Maintenance. Phase 2.

I am writing this halfway out of empathy and halfway out of frustration. I am somewhere between both right now.

Sophia started phase 2 of maintenance on Monday (two days ago) and this seems to be her lowest point in quite some time. As I said in previous posts, each of these segments are broken in to eight weeks over the next two years. Each starts with a spinal tap, include a vincristine infusion and is proceeded by one full week of dexamethazone (steroids). I’m not sure if it is because she hasn’t had steroids in a while or if it is because of the newly increased dosage, but she is NOT taking this well. Mostly she has been crying for the last two days. So much so that her cheeks are badly chapped from tears. She is incredibly volatile and angry at everything. She says that her skin feels “like it is being burned with tiny burns”. I’m not sure what that means, but it sounds very unpleasant.. I finally got her to sleep last night by taking her for about an hour drive until she eventually sobbed herself to sleep. Long story short, this is turning out to be a very terrible part of treatment… And here we thought that it was going to be a lot easier from here on out..

She was taking a drug called Marinol, which is the synthetic form of THC and it helped her SO much during previous bouts with dexamethazone, but we ended up seeing a seemingly very conservative doctor a few months back who became very upset that she was even prescribed marinol in the first place.. Like it was our fault or something, and decided that Soph can not ever have it again.. She then told me that she would willingly prescribe Ativan for her exasperation. So instead of a more natural remedy, we are left to resort to more medications to help deal with the side effects of these treatments… Not happy about this..

We said that we were not going to give her the Ativan unless we absolutely had to, but we absolutely had to just a few hours in to the first day..

This has been the worst week in a long time, and we are only going in to our third day now.

I wish I could find something that would help this girl with the horrible sickness and anxiety these drugs are putting her through.

The other bad thing, or possible bad thing, is that the chemo might not be working right now.. Sophia’s blood counts include an ‘absolute neutrophil count’ or ANC. Her ANC is suppose to remain between 501 and 1500. If it drops below 500, she will be deemed neutropenic, like earlier this year before her blood transfusion, and late last year (around thanksgiving). However the opposite is now happening and her ANC is sitting at over 4000..

Now, this would not be a bad thing for you or I, in fact ours is likely much higher, but the fact that hers is so high right now might mean that the chemo is not doing its job at regulating her cells. And if it doesn’t regulate the good cells, it might not regulate the bad ones, possibly allowing her leukemic cells to rebuild.. They said we shouldn’t worry until next month when they see her at clinic, and if that IS the case, then they will start by increasing the dose of her daily chemo.

So, until then, there is really nothing we can do except try to get through this next week..

Hopefully my next post will be with better news and a better outlook.

Maintenance – Day 0

I feel like I am becoming worse and worse at keeping this blog up to date.. Seems like months are flying by between updates. Between my work schedule and all of the hospital visits, it’s becoming harder to find time for the little things. I am learning more and more though, that the little things are very important and it is a necessity that said time be found.. or made.

So, today is the last day of interim maintenance II. Sophia’s been through quite a bit since my last update, but has again handled most of it with the same resilience as she has always shown. Her hair finally fell all the way out around February or March, but now in late June its coming back and looks like a fresh buzz-cut. I’m not sure if the upcoming treatments will cause it to fall out again.. but I don’t think it will. Either way, she doesn’t seem to mind much.

She had to take a lot of nasty drugs and chemo during the last few months. Obviously, some sickness and ill side effects accompanied that. I think that the worst of this though has been her mood. It might be partly because of the stress and partly as an actual side effect, but she has definitely become very high strung, snappy and pretty annoyed, all around. It has been a struggle trying to keep her happy yet not spoil her, or better, let her be the boss..

When she gets older, we want her to feel accomplished, not entitled.

I think a lot of that is starting to go away now. She seems to be eating better and less moody. Definitely more active, so for the time being, pretty good provided the circumstance.

