More updates ~
	6 ~ updates on Karis

Tuesday, July 11, 2006
(Debbie) Karis has been released from the hospital and gratefully found her bed here at home. Other tests are being scheduled on an outpatient basis, and she'll see the docs again at clinic Thursday. She's not feeling well enough to go to class tonight, but is happy to be home!

Val and I peeked in at Carissa this morning, back in ICU. Please pray for answers.

Monday, July 10, 2006 (Six months since transplant!!)
(Debbie) Sooo . . . since she was feeling so swollen and puffy, Karis decided not to do her nighttime IV fluids for the last few days. She got away with it as far as hydration, but her electrolytes are a bit out of whack. She's spending the night at the hospital getting her numbers back in normal range. Valerie is there with her.

The experiment did have some positive results, though--they're going to try giving her oral supplements, and if that goes OK, will remove her central line, since she doesn't need it anymore for hydration and it could be a factor in her blood flow problem (if Dr. Sindhi is right about what's causing the swelling). Karis has been wanting that to happen before she goes back to college. What an amazing thing to not have to care for a catheter or worry about central line infections!!!! (They also may remove her G-tube, another line item on her wish list, though are still noncommital about that.)

Despite the results of Saturday night's ultrasound, Dr. Sindhi still thinks the problem is with Karis's veins and has ordered a dye study through her central line, which will give additional information. That will be done later this week. He spent a long time with us in clinic today, discussing college and what he still wants her to accomplish in the next month before her big move back to Notre Dame. He wants her to meet with Dr. Green, the head of infectious diseases, for better definition of what she should do to avoid infection (FREQUENT handwashing is the biggest thing, and staying away from people with symptoms of illness). Karis has been offered a place in one of the grad apartments on campus. That will make her move a lot simpler than if we had to find and set up housing for her off campus. She'll probably have three apartment-mates, but a room to herself, and easier access to everything on campus. We are grateful once again for ND's willingness to do all they can to help her!

Carissa has had another seizure. Please pray!

Sunday, July 9, 2006
(Debbie) We spent several hours in the ER again yesterday evening. Karis was feeling worse, with a lot of pressure up into her head, so they decided to call in the ultrasound person on call. To everyone's relief and surprise, she does not have venous obstruction, which had been everyone's best guess as to the cause of the swelling. Her chest x-ray raised suspicions that something may be going on with a lymphatic leak again--either that, or there's still some leftover fluid that hasn't yet resolved from her chylothorax several weeks ago. Don't know whether there's any connection with the swelling in her shoulders, neck, and face. Once they determined there was no immediate danger (ie., a clot in a vein), they let her come home. She woke up this morning as puffy as ever and didn't feel good enough to go to church. It's very weird. We'll see what they say at clinic tomorrow.

Since Karis commented that her head feels as large as a pumpkin, her friends are calling it "pumpkinitis." Not totally satisfied with this diagnosis, Karis would like to know YOUR opinion . . . Send your votes to kariskornfield@gmail.com !

Saturday, July 8, 2006
(Debbie) Karis spent several hours in the ER yesterday because of significant swelling of her shoulders, neck, and face, most prominently on the left side. After some debate about the possible causes, and good blood test results, it was decided that further testing could wait until Monday. She'll have bloodwork, then an ultrasound, then clinic on Mon. morning. Karis is not happy to be stuck with a "swollen head" for the events planned for this weekend, but was happy to get out of the ER because her former ND roommate Hannah had arrived for a visit. I hoped she would get better overnight, but this morning she looks as puffy as ever, especially on the left side.

Friday, July 7, 2006
(Debbie) We're safely back home in Pittsburgh, after a marvelous reunion at my sister Linda's farm in Iowa with 37 members of my family (my dad, all of my brothers and sisters, most of their spouses and children). Karis stayed well (except for a small problem with high blood pressure)--we're so grateful that she was able to participate in this memorable event! Thank you for your prayers! Valerie is here with us now.

Carissa continues in the hospital, spiking high fevers which no one understands.

