Timing is Everything

I think we picked the absolutely most perfect week to be home with Isabella. Here in Connecticut, we are enjoying above average temperatures, mainly in the 50s all week and touching the 60s today. We've been able to take walks outside and go to the park and play at the playgrounds. Isabella has been riding on everything from the slides to the swings and even the monkey bars. Today, she even played a little soccer in our backyard. A couple weeks ago, she wasn't able to throw a ball because she wasn't able to open her hand quick enough to release the ball. But we've been having catches over the last few days and she's been throwing with little problems. Of course when it gets dark and cold outside, we settle in with our "music therapy", otherwise known as "Rock Band"!

We go back to the hospital on Saturday to continue with her chemotherapy, and the temperatures will again dip towards the freezing mark. We are hopeful that we are done with the long stays at the hospital and hope to be back home by next weekend.

Midweek Update

This is just a quick update.  Isabella has been home all week and I’ve been working from home as well so we’ve been spending a lot of time together.  The controlled chaos that Julianne wrote about earlier is back and it didn’t take long for someone to start crying about something.  Here are some quick pics from the week.

Nathaniel never likes sleeping in his crib.  For the first night, we wanted to keep Isabella in our room to be closer so we had her sleep in his crib.  Well once we put her in the crib, Nathaniel immediately got jealous and was insisting to go into the crib too!

Finally, a taste of normalcy

For the first time in almost three months, Julianne, Annalise, Isabella, Nathaniel, and I will be sleeping under the same roof.  This week, Isabella will be free from any medications and procedures, except for a quick blood draw on Thursday.  We are certainly going to try and make the most of this week.  Today was a great if not hectic start to the week, as we had to pack everything up from Rusk and the Pediatric unit to take home.  Once we got home it was a typical day with us having some lunch, dinner, and ending it off with a movie night watching Wall-E.  Here are some pictures from the day.

Isabella was so excited to go home, that from the time she woke up, she was running around and couldn’t sit still. 

Here she is getting ready to go home.  Annalise and Isabella are wearing High School Musical hats that they received from the hospital.

This is another nice picture of the sisters hand in hand as they leave the hospital.

Here are the girls leaving the hospital.  Isabella planted that plant a few weeks ago in horticultural therapy (I told you there were many types of therapy available!) This is our car after packing everything!

It was a long ride home and Isabella fell asleep on her sister.

Daddy’s finally home and cuddling with all of his kids.

Some Bad News and Some Good News

The bad news is that Isabella's platelet count hasn't quite fully recovered from the last round of chemo (platelets are the blood component that help to form clots to stop bleeding). She had the platelet transfusion on Thursday and had the bad reaction to it, but her platelet count has dropped a little more since then. In order to start the next round of chemo, we need to be sure that Isabella's body is producing enough platelets, but at this point, it doesn't look like she is, so Cycle 3 of chemo will be postponed.

The good news is that Isabella is being discharged today and we will be going home for a full week! We decided not to go back to Rusk because from previous experience with Admitting and the insurance company, she probably wouldn't get back until Wednesday or Thursday, then she'll have to come back on Saturday to start the next cycle. Instead, the doctors and us agreed that Isabella would do just as well and probably even better just going home. Her hand and legs have progressed so much that we don't expect to lose much (if any) progress by being home for a week.

We're all extremely excited to be going home. Julianne is on her way in now, and we'll have to pack the tons of stuff that we've accummulated over the last 3 months that we've been here. Sometime this week, we'll have to get another blood count for Isabella just to make sure that her platelet counts are back up. Then on Saturday, we'll come back in to continue her next cycle.

The Whole Tooth…

…and nothing but the tooth.  Isabella had 3 teeth come loose over the last few days.  Today, the first one fell out while she was eating her french fries.  She is so excited that it fell out and that she’ll be getting a visit from the tooth fairy that it was very easy to get a picture of her smiling this time.

P.S.  Sorry about the toothy pun.  I was debating over that one or “You can’t handle the tooth!”