In a few moments she will go in to the propofol clinic. Get knocked out and endure another spinal tap (LP) with introthecal methotrexate. We hate the anesthesia because of the obvious potential complications, although luckily she has never had any ill effects from it.. After that, she will have a vincristine infusion and we are free to go.

This is the last treatment in this phase and from here she moves to maintenance. The maintenance phase will last two years and because we have her enrolled in a study, she will be randomized in to one of four treatment schedules.

The study is something they asked if we would participate in when soph was first diagnosed to help with refining the treatment protocols for this type of cancer. The randomization is all based off of the same medications, methotrexate, vincristine and the steroid dexamethazone but different doses of them to see what works best with using the least amount of drugs. We will know in about 5 minutes what the next 2 years of this will look like for us, but we know for sure it will include those medications.

So, she is getting ready to go in to propofol, so I’m gonna cut this short and hopefully I get better at keeping this up. I promise to try my best, is this is as much for me as it for those of you who wish to read it.. a public journal of sorts, and will help should I someday wish to revisit this story.

…or edit it to include aliens, dragons and/or the use of super powers…

January

Seems likes it has been a lot longer than it really has since I last posted. Little over a month, but I suppose a lot has happened in that time.

So, last thing I was talking about was the rash.. Turned out it was some crazy average child virus that Sophia somehow caught. Thank goodness it was not due to the last cycle of treatment, otherwise it would have happened every week. It did have the dr’s stumped, but when a pediatric dermatologist from the hospital had a look, he said it must be a virus and would go away in a week or so. We ended up having to use lidocaine like lotion on her though.. for those first 4 or 5 days, she only slept a few hours a night due to the pain, but as said, it went away and all was well.

She ended the last treatment cycle last week, and she is now currently one week in to a two week break before she starts Delayed Intensification. This last cycle wasn’t terrible, but I suppose it wasn’t great either. I brushed on the specifics a few posts back I think. The hardest part of this last cycle was the escalating dose of methotrexate. If I am correct in this, she started off with an infusion of 50mg and that was increased every week until her last dose last week of 350mg. Pretty heavy shit, indeed. She had vincristine every week as well.. But that has been the same since the start.

The methotrexate infusions didn’t make her terribly sick, as anticipated. Just a bit here and there. I have definitely noticed a loss of appetite. Big time. It’s like she wants to eat because she is use to it.. meal times, that is, but once she gets something in front of her it is rare that she will dig in. Little bites, nibbles and snacks, but she doesn’t really eat a full meal anymore. Sometimes.. but it is rare.

The thing that really freaked me out (I didn’t know this would happen) is that her finger and toe nails have all started falling off.. really creeped me out at first. I noticed that she was missing a nail and I thought she may have tore it off playing or something.. Then another and another and so on until I realized what was happening. They never told me about that one.. She just lost her pinky nail on her right foot about 10 min before I started writing this. We bandaged them up one by one. It doesn’t seem to bother her at all.. But damn, it creeped me out.

The next phase of treatment (delayed intensification) will be 57+ days. She starts on feb 25th. As I was told, days 1-22 will consist of another fucking steroid called Decadron. She will have bursts of 7 days on 7 days off for this period. Not as bad as that terrible month of dexamethazone, but I have really come to hate these steroids.. personally I think they are worse than the chemo.. luckily it is not a drug she has to take very often. She has to have an EKG before this cycle begins because she will have to take a medication called doxorubicin, and apparently this can effect her heart.. in what way, I don’t know. She will also get a chemo called pegasparaginase, and of course, our old pal vincristine.. The spinal taps will continue as well.

So there you are, that is about the skinny of what has happened and what will happen over the next couple of months. I promise to keep this blog better updated, I have just had a crazy month at work.. In a good way, but I have had little time to keep up with this. So I’ll try and do better.

My next post however, will be amazing news. We finally heard back from the make a wish foundation (Soph became eligible for a wish in January) and she is getting something pretty amazing.. But I’ll leave that for next time. 🙂

Good night all.