Thursday, June 29, 2006
(Debbie)  We're off on our 17-hour drive to Iowa!!  Karis is doing great.  Please pray that she'll stay well the whole time we're gone.  Today and tomorrow family members are driving to Iowa from New Jersey, DC, Florida, California, Oregon, Oklahoma, Chicago, Mexico, Brazil . . .  I'm so happy that Karis can be a part of this gathering!

I just received the following note from Bev, who collected and sent cards and letters to Karis's donor family: "I sent 26 cards/letter - each one was very special and beautiful.  I know this will mean so much to the donor family."

Thank you so much to each of you who took the time and invested your love in doing this.

I don't know how many of you are tracking with Carissa.  The last couple of weeks have been really rough for her.  Details at http://www.monkeygirl.atfreeweb.com/Updates/current_update.htm

We won't be posting another update until we get back, unless there's some sort of emergency.

Tuesday, June 27, 2007
(Debbie) I actually did write an update, but it must have gotten lost in cyberspace between me and Ted! I'll try again, since what I wrote not only didn't reach Ted, but disappeared also from my computer. I've been having problems with my e-mail, not receiving what people send me and not sending successfully. Last night though I suddenly downloaded over 500 e-mails, written within the last month! I don't know where they have been! If you have written to me and not received a timely reply, please be patient while I work through all of this!

I just returned to Pittsburgh from Brazil. Don't know how to thank my sister Jan for the priceless gift of a month at home, being able to participate in Valerie's graduation and other special events, and see at least briefly so many other dearly-loved people. Karis has fared well--she looks fabulous. You'll see from the pictures that she's even riding her bike again! Just a few weeks ago, that was only a dream. She seems to be thriving on being home from the hospital. No sign of the cough that was so worrisome, and her ileoscopy this morning looked good (no evidence of rejection in her intestine). Her liver numbers are coming down more slowly than the doctors would prefer, but are out of the "danger" zone. The docs say they are going to keep her on steroids indefinitely to protect against another episode of liver rejection. This wasn't great news, but there doesn't seem to be any option at the moment.

We're extra delighted that she's doing so well because we plan to leave town Thursday morning to drive out to Iowa for a family reunion! We plan to be gone for a week. If Karis's labs look good tomorrow, she may not even need to have bloodwork done while we're gone! She's still on IV's at night, but otherwise is taking all of her medicines orally, and eats anything she wants, with great pleasure. She eats a LOT, with great frequency, but isn't gaining weight, so apparently her new intestine is still not absorbing as well as we hope it eventually will. Meanwhile she's in the enviable position of being able to eat as much of anything as she wishes, and it's such fun to watch her enjoy textures, flavors, colors . . .

I'm writing this while Karis is in the class she's taking at the local community college. She keeps very busy with friends, physical therapy, and a variety of fun activities (including the World Cup), sometimes needing to cancel plans for a rest break, but keeping up a "normal" day amazingly well. So much to be thankful for!!! With all hearts we thank you for your prayers and love for her, and thank God for his grace so evident in her life.

Thursday, June 15, 2006
(Janice) Karis was surprised Wed afternoon by the news that she could come home tomorrow (Fri 16), a week earlier than expected! She has responded well to an antibiotic and lowered steroids, although her cough persists, and she's met or exceeded the strength and skill goals she'd set, so they feel she's ready! Yeah, God!

It will take a couple days to get resettled and reoriented with medical procedures, although the small box of meds they are sending home with her is nothing compared with the boxes and bins and freezer chests of a year ago! She will report to Children's Hospital a couple times a week for labs, clinic, etc, return a couple times a week to Rehab for out-patient therapy, attend Spanish class Tues-Thurs evenings and services at Ascension and Three Nails, see friends... she'll stay busy! But Lord willing, she can enjoy meals she cooks, have less interruption in pursuing her own studies, and continue to prepare for the coming transition back to school.

Don't stop praying for rest at night (one recent night's sleep was lost, for instance, just with an IV pump that wouldn't stop beeping!), for daily plans and use of time as she works towards her goals and also seeks good closure with many friends here.

Saturday, June 10, 2006
(Debbie) I just talked with Karis and with Jan, so I'll send you a quick report before getting dressed for Valerie's graduation!

