Looney Lenny visits Isabella in the playroom.
Daddy and Isabella take a nap.
Isabella reads cards that her classmates made for her.
This page was created to keep our family and friends up-to-date on Isabella's battle with brain cancer. She has completed her chemotherapy and physical therapy at NYU Medical Center in New York City. She has also completed her proton radiation treatment at Boston's Mass General Hospital. With her tremendous spirit and courage, along with all of our support, she will ultimately prevail.
Looney Lenny visits Isabella in the playroom.
Daddy and Isabella take a nap.
Isabella reads cards that her classmates made for her.
On Monday, we will head into the City to start a second round of chemo. This round will consist of a different set of drugs than the first round and will consist of higher dosages. Because of that, the chemo needs to be administered in the hospital and we will be staying there for the next few days. Hopefully, we’ll be back home by the weekend, and with any luck, Isabella will be done with any nausea or fevers before Christmas.
Speaking of Christmas, we put up our tree today. Here are a couple pictures from the weekend. Enjoy, and wish us luck for the week!
We enjoyed a very nice Thanksgiving dinner over my mom’s house with friends and family. On Saturday, Isabella had another MRI, and unfortunately, it shows that the tumor continues to grow. We were expecting this because we have noticed she is weaker in general, although we were hoping for at least a stable scan.
We will be talking with our oncologist to start the next round of chemo asap. This round will be a higher dose and with different drugs which will hopefully have some effect. Isabella seemed to tolerate the last round really well, as she had very little nausea symptoms and her blood counts never really bottomed out. Her hair has started falling out, but aside from her hair looking a little thinner, you couldn’t tell just by looking at her. We expect it to all fall out with the next round.
It’s hard to believe it was two years ago when we started this journey, when Isabella was diagnosed with brain cancer. Part of me remembers it like it was yesterday, yet, part of me feels like we’ve been living like this for a million years. Unfortunately, because of Isabella’s recurrence, this anniversary is a lot more somber than last year’s. Last year, we had much more hope to cling to, and you can tell if you read that post (“One Year Later”). Now, we just go from day to day – our long term outlook is now just mere weeks instead of years. I would be ecstatic if I were able to write a “Three Years Later” and a “Four Years Later” post, but we don’t look that far ahead. Right now, we’re treating Isabella as best we can and for as long as we can.
I know a bunch of people jumped on board this blog sometime in the middle of our journey. For those of you, I recommend reading the first couple of weeks of post which narrate some of the events we went through in those first harrowing days. As always, you can see all the archived posts along the left side.
The First Week (11/16/08 to 11/23/08)
The Second Week (11/23/08 to 11/30/08)
As far as upcoming treatment, we’re still not sure what’s next. We know there will be an MRI, then potentially another round of chemo, although we’re not quite sure which cocktail of chemo this time.
Other than that, we’re looking forward to this holiday season.
So it’s been over a week since Isabella got her chemo. Fortunately, she hasn’t developed any side effects yet. Her appetite has been fine and she’s had no nausea and her blood counts are still good, so we don’t need any transfusions. Isabella has been going to school regularly as well. Early in the week, she was a little weak, but improved over the course of the week. If her hair is going to fall out, it usually takes a few more weeks.
So that’s it for now. Not much else to report until the next round of chemo, which should be in a couple more weeks.
Well, so far, Isabella has been doing really well. She hasn’t had any nausea yet, and she’s been eating pretty well. Yesterday and today, we played a little baseball and today, we hung out at the mall for a couple hours and bought her a bunch of new clothes. Isabella is feeling so good, in fact, that she wants to go to school tomorrow. So we’re going to see how that goes, but we’re going to hang out close to home just in case she runs out of steam early and we have to bring her home. She’ll also have a blood draw tomorrow to see how fast her blood counts are dropping so we’ll get an idea of when and if she’ll need a transfusion.
