Our venture into pushing labs out to every six weeks rather than every two went swimmingly.

Don's labs on November 14th looked stable and due to some scheduling issues we ended up just doing a phone call appointment with Christian. She felt good about how Don was doing but wanted to re-check labs in another four weeks -- mostly to check on his tacrolimus levels.

Don's labs on December 12th looked great. His white blood cells were a little higher than his normal but he'd been battling a bit of a cold so that was not out of the blue; and, they were still within a normal range. His liver enzymes look as good as they have in over a year (two years maybe -- when did the NAFLD even start?!).  His ALT was back in the normal range and his AST was only slightly elevated.

His thyroid (specifically his TSH), though, had gone up significantly. We'd made some changes in his thyroid medications back in October so when we spoke with our oncology pharmacist, Marie, on the phone she thought it would be prudent to not make any changes right now and to test again in six weeks. Don has not been experiencing any symptoms related to hypothyroidism and so we felt good with this.

Don has been feeling really good and has been able to continue building his strength. He works hard each morning stretching and training at home to build his physical strength and stamina. And, he loves his cold plunges -- though with Lake Elmo frozen over has had to take a hiatus on those (ask him about his legs vs the sheet of  ice sometime).

Our one hiccup has been a tooth that was bothering him. A trip to the dentist on the 14th showed an abscess and bone deterioration at the site of some previous work. Don was referred to Billings Oral Surgery and a call was put in to our oncology team. After talking on the phone with Dr. Hazin and the oral surgery clinic we have a plan in place. The tooth will need to be extracted and Don will both go on some stouter antibiotics prior to the procedure as well as temporarily discontinue his immunosuppressant, tacrolimus. The tacrolimus will need to be held a week prior and a week post the tooth extraction -- that's a big pause for his body. Though, during his July hospital stay his immunosuppression was held and his GVHD did not rear its head. 

We will be praying specifically for his GVHD to remain under control and for a safe tooth extraction -- the deterioration is so advanced the dental hygienist actually pulled metal from that area during his appointment on the 14th. Billings Oral Surgery has assured us they can do the removal without any metal toxicity, which would not be ideal. The stouter antibiotics will then run a full two week course.

These last couple of months have been full with family, kids, and holiday celebrations. Thanksgiving is always a treasured time for us, Josiah's birthday rings in December, and today marks Don's 3rd stem cell birthday. 

Three years. It's hard to fathom. I say it so often, but it feels like last year and a lifetime ago. It makes me emotional trying to think of how to even type the words. Three years and so much hope and excitement and heartache and trials and joy and sorrow. Transplant wasn't the start of our journey and it most certainly wasn't the end, but it was a big moment on our Path to Life.

Today, we celebrated that.