. No GVHD, no other issues. I really hate to see them pull Ryan's eyes open, and I know that Ryan hates to have it happen. You just have to chalk it up to necessarily evil. Easy for me to say, of course.

Finally, Ryan received a cool new chair from the physical therapy department here. It's called a Tumble Form and it's basically like a big, soft chair that's molded to support your body in lots of different areas. Ryan has been spending way too much time in the bed, but he can't exactly sit upright in a normal chair in his current condition. The TF should provide enough support to let him sit comfortably while maintaining good posture. We'll give it a whirl tomorrow to see what Ryan thinks of it.