We got the official instructions as well as a copy of the reports from the last two biopsies yesterday. There is still some mild rejection activity; nearly no change from last month. Because Shayna's LFT (liver function test) numbers spiked last month after they started her on prednisone, they don't want to do that again so are changing the added immunosuppressant from Cellcept to Rapamune (sirolimus). It's in the same family as Prograf (tacrolimus), the main immunosuppressant Shayna will be on for life, but acts a little differently. There is a concern of diminished white blood cell production, and therefore immune system response, but Rapamune does not cause kidney damage like Prograf can. She will start the new medication this evening, special order by the pharmacy, and we will check all her lab numbers in a little over a week. (I prefer Mondays or Tuesdays as that gives us time to get the results and react as needed instead of having to wait over a weekend.)
The results do not seem to impact our trip to Israel. The transplant team would prefer a biopsy in 6-12 months but are fine when I said we won't be back in the states until late July 2017 (13-14 months). It also doesn't change the medical system we will need to set up around Shayna in Israel. The same risks are still present so we are still planning to meet with a pediatrician the week we arrive and establish a place to get regular labs. Schneider Children's Hospital, a little over an hour south of Haifa in Petah Tikva, would be the center for a biopsy or any inpatient treatment Shayna might need. All these plans and connections would need to be made whether or not rejection had been found this spring as that is just life for Shayna.
On a playful note, Shayna and I loved the National Aviary in Pittsburgh. We sat in on the hot rooftop Soaring show where we were dive bombed by Black Kites catching flying chicken feet thrown by their handlers and watched small vultures hop around their handlers begging for treats. The penguins were beautiful and their setup was perfect for watching them gracefully glide through the water. We even got to see the baby sloth cuddled in a blanket with a handler. However, Shayna's favorite thing was gazing at the Stellar's Sea Eagles.
Elijah, Maya and Nahum did great while we were gone. The kids loved the extra school time and getting to eat lunch with their friends. They all got to go to a friend's house for dinner Tuesday where the kids were doted on by the older daughters and Nahum got to enjoy adults in the evening.
Today is the last day of school for Elijah and Maya, and my last quiet morning. I am cherishing it and preparing for the chaos to come.
Shayna and the Crown Victoria's Pigeons.
I thought these vultures were pretty cute the way they hopped around, titling their heads questioningly for treats.
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