Overall it sounds like Karis is doing well. She has had a bad cold for many days that doesn't seem to be getting any better. The cough combines with the steroids to keep her from sleeping well. At clinic Thursday they took a chest x-ray to make sure her lungs are still OK, which they are. Her liver numbers continue to improve, but they're going to leave her at the current level of steroids (15 mg of Prednisone) for two more weeks. The best news is that the pain is gone!

Meanwhile, Karis continues to make wonderful progress in therapy. Each Friday she does a 6-min. walk to see how far she can go. Yesterday her distance improved 26% from the week before! Her right foot is more mobile, and feels more "normal" to her. The rehab hospital bought her new shoes to fit her new brace, which she really likes.

This week both physical and occupational therapists took Karis home to evaluate how she did on the stairs and make sure the house is considered safe for her. They're still a little concerned but have set a date for Karis to go home, assuming she's well medically: June 23rd. That's the day I leave São Paulo, to arrive back in Pittsburgh the next day, and will give her almost two months before she starts classes at ND. God is good--all the time!

Friday, June 9, 2006
(Janice) Karis had a great clinic visit Thursday and they don't want to see her for another two weeks, which frees her to attend a Pirates game next Thurs with the rest of her rehab unit. :) They are continuing IV fluids at night and will hold the steroids at 15 for another week or so, which may continue to affect her rest. Her liver numbers are down and the back pain is gone, so the CT scan was cancelled! She's had a cold so they took a chest x-ray; no one wants a return of pneumonia or CMV. Thankfully, it was clear. Karis is happy to eat a wide variety of foods and needs to eat frequently; even so, her weight is only holding steady. We were relieved :) that she passed her IQ test! Actually, she scored very high in everything except a couple areas of processing speed. They didn't even give her the puzzle test, since the staff watch Karis, Debbie and friends assemble one puzzle after another in her room!

Karis continues with aggressive therapy and we get out for something at least once a day--a mile walk, dinner or watching a World Cup soccer game with friends, a Bible study, Spanish classes at the community college... This week she attended the Arts Festival downtown with her therapists and another day we were successful finding a cute pair of shoes that will accommodate her brace. Perhaps the most exciting moment was watching her put both heels on the floor and visibly raise the front of her right foot! She says the constant tingling pain there is changing to a more normal pain as sloooowly more control and sensation are returning. Exercise and electrical stimulation (e-stim) are bringing results, with God's help!

The current projection is clinic on June 22nd, move home from rehab the 23rd, Debbie returns the 24th, I leave the 25th to pick up another sister's family and head out early to Iowa to help set up for our family reunion, Debbie and Karis and other cousins drive out together June 29-30, returning to Pittsburgh for class the night of July 6th. Lord willing, Karis will move back to Notre Dame mid-August!

With all the good news, continue to pray for: sleep at night, healing from her cold and resistance to infection/contamination as she gets out more and more, continued restoration of her right foot, God's going before her in the big transition back to college life! It's both daunting and exciting! Thanks for standing alongside her with your interest and prayers. As Karis would say, "God bless!"

Sunday, June 4, 2006
(Debbie) Jan tells us that Karis has been busy with therapy, people, and events. The rehab hospital is saying another 1-2 weeks before she will go home (to the Browns' house). The high-dose steroids make it difficult for her to sleep, so the main prayer request is that she be able to rest. We hope that her liver numbers will be low enough by the time she has clinic on Thursday that they'll be able to start cutting down the dose of steroids.

Thursday June 1, 2006
(Janice) Just over a year ago I was with Karis, and what a change there's been! I know she grew a lot worse prior to receiving the second transplant and then faced the initial recuperation, which makes it all the more remarkable how God has intervened and how hard she's worked!
--Her hair is growing back, perhaps a shade darker and redder than before.
--She moves beautifully, whether walking or climbing, even though it takes effort.
--She can throw and catch more consistently than I can!
--She's thinking and conversing clearly, reading, studying, even attending a 3-hour class on Tues/Thur nites.
--She relearning "hunger" as she spent two years being hungry and she's now inherited someone else's digestive system and metabolism!
--She is thinking concretely about what it will mean to return to life at Notre Dame in August, Lord willing.