So, I’m gonna keep this brief, and hopefully, Isabella’s side effects remain nil.
Can you guess Isabella’s favorite color?
Look out, Grandma!
Grandpa being taken for a ride.
So Isabella finished up the second day of chemo uneventfully. Now we play the nervous waiting game. We’ll monitor her closely for nausea and fevers, although we don’t expect the nausea to hit for a couple more days. She has been ok so far and has been eating with no problems.
On Monday, we’ll do our first of several blood draws that will check her blood counts to see when she will need transfusions.
Since we don’t know how Isabella will react to the chemo, we don’t have any plans for the weekend (or for the next few weeks for that matter). We’re just going to sit around home and take it easy, and maybe catch up on some movies. Also, her hair probably won’t fall out for a couple of weeks, which we’ll be sad to see.
So we officially start up chemotherapy again tomorrow, Thursday, November 4. Our oncologist has put together different drugs for a custom treatment plan for Isabella. There is no protocol anymore – at this point, we’re just trying anything in hopes of trying to contain this thing. Right now, we have two cycles of chemotherapy planned. For the first one, she’ll receive two drugs over the course of two days. We’ll then monitor her blood counts, and over the course of the next three weeks, she’ll probably require some blood transfusions. With low blood counts, Isabella will be susceptible to infections, so we’ll also be watching out for fevers – if she suddenly develops a fever, we will need to be admitted to the hospital for antibiotics for 10 days.
In about a month, we’ll try two different drugs for the second cycle. The theory behind this approach is that since these drugs work in different ways, if we attach the tumors from different angles, we have a better chance at some sort of response. Shortly after the second cycle, we’ll do another MRI and see if there is any response and either try something else or do more of the same. At this point, we’re not looking past that next scan.
Isabella did well with the chemotherapy last time. She tolerated it fairly well and the tumor responded well. We’re hoping that it’s the same this time around.
Thanks to everyone for your support and well wishes.
As promised, we had a great Halloween weekend. On Friday night, the kids had a Halloween dance at their school. On Saturday, we went for a nice walk through the New Canaan Nature Center discovery trails. On Sunday, before the the trick-or-treating festivities, we played in some leaf piles. As they say, pictures are worth a thousand words, so we have a few thousand words below!
(Click on each picture to see a larger view!)
So I mentioned in the last post that Dr. Wolff (from Tufts and previously from MD Anderson) did not rule out radiation scarring in Isabella’s brain. MRIs are open to interpretation and does not distinguish readily between tumor and scarring. Based on some of Isabella’s clinical symptoms, there was still a possibility that this wasn’t tumor. Julianne found a study being done at the National Institutes of Health (NIH) in Bethesda, MD, where they were doing a special MRI (with spectroscopy) which looked at other characteristics in the brain. The study is to see whether this MRI with spectroscopy can provide more insight into whether a suspect area is tumor or scarring.
We drove down to Bethesda this week to take part in the study in hopes that the more detailed MRI would put to rest what is inside Isabella’s head. Unfortunately, we did not receive the answers we were looking for.
Based on the scan results, the doctor is certain that the lesions are indeed tumor. Also, based on some of the measurements, they showed that the tumor has grown and that it appears to be highly aggressive. The worst part is that the scan showed two new spots on Isabella’s right side of her brain. It is extremely uncommon for tumors to “cross hemispheres”, so the doctors suspect that tumor cells broke off, traveled through the spinal fluid to the other side. We are scheduling a spinal MRI next week, but this new piece of information is extremely troubling.
Also, we have been in touch with a neurosurgeon at Robert Wood Johnson Hospital in New Jersey, where they have one of the MRI guided laser treatment machines that I’ve written about in the past. These laser machines are able to treat tumors that were previously considered inoperable. However, these laser treatments are more suited to tumors that are in chunks (focal), as opposed to tumor cells that are more spread out over an area (diffuse). We met with the doctor yesterday on our way back from Maryland, and unfortunately, since Isabella’s tumor has some diffuse components, he does not consider her a candidate for the laser surgery.
