June 18, 2012

We had a bit of a scare since our last update. While getting SD ready for bed last Tuesday, Stephen noticed some tiny bumps covering SD's left shoulder. They were pinkish, with a few white bumps that looked like they might have been fluid-filled. After speaking with the oncologist at DeVos about it, Stephen took SD to the ER at Munson to have him looked at just in case it was chicken pox. For those who are not aware, chicken pox can be extremely serious to immunosuppressed individuals, such as those undergoing chemotherapy.

The doctor in ER didn't think that the bumps on SD's shoulder looked like chicken pox, but there was one bump on his hand which he thought looked more suspicious. Mandy had noticed this bump earlier and SD had asked her about it; she explained to him about bug bites, and that's what he told the doctor it was.

SD is glad to be home!

Our gut feeling was that it was not chicken pox, but that's how we felt when we learned SD might have leukemia, so we were taking no chances. The ER doctor spoke with DeVos, and the doctor there wanted SD down for observation right away. So Stephen came home and picked up the bag Mandy had packed for him and headed south at about 1:30 am. They arrived at DeVos at 4 am and were seen by four or five doctors while in absolute isolation over the course of the morning. All agreed that it was not chicken pox. No one knows what it was, but they sent him home at 11 am with a very relieved but exhausted daddy.

Apart from that incident, SD has been doing great! He is currently on day 11 of Interim Maintenance 2 and received an increased dose of methotrexate, along with vincristine today. So far he is taking the chemo well; we don't anticipate problems from the chemo itself, as he tolerated it well during the first Interim Maintenance phase. He will, however, be receiving a greater amount of chemo than he did during that first IM phase, so mouth sores and rashes are a possibility.

SD's hair is working on making a comeback! He actually never went completely bald, which surprised us. When we went into Delayed Intensification, Dr. Kurt promised us that he would lose his remaining hair, but he held on to a light covering of sparse, long strands. While his eyebrows and lashes thinned out, he never completely lost those, either; this is the second time during treatment that he started losing his eyelashes, only to have a new crop emerge well before all the old ones fell out. We've noticed that the majority of SD's new hair is coming in blonde, as it was before, but he has some darker patches emerging as well.

We are thankful for how well SD is doing. Today he was even giggling and acting goofy during our clinic visit! Several of the nurses mentioned his excellent attitude and had fun being silly with him.

June 7, 2012

SD is officially in Interim Maintenance 2! This is the final phase of intense chemo treatment. Once IM2 is done, he'll only need to make monthly trips to the doctor and will receive most of his chemo orally at home. Our family is very excited about how close the end of this is!

After a late night last night, SD awoke very tired this morning, but did well in clinic. He didn't need to have labs drawn since his counts were checked in Traverse City yesterday, so after having his port accessed we waited in the playroom for the "road trip" to sedation. We watched a couple wildlife documentaries about African animals (SD's favorites) while we waited; SD was quite enthralled with seeing the animals in action rather than just in books or toys.

Although SD is usually mommy's boy at home, at the hospital he is often a hard-core Daddy's boy. He wouldn't go to Mandy today for more than a few seconds at a time, not even to keep his poor freezing mommy warm. Lesson: always bring a sweater, even when it's 80 degrees or higher outside!

As usual, the spinal tap went just fine and SD had a hard time waking up. The last couple times, SD has become very squirmy after coming out of sedation, and today was no different. He desperately wanted food and once he finally got some he settled down. His Pentamadine was started soon after we arrived back at the clinic, SD got his lunch, and then received his chemo shortly after his infusion was over. It's nice when the clinic is not busy; we were out by 12:30pm!

We will go back to Grand Rapids every ten days through mid-July for very similar treatments each time. Please continue to keep SD and our family in prayer as we travel back and forth and SD undergoes increasing doses of chemo with each coming appointment!

May 31, 2012

We brought SD to the Traverse City clinic for counts on Monday, May 21. His platelet count had gone down to 46,000. He didn't need a transfusion, but since they were still headed downward we had to check again that Thursday. By then, the count had jumped to 330,000 on its own!

Waiting to hear that SD did not need platelets!

SD was originally scheduled for a spinal tap today to kick off the second Interim Maintenance phase. A call from the hospital yesterday changed that; another child needed a procedure today, so they needed to move SD's to a later date. They kept him on for his chemo, however, so we headed down to stay at the Renucci House last night.

Everything went as planned in clinic today until SD's lab results came back with a shocking result for us all: his ANC had dropped to 210! That means no chemo today. He seems to be feeling very well, but Dr. Kurt thought he might be fighting a cold or some other kind of infection, which would explain the low neutrophil count (it was at 896 a week ago). On the plus side, all his other counts have continued to inch up since last week.