Right now Karis is receiving a pretty high dose of steroids to counteract potential liver rejection. The steroids keep her from sleeping well and since her days can be pretty full, you might pray she can get good rest. The liver numbers were down somewhat at clinic on Wed, so that was good news! She'll do extensive labwork on Monday and by Thursday's clinic, we should have a better idea if the steroids have done their job and can be reduced. Her IV fluids were increased from six to eight hours and a new med added (Valganciclovir) to fight any recurrence of the CMV infection. Karis has a sometimes-ongoing and sometimes-sharp pain in her back; a CT scan will help evaluate whether the source of pain is primarily muscular, the liver, or something else.

Karis sends her love and may send the next update herself.

Monday, May 1, 2006, 11 p.m.
(Debbie) We spent a good part of the morning at the hospital today doing blood work, chest x-ray, and clinic, and came through all of them with flying colors. (A nurse at clinic gave Karis the gift of a Notre Dame t-shirt!) There is no more accumulation of fluids around Karis's lung, so today she was liberated to eat anything she wants. If the x-ray next Monday is still good, her chest tube will be pulled, and then she'll be able to shower again! After therapy this afternoon, we enjoyed walking/wheelchair riding through the gorgeous neighborhood around the rehab hospital, relishing the exuberance of springtime. Tomorrow we head back to the hospital for scope and biopsies, and then don't need to return to clinic until next Monday. Karis will be able to focus on rehab, preparing to come home.

Friday, April 28, 2006, 5:00 p.m.
A message from Karis:
Since you might know that my birthday is next week, I would like to make a request. Please do not send me cards. Instead, if you would like, please send a card or note to the family of my donor.

I've been thinking about this because if it weren't for my donor's decision to give her organs, I might not be celebrating this birthday. While I am celebrating life, I'm sure that my donor's family is still grieving. I would love to do something to encourage them, if we can.

I asked permission to do this, and was given guidelines to follow in sending a card or note to the family of my donor. A nurse from the hospital has offered to receive all of the cards and at the end of May, turn them over to CORE, who will then send them to my donor's family.

Guidelines from CORE:
1. No personal or specific information that could identify the recipient or lead them to find the recipient; i.e., write "I attend college with Karis," NOT "Karis and I attend Notre Dame"
2. Do not use city names, hospital names, phone numbers, or names of physicians
3. Use first names only
4. Refer to the donor as "your loved one"
5. Sign the card or letter with your first name and relationship to Karis; i.e. Bob and Carol, Karis's aunt and uncle; Matthew, a friend of Karis

All cards will be reviewed by CORE (Center for Organ Recovery and
Education) to ensure confidentiality and black out any personal information.

Send all cards or letters to Beverly Park by MAY 30th:
Beverly Park MSN, CRNP
Dept. of Transplant Surgery, 7 North
Children's Hospital of Pittsburgh
3705 5th Ave.
Pittsburgh, PA 15213-2583

THANK YOU SO MUCH!!!

I feel like my celebration has already started, just walking out of the hospital after being there 16 weeks! I'm free!!!! I have a window and a big room and privacy! Today I started physical therapy and occupational therapy and wore myself out. But it's so good to be working toward goals. Thank you all so much for your love and support through all of these days and weeks!

Fri., April 28, 2006, 8 a.m.
(Debbie) A little more detail about how Karis is doing:
1. Eating is going well, with a little bit of help from medications. No TPN, no tube feeds!! All of the new organs are functioning well!!!!
2. Lung x-ray yesterday was the best in recent history!
3. No more insulin! for the last two days--still checking her blood sugar with some frequency, but so far so good!!!).
4. Blood pressures have been good enough to be able to skip doses of blood pressure medication from time to time.
5. Still on 8 hours of IV fluids at night, with some electrolytes included.
6. Still on IV Zosyn (because of the abscess), until May 3rd 7. Still positive for VRE, which means Karis continues in isolation. That means, if you come to visit, you should gown and glove if you want to touch her, and you MUST wash your hands upon entering her room and upon leaving, even if you don't actually touch her. We can't take a chance of spreading this inadvertently to other kids.
8. Wound healing continues well. Perhaps another few weeks.
9. Karis left the hospital on only 10 oral medications!!! (most of them, of course, are given two or three times a day). Our discharge nurse said this is one of the simplest post-transplant regimens she can remember!