The Scariest Machine You’ll Ever See

Isabella went through her second day of stem cell harvesting today.  The official term for separating the blood for collection is “apheresis”.  The apheresis machine (shown to the left, click to enlarge) is a pretty intimidating machine, with what seems like miles of tubing running all over.  Two tubes are connected to Isabella, one that collects her blood and one that returns her blood.  Her blood goes through this machine and goes into a big centrifuge in the base of the unit, which separates the blood into its various components.  The stem cells are then filtered out to a bag hanging from the unit.  The rest of the blood then travels through a heater (it’s the metal, cylindrical thing in the upper left of the unit) where the blood is warmed to normal body temperature before going back in.  I didn’t want to take a picture with this thing hooked up to Isabella, but needless to say, we were both amazed and nervous at the same time watching all this.

Depending on how many stem cells they were able to collect, we expect to do this for another two or three days, which would delay Cycle 3 of chemo for a couple days.  For the last couple weeks, we’ve been taking placebo pills with Isabella and she’s been doing great.  At first, we started with Nerd candy, then Tic Tacs, then Mike and Ike’s and now we’re  at regular capsules.  We want to make the pill taking as routine as possible so that when the time comes to take the real things, she’ll be very comfortable.

Isabella also had an unrelated scare earlier in the day before the harvesting.  Her platelet count was a little low, so they decided transfuse her with some platelets.  Almost immediately, Isabella started feeling itchy, and hives started developing all over her body and her ears swelled to “Ross Perot” proportions.  They immediately gave her steroids and benadryl which caused the symptoms to abate and also knocked her out for a little while.  They said it’s not unusual for this to happen from time to time, although this is the first time Isabella had such a reaction to a transfusion.

Stem Cell Collection Begins

Today, they began the stem cell harvesting on Isabella. Since they could not use her mediport to do the harvesting, they accessed a major vein in her leg while she was sedated in the Pediatric ICU. Then, for several hours, her blood was extracted through a machine which filtered out her stem cells and returned the rest of her blood. There is so much tubing involved that an extra unit of blood was added since she is so small and a relatively high volume of her blood would be in the machine at any given time. They had to continually monitor her blood pressure and temperature to make sure that she didn't have any adverse affects to the procedure. The oncologist and nurse practitioner stayed nearby for the whole process "just in case", but the whole process went very smoothly. (They even seemed happily surprised.) During the collection, Isabella was calm and watched a movie to keep her occupied.

Once the collection was completed, they wheeled her back to her room in the Pediatrics unit. They kept the access in her leg since they will have to do another collection tomorrow and Friday. They will count the collected stem cells each day to help determine whether they will need to collect more. If they don't get enough over time, they will have to do a bone marrow aspiration, which can be really painful, but they say that is rare. Once the collection is finally complete, we go right into the next chemo cycle.

Univision radiothon encourages listeners across the country to support St. Jude

(Full Disclosure - I work for Univision)

St. Jude Children’s Research Hospital has once again joined forces with Univision Radio, the leading Spanish-language radio group in the United States, in its annual radiothon to help St. Jude find cures and save children.

During the radiothon Promesa y Esperanza (Promise and Hope), taking place February 5 and 6, listeners can pledge their donations by calling 1-800-998-VIDA (8432) or by visiting www.promesayesperanza.org. The event will be broadcast to more than 15 markets around the country, including Los Angeles, California; Miami, Florida; Chicago, Illinois; New York, New York; and Puerto Rico.

Click here to read the rest of the article.

I mentioned in a previous entry that pediatric cancer (and pediatric brain cancer in particular) receives very limited research and funding. I don't know if it's just that I am more aware now, or if St. Jude has greatly increased their marketing push because I am seeing many more TV commercials and billboard ads increasing the visibility of these diseases. And now, they will be reaching out to the Hispanic community with a radiothon.

Super Sunday

Normally, for Super Bowl Sunday, we’re hosting a party or going over someone else’s house to watch this game.  This year, I took Annalise and Nathaniel into the City to visit Isabella in the hospital instead.  We had originally planned to take everyone to a circus, where we got tickets from the Making Headway organization.  But unfortunately, Isabella's blood counts were still low, so she wasn't able to go.  Julianne took Annalise and Nathaniel to the circus while I stayed with Isabella back in her room.

