We had a long day today. We did Raul's GFR test this morning, and thankfully I heard tonight that his results were good, which means his kidneys are functioning well. The test involved injecting a small amount of radioactive fluid through his central line, and then after 2 hours his blood was drawn every 40 minutes for several hours
After rounds I met with Dr. Wagner for Raul's exit conference and to sign all the consents. This involved going over his results from various tests, the transplant process, a few additional studies, any potential risks, and information specific to this BMT protocol. It was actually quite interesting, and it was nice to learn about the treatment from Dr. Wagner since he was one of the original doctors who started the trials for EB. Raul's echo, EKG, chest CT, and labs were all good to continue on with the transplant process. He does have past exposure to several viruses that they will need to watch for closely after transplant.
Raul and his donor are full matches, which I was told is not too common with the EB patients with unrelated donors. They are 8/8 matches with their HLA typing and also have the same blood type. This should help reduce the chances of some complications after transplant, and having the same blood type will help his red blood cells recover more quickly.
We also met briefly again with the pain team, and made a plan for which pain medicines to try/when to try them. This afternoon we headed back to the OR for a few more procedures. Unfortunately, the OR was running two hours behind again, but luckily Raul fell asleep while we waited. He first had a GI scope, which was surprisingly good! No erosions or major inflammation, just more mild inflammation in the esophogus and in both his stomach and esophagus if the camera touched the tissue it bled. They did note a high stricture, so IR came and did a balloon dilitation of that next.
After that a PA from the BMT clinic came to do a few tests for the trial. This involved several tiny skin biopsies on his thigh, a blister formation test, and photos of his whole body. The blister test tests how quickly someone makes a blister when it is induced with a special suction device. Most healthy people would take around an hour, a carrier may take around 30 minutes, and someone with EB might take up to 10 minutes (though usually much lower with severe EB). I asked how long Raul's test had taken, and he said the site began to blister almost immediately.
Unfortunately, our PACU experience was not as positive this time. They allowed Raul to wake up fully before even calling me back to re-bandage him, so he inflicted some new wounds on himself itching and thrashing and worsened some current wounds (his entire body was unbandaged). They did finally give him more medication, but it didn't kick in until I was just about finished re-doing the bandages. Thankfully I do not think he really remembers that happening! Tonight he was back to wanting to watch cartoons, play on his iPad, and eating fruit pouches after a long day of being NPO!