If there is anything positive to gain from this new information is that the new lesions found on the right side appear to be focal and in an area that may be resectable. One of the other treatment options that we spoke about previously is immunotherapy (or vaccine treatments). But in order to create the vaccine, you needed a certain amount of tumor and Isabella’s was not resectable at the time. We are now discussing with our oncologist to see if we can verify that the new tumors are resectable, and if so, we would like to collect it for use in a vaccine. I should also mention that the vaccine would most likely not “cure” the cancer at this point, but possibly only extend survival.
So, to summarize everything, here is where we are. Our only option at this point is chemotherapy, and we will be looking to start chemotherapy very soon, possibly next week, following a spinal MRI. However, before we start, we would like to resect the new tumors if possible to be used for immunotherapy. One downside to surgery to resect the tumor is that it would delay chemotherapy further, from a few days, to possibly a few weeks.
In the meantime, we plan on enjoying the upcoming Halloween. We’ve already bought Isabella some special, no sugar, candy that she will be able to eat on Halloween.
Thanks again for keeping up with us through this difficult time.
So over the last two years, Julianne has been scouring the Internet for any and all treatment options for Isabella. As I’ve written, her tumor is extremely rare and very few people have worked with it before. Just to show how rare, she only found one case study that referenced her particular tumor type where the patient responded to chemotherapy, even after recurrence.
As we got the news of Isabella’s recurrence, we have been working with our oncologist on different types of chemo treatments that we can try (informally, they’re called cocktails as they mix and match several types of chemotherapy to see what gets the best response). Of course, we brought up that case study for the single patient and our oncologist informed us that she knew the doctor that worked on that case study and that he had just moved to Tufts Medical Center in Boston. We contacted him and he agreed to see us and look at Isabella’s case.
We met with him for a couple hours two weeks ago where we basically went through our entire history of treatment and he briefly looked at the latest scans. The good news is that he still hasn’t ruled out radiation necrosis. We also spoke about what our options are if it is decided that it is tumor. He mentioned that although Isabella’s tumor type may be rare, it appears to be of a type that responds to chemo, even after recurrence. So we were inspired that we should never give up when treating this tumor.
So here we are, more than three months after a routine follow up MRI showed some new areas of concern in Isabella’s head. Back then, we weren’t sure if it was tumor or radiation changes, and today, we’re still not sure. We still don’t have a treatment
We recently bought two new pets for the kids, sugar gliders, also known as sugar bears. These cute little furry animals are part of the marsupial family and come all the way from Australia. The attractive features they bring as pets are that they are clean, friendly, and need relatively little maintenance. We’ve had them for about a week now and are still going through the bonding phase, and we think they are getting a little more used to us now.
Here are a couple pictures and videos of “Oriette” and “Squeeky”, our new sugar gliders. (FYI, Annalise wanted to name hers Oreo because it was black and white, but since it is a girl, she wanted the name to be more feminine, hence, Oriette!)
Click each picture for a larger view.
Shortly after Isabella was diagnosed with her cancer, one of our neighbor’s children, who also happened to be in Isabella’s class, was also diagnosed with cancer – this one leukemia. He went through his treatment and was showing that he was clear until his last scan, which showed his cancer had returned. He will now require further treatment and probably a bone marrow transplant. If none of his family members match, they will need to find a match in the national registry to find a matching donor.
If you haven’t already, I urge you to register to become a donor. They will send you a kit, where all you need to do is swab your cheek and mail it back to them. There are some restrictions to be eligible to be a donor, so if you don’t qualify, you can contribute monetarily (it costs $65 to process registrations).
You can register or get more information here:
Here are a couple recent pictures showing some fun that we’ve been having. Enjoy!
The kids try out this tractor during our visit to the Norwalk Department of Public Works.