We left the hospital feeling tremendous gratitude for all of the wonderful people who have cared for and invested in Karis' life over all of these weeks. And in awe of the miracle of new life and health. If the doctors were right about how sick Karis was before transplant, she probably wouldn't be alive today.

The Children's Institute has been completely remodelled since Karis was there (briefly!) a year ago. The rooms are large and lovely with big windows and lovely views. Karis has twice the space she had at the hospital, and can see green grass and trees instead of roofs and walls. I expect she will make progress quickly in this lovely new environment.

Early Monday morning Karis will go back to Children's Hospital for blood work and repeat x-ray before a clinic visit with the transplant team. Tuesday she goes back for scope and biopsies. Other than those interruptions, however, she'll be able to focus on rehab, getting ready to come home (to the Browns' house). Our hope and goal is to move to South Bend mid-August.

Thurs., April 27, 2006, 6:30 p.m.
(Debbie) Karis is out of Children's Hospital!!!!! She moved over to the Children's Institute (rehab hospital) this afternoon, looking and feeling great!!! We're so excited and grateful!

The phone number in her room is 412-420-1507. She can receive calls until 10:30 p.m. Visiting hours are 4:30-9:00 p.m. on weekdays and 9:00 a.m.-9:00 p.m. on Saturdays and Sundays.

Karis's chest tube is capped off. Present goal is to remove it week after next, if there's no sign of more fluid around her lung.

Wed., April 26, 2006, 8 a.m.
(Debbie) Happy Birthday to Battle!

The plan I described was moved up a day, apparently because the rehab hospital wants Karis to be showing that she can eat again for a bit more time than had been allowed for. So the chest tube was clamped on Mon. afternoon, and Karis started eating yesterday afternoon. That was fun, but it went right through her--literally, within a few minutes. I don't think there was time for her to absorb anything from what she ate. They're trying this "cold turkey"--going from TPN to 100% oral just like that, not even using tube feeds. Makes me nervous. I hope she's ready for this!! Still aiming for transfer to the rehab hospital tomorrow (Thurs.).

We talked briefly to David on the phone last night. The strike was called off, and things are going well in Santa Cruz! Praise God!

Wednesday, March 22, 2006
(Debbie) Happy Birthday to Sharon (Carissa's mom)!

Karis has had a busy day, including evaluation by the hospital rehab team of her strength, endurance, dexterity, mobility, etc. They are recommending that she go from here to a rehab hospital for a short stay. They think she will make progress through an aggressive rehab program much faster than she would by doing outpatient sessions two or three times a week. Makes sense, although at first Karis resisted the idea of extending hospitalization. The transplant team is now aiming for discharge from Children's next Monday or Tuesday, assuming she remains stable. First choice is to be transferred to Children's Institute for rehab, where she was last February, but if she's considered too old, they'll arrange for an adult facility.

Karis also had an educational session with a nurse from the diabetes team re. diet, signs and symptoms of high and low blood sugar, giving herself insulin injections, etc. We hope that her new pancreas will soon begin producing enough insulin on its own, but at this point she is still dependent on insulin injections. They're calling it "steroid-induced hyperglycemia," not actually diabetes. When she goes home, she'll have to prick her fingers six times a day to test her blood sugar (including midnight and 3:00 a.m.!) and call the diabetes team here at the hospital every morning to find out how much insulin to give herself that day. I'm sure it's a familiar routine to people who deal with diabetes, but it will be new for us.

This afternoon we went to the Pathology lab to view Karis's old organs, which were scheduled for incineration as soon as Karis had the chance to see them. Bev took pictures, so we'll post a couple of them for you, and if they gross you out, you don't have to look at them. :) I'll save the description for whenever we manage to get them posted. It was a bit shocking to see with our own eyes how bad the liver was (Bev ranked it a 9 on a scale of 1-10 of the worst she had seen), but it made us even more grateful for God's preservation of Karis's life.

