Is it sunburn? Is it clogged sweat glands? No, it’s GVHD!

Jeff has been having skin issues for about a month which warranted an extra trip to Dr. Porter’s office.  Dr. Allison Rager wanted to eyeball Jeff’s face which is a little rough right now.  However, Allison was going to be in class today and wasn’t going to be in the office at all.  She called before we left the house to tell Jeff that she would miss him.  Jeff said she sounded disappointed.  She confirmed that Jeff should have labs drawn today but he’d have to settle for Nurse Heather and Dr. Porter.

At the Perelman Center we had our beverage treats at Gia Pronto and then got in line for the elevator.  Jeff started to chuckle.  “Look up,” he said.  There was a man on his knees directly overhead.  He was washing the glass roof!  We have seen workers on that cantilevered roof before but never from the vantage point directly beneath them! Cool!

We checked in with reception at Dr. Porter’s office.  The receptionist always asks, “Are you having labs today?”  And the answer is always, “Yes.”  Today, Jeff said, “Yes, they just can’t get enough of me.” 

After labs were drawn and vitals checked (good bp, good weight), Heather examined Jeff’s face.  She said, “Wow!  That is classic chronic GVHD.”  She commented that it had been over a year since transplant and Jeff remarked, “Yes, I am one of the 80%.  Each year it will get worse…”  Still, Jeff kept Heather laughing throughout the examination.  She thanked him for the entertainment which she said she needed on a Friday.  Jeff showed off his brand new UV50 shirt and his new Aussie-style wide-brim hat which are meant to keep him from burning so easily.

Heather asked more questions about when the skin rash began (probably the day after Jeff’s last visit to the Perelman Center) and when it appears worse and does it itch (no).  It is a little tender like having pimples.  She suggested Jeff see the dermatologist again but let’s see what Dr. Porter says.  We told her it was our experience that Dr. Porter is never impressed with skin conditions.  She laughed and said this would be different because it was occurring during a steroid taper. 

It turns out that Dr. Porter agreed.  Jeff has GVHD.  They will set up an appointment with the dermatologist who, we are told, has “tricks” and a cream that may enable Jeff to continue the steroid taper.  The goal is still to get him off steroids. 

Dr. Porter said, “You have something I never want to see in my office.”  Jeff was horrified.  What can be worse than what has already transpired?  With some concern, he asked, “What?!”  Dr. Porter said, “A tan line.”  Dr. Porter assured Jeff he could go deep-sea fishing with the guys from church if he takes care to lotion and cover up.

He wants Jeff to keep his original appointment on July 3^rd for his “childhood” immunizations and a bone marrow biopsy.  Jeff was not thrilled to hear that.  Dr. Porter said that Allison would do the biopsy.  Jeff asked, “Has she done it before?”  Dr. Porter said, “No, but we’ll teach her the day before.”  Jeff said, “Yeah, on a dead pig.”   

Joanne wasn’t in the office today but I emailed her to see whether she has heard anything from Jeff’s donor.  Maybe soon.    

On the way home, Jeff wondered, for the umpteenth time, whether there would be a letter from Keith.  In Keith’s middle-of-the-night I-got-to-boot-camp-safely call, he said that he would write in 7-10 days.  It has only been 10 days.  However, when we got home, Jeff checked the mailbox eagerly.  There was no letter from Keith but there was a letter from Wichita, Kansas.  That was a puzzle.  Jeff turned it over and over and asked, “Who do we know in Kansas?”  I said, “Open it.”  It turns out that while en route to boot camp, Keith met a Marine family in line at the TGIF restaurant in the Atlanta airport.  They invited him to have dinner with them and told him he could order anything he wanted.  They had nice things to say about Keith, the Marines, and their son who is serving in Afghanistan.  It was a very nice letter, good enough to get us by until we hear from Keith ourselves.