Day 136, Tuesday, June 11th, 2013

In the ten days since my last missive, I have had energy ups and downs, continued digestive 'meh', and not very much else. I am still considered to be doing phenomenally well for a patient about a month out of an allogeneic transplant, and these ups, downs, and 'meh' are below par for the proverbial course. I'm off to the SCCA frequently for blood draw, as they continue to adjust my tacrolimus levels up and down, trying to find the also-proverbial sweet spot that will keep the GVHD down, but not cause any attendant physiological problems that are directly related to said tacrolimus.  I have watched a lot of movies, and spent entirely too much time reading things on the internet; but I have done it from my room, and in reasonably close proximity to the bathroom (I think the furthest I can physically be from the toilet and still be in the room is about twenty feet, so it's not terribly difficult). 

Tacrolimus, primarily, works by suppressing interleukin-2 production by T-cells, which prevents them from populating and differentiating into effector T-cells. It also inhibits the production of regulatory T-cells, inhibits B cell immunoglobulin production, inhibits the production of natural-killer cells (NK), and inhibits adaptive immunity to pathogens (mean ol' viruses and bacteria). The short version (or tl;dr) is right in its classification: it is immunosuppressive, an immune suppressant. 

Immune suppressants aren't terribly nice to the body, and have a laundry-list of potential damages and side effects. Straight from the wiki for Tacrolimus:

 "Side effects can be severe and include infection, cardiac damage, hypertension, blurred vision, liver and kidney problems (tacrolimus nephrotoxicity),^[17] hyperkalemia, hypomagnesemia,hyperglycemia, diabetes mellitus, itching, lung damage (sirolimus also causes lung damage),^[18] and various neuropsychiatric problems such as loss of appetite, insomnia, Posterior reversible encephalopathy syndrome, confusion, weakness, depression, cramps, neuropathy, seizures, tremors, and catatonia.^[19]

Right now, my kidneys are under a very close watch, but I've got nothing that's actually considered serious or particularly worrisome taking place, and I'm not worried about anything developing. Prognosis: kickass.

In summary, I'm often tired, and I haven't trusted a fart in two and a half weeks.

The "Rocky" Drinking game (works for any Rocky movie): Drink every time Rocky takes a punch. You stay mostly sober until the end of the training montage, and then WHOOSH.