So. We will check his counts in Traverse City next Wednesday. If they are high enough, we'll head back to Grand Rapids and try again on Thursday.

May 17, 2012

SD no longer has to take chemo in his port at home. We had two 4-day (Thursday - Sunday) rounds that we had to give him. At the end of the first round, we had to de-access him at home. The needle in the picture below is what goes into his chest every time we go to clinic to draw blood and inject chemo (click on the picture to see it full-size). Mandy gave SD chemo through his port on eight different days; she was very brave, and so was SD!

As planned, we took SD to Munson on Monday to get his counts checked. He didn't look extremely pale to us (he has always been Very Fair; there aren't many more shades of pale one could be) and had good energy, so we figured that it would be a quick visit. It turns out that his counts had actually gone down quite a bit and that he needed some blood. Just getting that information took over two hours and we had not come prepared for a long stay! They allowed Emma to be with us, so it was a bit of a challenge to get through a long day confined to a little room, but we managed. Actually, the nurse was extremely impressed with how well the kids did - she was still talking about it when we went back today!

The transfusion took three hours, but we were at the hospital between 6 1/2 - 7 hours. Thank goodness there is a Meijer so close by! Stephen went out to pick up some food and a couple things to occupy SD and Emma. We were given our own room because SD was so neutropenic that the nurse wanted to keep him away from other people as much as possible.

After his transfusion, we were amazed over the change in SD. As mentioned above, he was energetic and cheerful before (although we were still dealing with the bouts of odd behavior mentioned in our previous post), but he had SO much color and was even more cheerful, laughing and giggling all the time like he used to do. The frightening thing for us is that he was that low in his counts and we didn't recognize it at all. We just can't get over how a child needing blood could still be as active as he had been.

SD had his counts rechecked today. While his hemoglobin is way up thanks to the transfusion (11.3 as opposed to 7.7 on Monday), his platelets and neutrophils have gone way down even since Monday. They haven't been this low ever, even during induction (except when he didn't have any neutrophils during the first few days after diagnosis). His risk of infection is very high right now, so we still need to be especially careful about what he's exposed to. We are just keeping him at home or outdoors, aside from the necessary hospital visits. He needs to go back on Monday for another blood count, and they expect to have to give him platelets that day.

We're so thankful for blood donors! SD's life was saved by multiple blood transfusions at the end of November, and he may need more transfusions before he's fully recovered. To all blood donors everywhere, we say *Thank You*!

May 10, 2012

All through last weekend we were amazed over how wonderfully SD was doing. Even after his spinal and long, chemo-filled day last Thursday, nothing changed from our last report of him for several days. We kept expecting to see him lose energy or become moody or complain of pain or something, but he just stayed bright and energetic. We so enjoyed having our little boy back!

On Monday things started to take a turn; he's been acting rather strange, almost like he's on steroids. We think it might be the 6-TG. He frequently says "ow" but when he ask him about it, he won't give us any hints to what bothers him. He gets extremely upset over little things, often screaming or hitting over them, but if we keep things light and smile at him, he will often instantly turn around and smile back as though he was joking. It's odd.

SD's clinic appointment brought a couple pleasant surprises to us today. First, SD only received Pentamadine, so he had no chemo in-clinic. This made our stay into a quick three hour visit. The other surprise was that we aren't scheduled to go back for three weeks! We were thinking that the rest of the month would still be somewhat intense, but it turns out that all he has left to deal with this month is two chemo drugs taken at home. One is called ARA-C, which is the one we administer via his port; he will take that one tonight (Thursday) through Sunday. The other is 6-TG, of which he has one week remaining.

His counts are a little low, however, so we'll be getting them checked in Traverse City on Monday. One convenience to SD's remaining accessed for the ARA-C is that we can wait an extra day to take his needle out, allowing him to have his blood drawn in TC without an extra poke. If he does need a transfusion (his hemoglobin is about borderline right now), he'll already be set up for it. As long as he continues to do well, he won't need to return to DeVos until May 31. And...that will be the start of Interim Maintenance 2!

May 3, 2012

Over the past week, we realized that we'd almost forgotten what SD was like before his illness. Because of the set-back last week, he hadn't had any type of chemotherapy for two weeks and obviously felt much better than he has in five months. He's been the vibrant, joyful child that has become a distant memory to us, having seen only glimpses of him to remind us he really is still there.

