Enzyme Ups and Downs
Just a very quick update on Ana. Last week she had her labs drawn and they showed a marked increase in her liver enzymes (it was about a month from her last lab draw). Dr Martinez immediately increased Ana’s tacro level (she doubled it, actually) and started her on 20 mg/day of Prednisone which she said she’d only keep her on for about six days. This hit Ana hard because she struggles so much with the side effects of Prednisone, but it’s really a necessary evil. When she had her rejection episode last May she had a superhuman dose of Prednisone (in the hospital) and it reversed the rejection. Ana was then on oral Prednisone for about eight weeks until her enzymes were back to normal – and they stayed normal for nearly a year until last week’s lab results.
Anyway, it’s hard not to flash back on that horrible moment last May when Ana was in moderate rejection…on her birthday…and had to go straight to the hospital right from her birthday party (the same day she had a liver biopsy and had already spent most of the day in the hospital from that.)
Dr. Martinez said that she feels this is different. Ana’s a lot further out from transplant now and her tacro level has been really low (since they reduced it after her tumor recurrence). She felt that increasing the tacro level would do the trick and introducing prednisone was just an extra push to that end (and may also help with shrinking the tumors). And, I’m happy to say that her labs from this week show that her enzymes have begun to decrease again! (I’m sorry I waited three paragraphs to tell you that). A quick refresher – elevated liver enzymes are the first sign of rejection because it means the liver is inflamed. Inflammation is the liver’s natural response to the immune system attacking it. Enzymes measured are AST/ALT and GGT. They were (respectively) around 23/26 and 29 before last week. They came back at 176/292 and 69 last week which is when my heart thudded to a halt in my chest. As of Wednesday, they were 50/130 and 59.
Dr. Martinez is waiting for the tacro level to come back and then she’ll likely adjust Ana’s medication again (or keep it where it is for another week). My guess is she’ll want more labs next week and hopefully we’ll see the enzymes come down again!
Oh, and did I mention that Ana has strep throat? She was diagnosed on Monday and has been on antibiotics since then (feeling MUCH better today with just lots of stuffiness). Emily had it last week but it went untreated for a couple of days because the preliminary strep test was negative. So she walked around with strep germs for a couple of days before being on the antibiotic. But now both girls are doing much better and I have the photo to prove it!
This was taken yesterday at Willow Kiln Park in Rosendale. We took Emily to the Red Brick Tavern for her birthday (which was Tuesday). Today I’m taking the girls to get manicures in Rhinebeck (I took a few days off for spring break). I hope everyone is having a great week.