Valentine's Week: Cowboy Monday

Jan, my favorite minder, is here this week. It's the first time we've been able spend days and nights together in four months. This is good!

On Monday, we go to my weekly appointment with my doctor. My blood counts are roughly the same as the week before, and probably a little suppressed by GVHD. My rash has mostly faded, so my doctor decides it's time to poke the hornet's nest a little. She describes what I'm going to do as tapering my immunosuppressant, although skipping one day, taking it one more day, and then stopping altogether seems too abrupt to be called "tapering." In any event, we are discontinuing the drug more than a month earlier than the typical schedule.

On the other hand, I already have (just barely) sub-therapeutic levels of the medication in my blood, so in that sense stopping completely might not be a drastic change. It might be enough to trigger another round of GVHD — maybe of the skin (symptom: rash), or of the intestines (symptoms: diarrhea, cramps, vomiting), or of the liver (symptom: jaundice [maybe vomiting, too]).

My doctor reminds us that a little GVHD is good, not for its own sake, but because it indicates that my donor cells include some T cells that recognize me as "other," which offers hope they also recognize leukemic cells as "other." On the other hand, as she further reminds us, too much GVHD is life-threatening, and I don't need any more of that. If any of the symptoms get too serious, I can go back on the immunosuppressant and/or take some steroids

When do I get to go home? Not yet. My doctor would like to see how I handle the medication change. She even seems a little superstitious, as if going home is asking for trouble, the way not having an umbrella causes rain. All I know is that I am one day closer to going home.

When the nurse stops by near the end of the appointment, my doctor tells her she's taking me off the immunosuppressant. She says something like, "I'm being a bit of a cowboy."

Giddyup.