When they got back from the circus, we spent a very nice and enjoyable Sunday afternoon.  It was very typical with the kids running around and laughing with each other.  Since Nathaniel was sick for a few days last week, this was the first time in a while that we were all together, so it felt nice. 

Here are some pictures from the day.

As soon as Nathaniel walked in the door, he went over and gave Isabella a nice big hug!

Annalise and Isabella listening to her MP3 player while enjoying some pizza.

Annalise and Isabella got a bunch of toy horses from a friend and they played with them for hours.

Whole Lotta Nuthin’ Goin’ On

The last few days have been pretty uneventful.  Although Isabella has been feeling fine, eating and drinking fine, her blood counts remain low, so they're keeping her on the Pediatric floor.  She also continues to improve movement in her right hand and is using it more and more.  Her walking is almost normal now, and she only has a slight limp.  Amazing since she hasn't been at Rusk in almost two weeks, and she only receives limited therapy (maybe 30-60 minutes a day) in her room.   And because of her low blood count, she’s not even allowed to leave the room to go to the playroom or even just take a walk around the hallway.

It's too bad that she's still in the Pediatric unit because we received tickets to attend a circus on Sunday.  We were fully expecting her to be back to Rusk by now and to be able to take a day pass and see the circus.  But instead, we'll be taking Annalise and Nathaniel to the circus and Isabella will have to stay in her room.

Her third cycle of chemo will start a week from this Saturday on February 7.  Sometime next week, before the start of cycle 3, they will perform a stem cell harvest on Isabella. In a stem cell harvest, they will pump Isabella's blood through a special filter which removes and stores the stem cells then pumps the blood back into her.  The process can take 3-4 days.  The stem cells that they collect will then be frozen and saved until the 5th chemo cycle.  During the 5th chemo cycle, they give Isabella an extremely high dose of chemo which actually destroys her bone marrow.  At that time, they will reinject her stem cells back into her so that it helps regenerate her bone marrow.  She could take up to 3-8 weeks to regenerate her bone marrow, and that time will probably be the most dangerous period during this whole chemo treatment.

Hair Today, Gone Tomorrow

It looks like we got those hats just in time. Today, the giant clump of hair that was still hanging on to the top of Isabella’s head by a few strands finally fell off. Isabella had been asking for the last few days when her hair would fall out because what was left was really scratchy and bugging her. She kept scratching it and flipping it around until it finally just fell off. There’s still a few stubborn strands on her head that didn’t fall out, and I even see a few new stubs of hair already growing back.

What fell out is all still in one giant clump that Julianne has kept and will store. It sounds weird and it looks really creepy, but we hear that people’s hair sometimes comes back differently after chemotherapy – maybe straighter or curlier, or a slightly different shade of color. So this way, we’ll have something to compare to.

Isabella isn’t fazed one bit. She saw herself in the mirror and we took a bunch of pictures (as usual, it took a lot of work to finally get some pictures of her smiling!)

On our side though, it’s just another reminder of the reality of the disease that we’re battling. Before, she looked like she was just sporting a rebellious mohawk. But now, she definitely looks like one of those kid cancer patients on TV. We also now get a really good look at the incision scar left behind and see just how big an area they had to cut to remove the tumor. And even though I may get sad when I look at her now, it only lasts for a few seconds, because she’ll smile or laugh and that makes me smile.

View Slideshow

Schumer, Vitter Join Rep. Barbara Lee in Introducing Bill to Combat Brain Tumors in Children

With 2,200 Children Diagnosed with Malignant Brain Tumors Each Year, Critical Funding, Research, and Coordination are Desperately Needed

Legislation will Create a New Pediatric Brain Cancer Research Network within the National Cancer Institute to Study and Prevent this Tragic Disease

Washington, D.C. – U.S. Senators Charles E. Schumer (D-NY) and David Vitter (R-LA) joined with Congresswoman Barbara Lee (D-CA) today to introduce legislation that would require the National Cancer Institute at the National Institutes of Health (NIH) to establish a National Childhood Brain Tumor Prevention Network. The new National Childhood Brain Tumor Prevention Network would be tasked with conducting and coordinating research, providing grants, and issuing guidance and recommendations with the ultimate goal of preventing and curing pediatric brain cancers. Senator Schumer and Senator Vitter introduced the bill in the Senate today. Rep. Lee reintroduced the legislation in the House.