Another picture of the kids at the Norwalk DPW.
Roneil getting ready for the first game of the Yankees playoffs. He’s wearing his Yankees hat, shirt, jacket, snuggie, foam finger, shopping bag, and coffee mug.
Annalise is pretty upset that all the Yankees ice cream is gone!
The kids had their own sleepover party last night.
Isabella shows off a new hand-made shawl from a friend.
The kids enjoy treats from apple picking. We actually brought a portable scale to the orchard so that we can weigh the apple that Isabella ate. (By the way, the apple Isabella ate was 104g and 12g of carbs.)
From the odd and bizarre file. This half eaten apple was still on the tree!
The kids pick out their pumpkin to prepare for Halloween.
We haven’t had many medical updates recently because frankly, there hasn’t been much to report. Since it’s been awhile, let me take a minute to review where we are.
In mid-July, a routine follow-up MRI showed areas of concern in Isabella’s brain which immediately gave us reason to worry that Isabella’s cancer had returned. Our doctors were split on whether this was recurrent tumor or changes due to radiation, so they suggested we do another MRI a month later. Also in the meantime, we sent out several requests for second opinions.
The wait for the next MRI was very difficult for us because Isabella exhibited many symptoms that the tumor was indeed affecting her. Her right hand and foot progressively got weaker and her mental functions degraded as well – she found it difficult to talk and put sentences together. The MRI showed that the spot grew slightly and we worked with her oncologist to develop treatment options. We were also still waiting for responses for second opinions so we stayed in a holding pattern.
While we waited for a treatment plan, we put Isabella on a modified Atkins diet. Almost immediately, we noticed that Isabella’s symptoms stopped getting worse and in some cases, such as her mental function, actually improved over time. She seemed to have plateaued, which gave us a little bit of relief.
Isabella also has been loving going to school. At first, we were concerned how she we do physically, but the school has been very accommodating in assisting Isabella. At the beginning of September, she was deteriorating so fast, we thought that she would need a wheelchair. But fortunately, she improved physically and has been able to walk on her own. We were also worried because all of her friends from last year went to different classrooms, but Isabella, with her magnetic personality, had no problems making new friends.
This past Tuesday, almost three months after the spot was first detected, Isabella had another MRI. We were hopeful that since Isabella’s symptoms stopped getting worse, perhaps the tumor had stopped growing. But unfortunately, the results showed that the spot had grown again, albeit slightly, but it did grow, and our doctor believes that we should start treatment as soon as possible.
Over the last few weeks, I described some new and innovative treatment options for brain tumors, but unfortunately, few of them are mature enough for Isabella. Ideally, if we had all the time in the world, we could somehow keep the tumor in check, and let these other technologies develop an alternate treatment or even a cure.
Our doctor has recommended a couple chemotherapy options, which we are currently evaluating. Although we’re not looking forward to the side effects of chemo and the hospital stays, we are hopeful that the tumor responds to the chemo positively as it did last year. Again, we’re trying to buy time here in the hopes that something, anything pans out – whether it’s a vaccine or a laser or a magnetic helmet.
So here we are at the end of September and the end of Pediatric Cancer Awareness Month (and Prostate Cancer Awareness Month, Ovarian Cancer Awareness Month, and National Sewing Month). I hope that I’ve helped bring at least a little bit more awareness to this horrible disease that affects not just mine, but thousands of other families across the country. What have we learned?
Pediatric cancer awareness should not be limited to a single month. Every day, kids like Isabella are fighting for their lives while their families try to cope with their future’s uncertainty. So the next time you find yourself with some problem, think about these kids and compare your problem with theirs. That should help put everything in perspective.
In case you missed it, CBS News had a story on immunotherapy, using vaccines to treat cancers. It’s about a little girl who had a neuroblastoma, which is a cancer of the nervous system.
http://www.cbsnews.com/stories/2010/09/29/eveningnews/main6912677.shtml
Also, check out this story they did last May about tumor vaccines.
http://www.cbsnews.com/video/watch/?id=5014935n
Flashes of Hope photographs its 15,000th child!