Karis is working on her application for re-admission to Notre Dame. It's wonderfully motivating for her to have the goal of being strong and independent enough to return to college in August! She has come so far that we're quite confident she'll be able to do this, by God's grace.

Tuesday, March 21, 2006, 10 a.m.
(Debbie) Happy Birthday to Bach! And it's now ten weeks since Karis'
transplant.

I'm sorry I haven't updated for so long. I keep hoping to learn something useful to comment on. After the first x-ray was done to locate the camera, we were told that it was still in her stomach(!) so didn't yield any useful pictures. The second set of x-rays, done yesterday, apparently show that it has left her stomach and is somewhere in progress through the intestine, but of course it's no longer taking pictures. So yeah: a big build-up and then a fizzle. We're now told that it can take 2-3 weeks for the camera to emerge.

However, there have been no more episodes of bleeding since Saturday, so it seems to us that there's nothing more to worry about, unless of course she should bleed again. Sunday evening Karis did successfully go out on a pass! She wanted to go out to eat, and chose a Thai restaurant where she ate soup, a spring roll, and maybe a quarter of a low-spice dish, the most she's eaten at one time since her transplant. Then we drove up Mt.
Washington and enjoyed the view of the city lights, though it was too cold to get out of the car. Karis was exhausted by the time we got back to the hospital. After resting for awhile, though, she enjoyed the visit of two friends, and looks forward to her next chance to break out of here for awhile.

Meanwhile, it seems we're gradually drifting back to more IV meds. Karis had been taking magnesium tablets, but every other day her magnesium level has been low enough to require a "mag run," an IV infusion of magnesium that requires spending 3-4 hours in bed hooked up to monitors. So now she's back on IV fluids during the night that include mag and several other electrolytes to keep all of her levels balanced out. The amounts are adjusted according to daily blood tests. The intention is that all of this, and her up-and-down Prograf level, will reach a "steady state" that will allow her to go home without depending on IVs or frequent blood tests.

The only other thing that I know of still keeping her in the hospital is a concern about a bile duct which seems to be a bit abnormal (hence the liver ultrasound last week). The test was prompted by some high liver function numbers, but those seem to have normalized. They want to do an MRI to have a closer look at this bile duct, but can't do it while the camera is still
in her body. (You can use your imagination on that one . . . ) Maybe
this liver thing too will prove to be a non-event. We are so ready for re-discovering "normalcy"!

Saturday, March 18, 2006, 9:00 p.m.
(Debbie) Well, the camera hasn't come out yet--it's still somewhere inside Karis, but no one seems worried about that--and we won't know the results of the 57,600 pictures it took (two per second for eight hours) for at least a couple more days. Karis had been granted her first pass out of the hospital this afternoon, and she planned to go to the Sat. afternoon service at Ascension. Just as she was getting ready to go, though, she had another one of those bleeding episodes and they cancelled the pass. We were so grateful it didn't happen in the middle of the church service! So strange--she hadn't had any bleeding since 3:00 a.m. Thursday morning, so we were starting to think it was a thing of the past.

By the way, we learned that Karis is the 39th patient to swallow a camera here at Children's over the past year, so it's been in use longer than we had understood originally.

Karis figured out she has to take about 30 pills per day (it varies somewhat day to day). We hope that number will be reduced a bit before she goes home.

We went to visit Carissa last evening. It's such a delight to see her doing so well!!! Montefiore Hospital is connected to Children's by an indoor walkway, so Karis doesn't have to get a special pass in order to go there. We just have to fit it into her schedule. She's been walking more of the distance and riding less each time we have gone.

Thursday, March 16, 2006, 8:30 p.m.
(Debbie) Well, it's for real, not sci-fi: tomorrow morning at 7:00 Karis is scheduled to swallow a miniature camera enclosed in a capsule. It's tiny for a camera, but a big pill to swallow. She'll have receptors attached to her abdomen that will feed two-per-second pictures into a small computer that she will wear on a belt, as the camera travels through her intestine. When the journey is over, the pictures will be downloaded onto a regular computer. Hopefully they will identify the source of the bleeding; otherwise, I suspect the pictures will be rather boring. (My dad asked on the phone this morning, once they find the source of the problem, which of the transplant docs will be miniaturized to go in and fix it . . .)

