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So, this is where we're at.  Maggie's bleeding issue is under control.  She's not throwing up anymore, and her stools--which were testing positive for blood overnight and this morning are now negative.  So she was bleeding somewhere in her throat or stomach, I guess, and it was coming up when she vomitted, and was getting digested in her stool as well.  

Her fever is under control, she's keeping it down without tylenol.  

Her hydration levels are back up to a better range.

She had an abdominal ultrasound repeated and it the tech thinks things look similar to last week (the doctors do the official interpretation and reporting, though--we'll hear more tomorrow).  Maggie has several organs that are either slightly enlarged or at the upper limits of the normal range.  This may be due to the stress all of her diarrhea is putting on her body.    

Her blood counts are still low enough that Maggie can't fight infections on her own.  This will take a little bit of time for the chemo from the past week to wear off.

Her diarrhea is still our biggest issue.  It is a tough, vicious cycle at this point.  She got diarrhea in February (from something, maybe a virus initially).  Her GI tract was weakened and made vulnerable.  Chemo continued in order to treat the cancer...the diarrhea worsened.  This part of the cycle repeats over and over.  

She has trouble absorbing enough calories because of the diarrhea, and she is undernourished and underweight.  This can make diarrhea worsen as well.  It feeds on itself.  Due to her weakened state and the chemo, her blood counts dropped, she picked up an infection which requires antibiotics.  Antibiotics cause diarrhea.  Today she had liquidy stools close to 20 times, many of which smelled like antibiotics.  So the diarrhea improves slightly with time, but chemo or antibiotics, or undernourishment itself causes it to worsen.  And on, and on, and on.  For 4 months.  

This seems to be where we're at.  We are begging for a plan to break the cycle and a medication to reduce the diarrhea enough to continue with chemo and to keep her from dehydrating.  But they are reluctant to give immodium or anything similar, because there are risks involved if she would get too stopped up.  We think it can be used conservatively but regularly, at low doses, to improve things a bit and get things going in the right direction again.

Dr. French is also is close to taking her off of her feeding tube feeds and giving her nutrition directly into the bloodstream (via TPN, which is IV nutrition).  This is a nice option as her bowels would get a rest and her nutrition and weight would definitely improve.  But, TPN is can be taxing and potentially dangerous to the liver.  And Maggie's liver is already taxed and swelled.  So we'll see if they move forward with that or not.

We're blessed to have a few of Maggie's issues on the way to being resolved today, but we're still very frustrated.  There seems to be no end in sight, no plan in place, no commitment to make the decision to get things going again.  And no real consensus about the true cause of the diarrhea and the role of chemo in exacerbating it.  We don't need complete healing from the diarrhea, just to manage it so that she can get back on her daily and weekly oral chemo (so the cancer doesn't come back) and so her body doesn't get dangerously dehydrated so regularly.

Maggie still isn't feeling well, overall.  She's not acting like herself.  She did start being more verbal and had 2 or 3 smiles late tonight.  Hopefully her mood will improve when the ear infection is further improved tomorrow.

Thanks for following along with our depressing and complicated saga  We will hopefully enjoy passing along good news in the near future about the diarrhea getting better and staying better.  But right now, that seems hard to imagine for us.