Posted on September 10th, 2010
This month Flashes of Hope reached a new milestone. Since its inception in 2001, Flashes of Hope has provided free portrait packages to over 15,000 families all across the country! This summer alone, over 3,000 children were photographed at camps across the country. In 2010, Flashes of Hope will photograph 50% of the children diagnosed with cancer in 60 locations across the United States.
Flashes of Hope is a national nonprofit organization that creates portraits of children fighting cancer and other life threatening illnesses and raises money for pediatric cancer research. Families photographed receive a generous portrait package, all free of charge. The photographs, taken by award winning photographers, help children feel better about their changing appearance by celebrating it. For families of terminally ill children, it is especially important to have a portrait that preserves forever the bravery, grace, and dignity of their child.
| Food | Carbs (grams) |
| Ketchup (1 tbsp) | 4 |
| Popcorn (1 cup) | 6 |
| Watermelon (1 cup) | 11 |
| Potato Chips (1 small bag) | 14 |
| Apple | 19 |
| Bowl of cereal and milk | 28 |
| Chocolate Cake | 35 |
| Spaghetti (1 cup) | 43 |
| Rice (1 cup) | 44 |
| Kraft Mac and Cheese (1 cup) | 54 |
Last May, the FDA approved a device from Monteris Medical, Inc. that uses an MRI-guided laser to kill tumors that are otherwise inoperable. There are only three such devices installed in US Hospitals, the latest of which went live at Barnes-Jewish Hospital in St. Louis just earlier this month.
The press release is below.
Treating Untreatable Brain Tumors: FDA Approves New Laser Surgery
Monteris Medical Earns 510(k) Clearance for AutoLITT(TM)
KALAMAZOO, Mich., and WINNIPEG, Manitoba, May 13 /PRNewswire/ -- An MRI-guided laser surgery method, in investigational use at both The Cleveland Clinic and University Hospitals Case Medical Center, holds promise for thousands of brain tumor patients and has earned clearance from the Food and Drug Administration (FDA) for use in neurosurgery. The first applications of the technology are expected to be for the treatment of otherwise inoperable brain tumors.
The AutoLITT System uses an MRI-guided laser probe, passed through a small bur hole in the skull, to deliver laser interstitial thermal therapy ("LITT") to heat and coagulate the tumor from the inside. High-intensity laser energy is applied directly to the tumor, rather than passing through normal tissue, while the MRI measures the temperature inside the brain, showing thermal damage as it happens and facilitating precise control of the treatment. Once coagulated, the treated tumor mass is dead.
"The AutoLITT procedure delivers new-found hope for patients who have previously been given limited options in the treatment of their tumors," explains James Duncan, president and CEO of Monteris Medical, the AutoLITT manufacturer. The system offers a potential option for patients with tumors that are too difficult or too risky to treat, tumors that don't respond to other treatments, and tumors in patients that are otherwise not good candidates for surgery or radiosurgery.
About Monteris Medical
Monteris Medical(TM) Inc. is a medical device company dedicated to developing new cancer treatment technologies that improve clinical outcomes, quality of life, and the cost and complexity of care. The company's U.S. corporate headquarters are in Kalamazoo, Michigan. R&D headquarters are in Winnipeg, Manitoba, Canada. The website is www.monteris.com.
This NFL season, FOX Sports wants football fans across America to get in the huddle with St. Jude Children's Research Hospital and help lead the drive against childhood cancer.
This fall, FOX Sports has teamed with St. Jude Children's Research Hospital to help kids who are sidelined by cancer and other deadly diseases. This season-long partnership will include public service announcements that will be aired all season long—including Super Bowl Sunday—and feature additional on-air mentions and other St. Jude events and activities.
Read more.