As is usual the night before an early appointment, we spent Wednesday night at the Renucci House. We arrived just in time to be treated to a delicious home-cooked meal provided by a local company for guests of the hospitality house. Many groups contribute in this way, which we appreciate so much! SD wanted to watch Winnie the Pooh when we settled in our room, so we got ready for bed and turned it on in hopes that it would help him get to sleep. This sometimes works. Not this time. Mandy suspects this had something to do with her sharing her ice cream with him (a RARE treat!) at 7:00 PM.

SD invited Mandy to sleep on his bed again. He considers this another rare treat, it seems; he smiles and giggles for the longest time before going to sleep, plays little games, comments on the city noises, holds his Mommy's hand...

Despite his late night, SD woke up on the morning of his long clinic day in fine spirits! He was cheerful most of the time we were getting ready. Since he was getting a spinal tap in the morning, he couldn't eat breakfast; Stephen and Mandy also skip breakfast on those days. In spite of that, he was happy to go see the "doctor" and get "poked", pushing elevator buttons and playing Angry Birds on the iPad as we made our way through the hospital.

SD acted like an old pro during the basic checks: he knows how to hold his arm for the blood pressure, Oxygen sensor, and thermometer. He knows where to stand to get weighed, and he knows not to lean on anything while they're checking his weight. He knows where to stand for his height measurement, though he doesn't quite put his feet back to the wall. These basic checks are done every time we go to clinic, and it's a well-known and comforting routine.

Nurse Mary came in and accessed his port (as a reminder, this means that she stuck a butterfly needle into him and taped over it to make an IV). SD began calling her "MehMeh" for the first time. Then Doctor Mary came in and gave him a brief checkup; after last week, they wanted to be sure it was safe to sedate him.

After his checkup, we went into the play room and SD chose a "poke prize." About half the time he's not interested in the prizes at all, but this time he wanted three! Two were bug collector kits, and he was also interested in a baseball bat with ball. He settled on one of the bug collector kits; it'll be interesting to see what he does with it this summer! While we were in the play room, we also met a young girl - probably 13 or so - who had Leukemia (ALL, just like SD) when she was 10, and has been off chemo for over a year, but recently started having headaches. So she was back in for a procedure to determine if her cancer had returned.

We were the first ones to go into sedation. While we were waiting, one of the male nurses started blowing bubbles for SD. This started a "bubble theme" that would continue throughout the day. The only thing different about this sedation was that SD actually fought it; he usually drops off immediately, but this time he really did not want to sleep! He also didn't want to wake up, which is normal. We always feel bad waking him up because he almost never gets a good night of sleep before an early clinic, but we have to wake him up before the sedation doctors can leave.

Most of our day in clinic went by swiftly! SD spent a good deal of time playing Angry Birds and Curious George at the Zoo. He also watched Winnie the Pooh (the 2011 version). We kept trying to get him to do other things, but he preferred brainless activities. we had planned to work on a birthday card for Uncle Josh (and SD was looking forward to it), but he would have nothing to do with it during his clinic visit.

Mandy and Stephen tried a grilled mushroom pizza for lunch; the clinic provides SD's lunches (pb&j that day), so he did not eat mushroom pizza.

SD did get to talk to Uncle Josh at one point, which he greatly enjoyed!

Near the end of our day in the clinic, we returned to the play room. SD got to play the Wii a bit, and Mandy gave SD chemo through his port for the first time.

Overall, SD did so well! Especially for not getting a nap. He only briefly got sassy at one point, but other than that, he was bright and cheerful the entire day!

After our clinic visit was over (about an hour earlier than we were expecting), we returned to the Renucci house. SD and Mandy pretended they were frogs while the dinner was being prepared.

Once dinner was complete, we played outside again until it started raining. When SD felt the drops on his head, he put his hand on his head and ran for the door!

It's hard to think of how the day could have gone better. We are so thankful for everyone's prayers!

May 2, 2012

This is just a quick note to say: last week when we went into clinic, the doctor decided that SD's congestion was too significant to sedate him. (They did sedate him when he was that congested during our first week at the hospital, but that was an emergency situation - they had to take over his breathing and everything). So, SD had his port accessed in the morning and they started him on fluids, but then we ended up leaving around 10 am instead of being there all day.

We rescheduled for this week (tomorrow, actually). SD's cough has been getting better, so we will hopefully spend about 10 hours in the clinic tomorrow.

We have mixed feelings about the clinic visit tomorrow. SD has been more himself the last few days than ever! He's been smiling and laughing and talking so much! Of course, it's better for him to get his chemo, but we know it'll give him a lot of pain (at least). We do expect SD to regress again this next month (starting tomorrow) - his temper, patience, energy, and vocabulary are all hit pretty hard by chemotherapy.