Day +190 post hsct update

The last three weeks have been a bit of an emotional roller coaster. I have been feeling so out of sorts - kind of like I am a puzzle piece that just can't find its place in the picture. I am happy with being a puzzle piece, but I desperately feel left out and confused. Does that make sense? lol Any-who, my body has been an absolute piece of work since mid Jun, so I actually have quite a bit to update. The last week of June I headed to Chicago to see my HSCT team for a six month follow up, and it was a raging disaster. Yikes.

June

• The last week of June I trekked out to Chicago to see my transplant team for a six month post HSCT follow up. Remember, I signed my life away for 5 years to participate in this study, which means I have to return to Chicago once a year to update the doctor on my progress for research purposes. I basically got one piece of bad news after another the entire trip. I saw the researching physician, the pulmonologist, and the gastroenterologist. I also had blood work, a PFT, an EKG, and a last minute angio-CT preformed. My blood work showed my autoimmune markers didn't change a bit (ANA still tittering at 1:1280), my DLCO actually dropped 22%, my skin and raynauds somehow worsened, and my GI tract decided to crap out on the trip which resulted in many sleepless nights vomiting undigested food. Now to be fair, everything was going swimmingly for the first 5 months, but for some reason in June all hell broke loose. I started having a lot of nausea/bloating while eating, uncontrolled diarhea, and on the trip started throwing up about 3-4 hours after meals. My fingers noticeably tightened, and I just couldn't get my raynauds under control. To top it all off we, suspect aspiration. Basically, the whole trip consisted of everyone telling me how "unfortunate it was that the effects of my transplant only lasted 6 months." *Insert tears and eyeroll here* I am hoping this is just the "rollercoaster" that is so often talked about and not a relapse!

July

• Due to the severity of the digestive issues my transplant team sent me back with loads of test to preform here in Seattle. The tests due to be completed are: an aspiration assessment, a gastric emptying study to asses stomach function, and a small bowel follow through to asses intestinal function. The tests will help us better understand what organs are malfunctioning, and what type of tube I will need moving forward - or if possibly, all these digestive issues are of a more transient nature due to a virus, or possibly even Graft Vs Host. (Fingers crossed for transient!) In the interim, my GI physician placed a NJ (Naso-Jejunal) tube. This is a feeding tube which is inserted through the nose, fished through the esophagus, past the stomach, and into the intestines. Due to my suspected aspiration she wanted a tube that bypassed the possibility of aspiration, while still providing nutrition until we have the situation assessed. Honestly, my digestion by that point had gotten so bad I welcomed the horrible little device. I was so light headed from malnutrition I was unable to drive myself around upon retuning from Chicago! It has given me the much needed nutrition I had been deprived of the previous two weeks. 
• Monday I had the aspiration assessment preformed in fluoroscopy. The test was done by a speech pathologist who uses an x-ray machine to watch different consistencies of barium pass through the oral, pharyngeal, and esophageal phase of swallowing. Compared to a similar study I had done about two years ago my esophageal muscles had improved greatly! Liquid was able to pass through the esophagus unaided - While I still couldn't pass solids unaided, such as thick pudding super well, being able to pass liquid easily was a huge improvement post transplant! While the test didn't show any barium entering my lungs, my doc explained that it doesn't necessarily mean I am not aspirating. Unfortunately, these kind of tests are limited as food/drink in the "real world" is varied from that in a lab environment. The speech therapist did notice something odd though during the test, a violent Laryngospasm. For reference, the larynx protects the trachea from aspiration. Even though they couldn't see aspiration, my vagus nerve is clearly telling my larynx that I am in danger of aspirating, causing it to abruptly close as a defense mechanism. Yes, momentarily closing my airway. The vagus nerve is part of the autonomic nervous system which regulates unconscious actions such as digestion, heart rate, breathing, etc. The speech pathologist explained to me that I have Vagus Neuropathy, meaning I have damage to that system, causing overreactions. 

Tomorrow I have my gastric emptying study to asses my stomach motility. This is the gold standard test to diagnosis gastroparesis, aka stomach paralysis. This is often a comorbidity of scleroderma, and besides esophageal paralysis, is the number one reason a patient requires a feeding tube. I already feel my motility has improved a bit since we ordered the test a week ago, so here is to hoping all the vomiting and nausea was due to some crazy virus and not gastroparesis! However, gastroparesis can be a "flare" illness, meaning the paralysis can come and go - when caused by, you guessed it, a faulty vagus nerve! Guess I'll find out tomorrow!