A couple of weeks ago, my aunt told me that Father Fernando Suarez would be coming to Connecticut to do a healing mass. Father Suarez original comes from the Philippines and has claimed to be able to heal all types of ailments from a sore neck to blindness to cancer. My aunt and my mom insisted that we take Isabella to the healing mass and although I was skeptical, agreed.On August 31, President Obama proclaimed September as a National Cancer Awareness Month, but not for pediatric cancers – he proclaimed it for Prostate Cancer and for Ovarian Cancer. I guess in the “better late than never” category, a full 10 days into the month on September 10, President Obama recognized September also as Childhood Cancer Awareness Month. Here is the full release:
Presidential Proclamation--Childhood Cancer Awareness Month
- - - - - - -
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
Each year, thousands of children face the battle against cancer with inspiring hope and incredible bravery. When a child is diagnosed with cancer, an entire family and community are affected. The devotion of parents, grandparents, loved ones, and friends creates a treasured network of support for these courageous children. During National Childhood Cancer Awareness Month, we honor the young lives taken too soon and the survivors who face chronic health challenges, we celebrate the progress made in treatment and recovery, and we rededicate ourselves to fighting this disease so all children may have the chance to live a full and healthy life.
While survival rates for many childhood cancers have risen sharply over the past few decades, cancer is still the leading cause of death by disease for young Americans between infancy and age 15. Too many families have been touched by cancer and its consequences, and we must work together to control, and ultimately defeat, this destructive disease. I invite all Americans to visit Cancer.gov for more information and resources about the symptoms, diagnosis, and treatment of childhood cancers.
Tragically, the causes of cancer in children are largely unknown. Until these illnesses can be cured, my Administration will continue to support investments in research and treatment. The National Cancer Institute, the Federal Government's principal agency for cancer research, is supporting national and international studies examining the risk factors and possible causes of childhood cancers.
The health reforms included in the landmark Affordable Care Act advance critical protections for individuals facing cancer. Provisions in the law prohibit insurance companies from limiting or denying coverage to individuals participating in clinical trials, the cornerstone of cancer research. After recovering from cancer, children can no longer be denied insurance coverage due to a pre-existing condition. It also requires all new plans to provide preventive services without charging copayments, deductibles, or coinsurance, increasing access to regular checkups that can help detect and treat childhood cancers earlier. The Affordable Care Act eliminates annual and lifetime caps on insurance coverage and prohibits companies from dropping coverage if someone gets sick, giving patients and families the peace of mind that their insurance will cover the procedures their doctors recommend.
This month, we pay tribute to the health-care professionals, researchers, private philanthropies, social support organizations, and parent advocacy groups who work together to provide hope and help to families and find cures for childhood cancers. Together, we will carry on their work toward a future in which cancer no longer threatens the lives of our Nation's children.
NOW, THEREFORE, I, BARACK OBAMA, President of the United States of America, by virtue of the authority vested in me by the Constitution and the laws of the United States, do hereby proclaim September 2010 as National Childhood Cancer Awareness Month. I also encourage all Americans to join me in recognizing and reaffirming our commitment to fighting childhood cancer.
IN WITNESS WHEREOF, I have hereunto set my hand this
tenth day of September, in the year of our Lord two thousand ten, and of the Independence of the United States of America the two hundred and thirty-fifth.BARACK OBAMA
The other day I mentioned that researchers need to start thinking “outside the box” when it comes to treating cancers. Stand Up to Cancer is a relatively new charitable organization that funds these new types of treatment. Not only that, but SU2C encourages collaboration among different researchers as opposed to the traditional competitive nature between them.
This link shows all the new and innovative research that they are currently funding. Some of them sound truly amazing!
http://su2c.standup2cancer.org/su2c/about_us/innovative_grants
SU2C will be holding a television special tonight, September 10th at 8:00 pm ET on all the major networks.
It’s long overdue that we all stand up to cancer!