“There is very little that we know about the causes of brain tumors in children. But what we do know is that this disease confounds researchers, inflicts heartache on families, and shortens the lives of far too many children,” Senator Schumer said. “For kids enduring treatment, and family and friends watching them suffer, research provides a ray of hope. We must provide the National Cancer Institute with the mandate, and the resources, to study this terrible disease, because every kid should be afforded the opportunity to grow up healthy and happy.”

To read the rest of the article, click here.

Due to the relatively few cases of pediatric brain cancer, there is very little research done to treat and cure this type of cancer. In addition, the pharmaceuticals don't find it profitable to invest their R&D towards children's brain cancers. You can help by contacting your state senators and congressman and urge them to pass this bill.

To find and contact your state reps, click here.

Urge your Representatives to support House Bill HR 653.

Urge your Senators to support Senate Bill S 305.

We'll also provide updates to the bills over to the right --->

Hooray for Hats

My aunt, Tita Nits, belongs to the Over 60 Club in Stamford, CT.  When the group heard about Isabella, they all decided to make some hats and donate them to NYU Medical Center’s Pediatric Unit.  We’d like to thank them for their time, thoughts, and generosity.  We gave Isabella first pick of the hats and as we expected, she picked out the pink one.  Here she is modeling her new headwear.

MRI Update

We are still waiting on the official MRI report. Initial indications are that the tumor is the same size, but there is less perfusion, meaning that the remaining cancer cells are receiving less blood flow. Although it is very disappointing not seeing any decrease in the cancer size, the oncologist says that we can take the less perfusion as a positive sign. As such, we will be continuing with two more cycles of chemotherapy, followed by a final blast of high dose chemotherapy with stem cell rescue.

Pretty Big Day Coming Up

Isabella finished up her second cycle of chemo on Friday with the last vincristine dose. Isabella has been doing very well over the last few days. She's felt great, been engaging, eating and drinking well (we just found out she loves a mint chocolate chip milkshake). She has been using "Mr. Righty" for practically everything and building up strength in her hand. She is also walking much better than before. She's still neutropenic (low white cells), so we are still very careful around her - for example, Nathaniel has a runny nose, so he will not be able to visit her tomorrow. We are planning on going back to Rusk on Monday to continue her physical therapy.

On Saturday, she is scheduled to get an MRI where we will see the effects of the chemo on the remaining cancer cells. We are hoping to see a great reduction in cancer cells and at worst, see no growth in those cells. We should know the results on Monday. Part of me wants to just get it over with and see the results, and part of me does not want to see the results. Part of me wants to hope for the best, while part of me wants to prepare for the worst and perhaps be pleasantly surprised. This constant emotional tug-of-war, as well as just the not knowing is mentally and emotionally exhausting. This is not an uncommon state that people experience. I just read an article where millions of people don't get routine physicals or go to the doctor just because they are scared to find something and would rather not know. It's not logical, but it is human nature.

So as soon we know, we'll let you know. Thanks for reading.

Reality Starts to Set In

Disclaimer - if you're not in a mood for a tear-jerker, skip this entry. . .

The reality of Isabella's cancer is starting to sink in.

A short time after her surgery, I had gone to one of the school assemblies to see Annalise's class sing. I saw Mrs. Stelly's kindergarten class and actually scanned the group to see if I could find Isabella even though I knew she could not possibly be there. A couple of weeks ago I was waiting to get Annalise at the bus stop, and while watching about a dozen kids unload, I envisioned Isabella climbing out, too. Then suddenly there were no more kids and the doors shut and the bus drove off and I had to admit that she really was in the hospital.

I have finally stopped trying to find Isabella in her bed when I wake up in the morning so that I can tell myself everything's OK, it was just a really, really bad dream.

I am a member of this on-line support group for parents of kids with brain cancer. People offer some really good advice on everything from sibling care to meds to new protocols that they've found. Normal, non-medical people discuss medication side effects, dosages of radiation, and the latest research studies they've come across in their desperate search to find something else to try. I'm getting used to the "lingo" - people often sign their names with "mother of (name), ___ years old, diagnosed (date) w/ (cancer type), chemo (dates), radiation (dates), recurrence (dates), now on (meds/ protocol)." Or if they have lost their child they say, "mother to Angel (name), forever 11." Or forever 3, or forever 17. Then I suppose most move on to the bereavement support group.