The process today of getting ready for this marvelous experience has not been so fun: only clear liquids all day, and having to ingest horrible stuff to completely clean out her intestine. She gave up on drinking it and asked to have it put in through her G-tube, a stroke of genius. Besides that she was stuck in her bed hooked up to monitors for several hours while receiving an infusion of magnesium, and after that was taken downelevator for a looong ultrasound exam of her liver. Maybe that was the best part of the day, because she got a nice nap. No, actually, the best was having a series of kind visitors, and hearing the amazing news that Carissa is already released from ICU to the transplant floor over at Montefiore!! Unbelievable!

Wednesday, March 15, 2006, 3:45 p.m.
(Debbie) Dr. Squires just came to talk with me in the surgical waiting room about the endoscopy. They saw nothing amiss from the top (through her mouth into her stomach and the upper part of her intestine). From the bottom, through her stoma, blood was present in the intestine as far up as they could go, but they were unable to determine where it's coming from. Dr. Squires said the next step is either an angiogram, to try to discover which blood vessel is bleeding, or having her swallow a capsule containing a miniature camera that will take pictures as it travels through her intestine (really--I'm not making this up! These have apparently been in use here at Children's for a whole month already!). Dr. S will discuss with the transplant team what they want to do next. He said that the good news is that this is clearly NOT related to rejection, so in comparison to that, it is only of secondary concern. That is very comforting!

As soon as they call me from the recovery room I'll be able to see Karis and accompany her back to her room.

Tuesday, March 14, 11 p.m.
(Debbie) First of all, for details and updates on Carissa, see www.monkeygirl.atfreeweb.com/updates/current_update.htm She's doing amazingly well! We are so grateful to God.

When I got back to Karis' room from the waiting room at Montefiore about 1:30 a.m. after Carissa was successfully out of surgery (yes!!), I learned that Karis had another bleeding episode from her stoma, almost identical to the night before, even to the time that it happened! Since it wasn't clear what was really going on with her, and I didn't want to come home and then be called back at some odd hour of the night, I decided to stay with her at the hospital. The rest of the night was peaceful, and there hasn't been any sign of blood today, but the docs think we need to check out what caused it, since that much blood came from somewhere. So she's scheduled for the OR around 10 or 11 tomorrow morning for both an endoscopy (looking at her stomach and upper intestine) and a more thorough ileoscopy (going up as far as they can through her stoma). They want to do it under general anesthesia so that they can have the freedom to do a more careful job. They'll be repeating biopsies both from the top and from the bottom, although they suspect this is more likely a gastric or intestinal ulcer or just a small area of irritation than that it is rejection. We questioned whether the endoscopy is really necessary, and they agreed that there's a good chance they won't find the source of the blood, but they feel that it is important to try.

Long story short: she's not coming home from the hospital quite yet. But she's doing really well in almost every way, so we think that once we deal with this little "blip," the docs will soon start talking again about springing her loose. Karis is more than ready for a break from hospital life. (You may remember that the longest period Karis had out of the hospital at one time during 2005 was five and a half weeks. That was when she got to visit "her class" at Notre Dame before their graduation, and then spend four weeks in Brazil. She had one other five-week period out during 2005. All of her other home breaks were shorter than that.)

Prayer requests:
1. Find out, if possible, what caused the episodes of bleeding, and how to treat it.
2. Figure out ways to make the hospital time not just bearable, but actually profitable.
3. Karis still has low energy, so even though she has ideas of things she'd like to do (e-mail, for example), her actual accomplishment is still very limited. Please pray that she can be patient with the healing process, that she can sleep better at night, and that she will be able to eat more (often she doesn't eat at all, or just two or three bites).
4. Continued protection from both rejection and infection; continued healing of her incision.
5. For Justin in the ICU, and Ian as he goes home tomorrow.

THANKS!