Every once in a while there's a post that someone's child just lost their battle. One that really upset me happened a few days ago. Her boy was in 5th grade and I didn't know them personally, but just found out he was treated at NYU also. She wrote, "As difficult as the last two years have been for Jacob, the end was peaceful. Lying between us as we recounted stories and sang to him, Jacob just went to sleep. Pain free. At home." I still cry every time I read this. I told Roneil I wouldn't have any stories to tell. I wouldn't be able to sing if I knew he was dying. I COULD NOT GET THROUGH THIS. My mind starts to wander, and I think, what did she do with her 6 year old son during all of this? When does she call someone to take the body? And then my mind screams, "Stop thinking about this! This will not happen. This CANNOT happen!"

One of the moms created a "Wall of Courage" that she displayed at a local "Relay for Life" event. She just created a virtual version of it to circulate around:

http://heidster.com/relay_2008/virtual_wall/

Watch the video - you should see these beautiful children. The author included that, "Unfortunately, there are a number of children that have since become angels as this wall was created in May of '08. Please feel free to circulate and share this link."

When I do literature or internet searches on Isabella's type of tumor (I can't seem to stop myself from doing this), the information is so dismal. I try to cling to the one sentence that talks about the occasional exception - there are a few reports of children surviving.

Why did this have to happen to my precious Isabella? She never did anything wrong. She is a good and kind and smart and funny and friendly and lovable girl. No one could ever deserve anything like this. No one should ever have to go through this.

I cannot lose her. I would not be able to go on.

I am having a very difficult time.

In Case You Missed It

One of Isabella's classmates, Henry, left a note in the Update to MLK update thread. Isabella read it and typed out the reply herself!

Anonymous said...
I miss you Isabella very much have a nice day
Love Henry

January 20, 2009 6:30 PM
Anonymous said...
Thanks for the note Henry. I miss you and everybody in K-2.

Isabella

January 20, 2009 10:41 PM

Update for Wednesday, Jan 21

The nausea effects from the chemo seem to have all gone, and Isabella's appetite is definitely picking up (she just ate a big bag of sour cream and onion chips and some chocolate milk). She also has recovered from the most recent infection and has not spiked a fever since she's been up here on the pediatric floor.

As expected, her blood counts have continued to drop. She's had a bunch of nosebleeds and she's gotten a couple of platelet transfusions. She's also neutropenic again (low white cells) and she is receiving neupogen shots, which help stimulate the growth of the white cells. She's got one last dose of vincristine this Friday to finish up this second chemo cycle, then she will get her MRI on Saturday.

Unfortunately, her rehab is again disrupted with her being here. We just can't seem to make any traction and get momentum going for the rehab. Since Isabella is neutropenic and she's due to get another chemo shot this Friday, we will probably keep her here in the pediatric unit through the weekend, then hopefully go back down to Rusk early next week. At least we got our old room back, which is a big double room with no roommates, so we have the whole room to ourselves!

Update to MLK update

Well, she spiked a fever again to 104. She also had 2 pretty impressive nosebleeds - enough to need a transfusion, so she just bought herself an admission back to the inpatient floor tonight.

Considering what's been going on today, she's been in pretty good spirits tonight. So I'm going to stop writing and get back to our favorite card game Super Duper Schmooper 8's.

MLK Day Update

Isabella was finally starting to lose the effects of the chemo over the weekend when she suddenly spiked another fever this morning. As you read before, Isabella has been nauseous and not able to eat, but finally on Saturday and Sunday, she was able to eat little bits and pieces and kept it down. Last night, she started feeling more sluggish and finally this morning when they took her temperature, she was up to 102.

They gave her some Tylenol and some antibiotics and her fever is back down and she is feeling a little better. All of her blood counts are still normal, but dropping pretty quickly, so it's not helping that she hasn't been eating. They have been running IV fluids to keep her hydrated.

We were possibly hoping to get her home on a day pass after her morning therapy was done, but obviously, we won't be able to do that.