Rash? (Pt.2)

So they sent us home from the hospital last night. I suppose it is good that we didn’t had to spend the night.. But this is still getting worse..

The ER doctor said that it IS most likely a reaction to the methotrexate dosage, but since the rash isn’t accompanied by any respiratory problems, it is one of those ‘discomforts’ that can happen.. The rash has now spread throughout her feet, legs, hands and arms. The bumps have become more defined and are pretty painful.

They gave her a prescription for Hydroxyzine, an anti-histamine that is suppose to be stronger than Benadryl. It did help, she slept through the night last night, and it does seem to help relieve the itching.. But the rash is still growing. I think it might look worse than if feels. She is having trouble walking because the rash is all over the bottom of her feet, but other than that, it doesn’t seem to be bothering her much.

So, today we are waiting on a call back from oncology to see what they think about it. As far as we we told yesterday, since it is not messing with her breathing or causing any severe pain, it may be something that she just has to push through for the next 8 weeks.. So the remedy, as with many other side effects, is just to pump her full of even MORE drugs.

Lame..

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Rash?

Christmas was pretty good. We had two weeks off from any hospital visits/procedures, other than the daily mercaptopurine chemo pill, and the septra on he weekends, Soph got to enjoy her short Xmas break. Great people came around to show us support, including a huge group of bikers who brought family, friends, a bunch of police and even Santa Clause himself to our house to see Sophie and give her some goodies. However, the roadmap started moving forward again on Dec 27th. That Thursday, she had pre chemo labs, passed her blood count requirements and started interim maintenance on the 28th. This new part of treatment brings us to something expected but not yet encountered during her treatments so far.. Infusions.

As I have mentioned in a previous post, this round she is getting methotrexate administered through her port. (Usually administered in her spine) Being as this is her first time having this drug in her veins, we are told to expect a few different side effects, also mentioned in a previous a post.. But currently, we are potentially encountering a very unexpected side effect.. A crazy rash..

As far as we can recall, we have done nothing different in the last few days, aside from the new method of receiving the MTX chemo and taking her Zofran in a bit larger dose, everything has been pretty normal, but last night she started complaining of foot pain.. Then itching.. It just got worse. She only slept about 3 or 4 hours last night due to the pain in her feet, and by this morning she had a full blown rash all over her feet. Tops, bottoms, toes.. The whole nine. Her feet are red, bumpy and itchy and it is continuing to spread.. Neither hydrocortisone nor Benadryl seemed to help it for very long.. If at all.

We called the clinic emergency number this morning, a number that is programmed in to our phones for things like this.. or worse. The doctor on call told us it would be a good idea to come in to the hospital to check it out, especially since neither of the two above mentioned medications seemed to have provided any relief.. So, seemingly, this could be a bad reaction to the chemo administered on Friday. We shall see.

So instead of hanging out at home and having a great Sunday, we instead made the hike to Denver so we could get this sorted out.. By the time we got here the rash made its way to her hands and arms.. And it is seemingly still spreading. Her upper extremities are not in bad shape yet.. But neither were her feet early last night, so this thing must be moving along at a steady pace. We are currently sitting in a room at the hospital waiting for the doctor to come in and check it out.. Obviously I am hoping that this isn’t something that will get worse.. But the problem I foresee is that this was the first of 8 weeks worth of this type of chemo, so if it is related to the new treatment.. What do we do?

Well, I’ll let you know as soon as I find out… But rash or no rash, it still seems to be a good time for funny faces.

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The Beginning

I decided to start a blog to talk about my daughter. Her name is Sophia Bijou Valdez. She is now 3 and a half years old. On October 23rd, 2012, she was diagnosed with Acute Lymphoblastic Leukemia (ALL). We are currently on week 3 of Sophs first round of treatment, so having started this blog a bit late, let me catch you up on how this whole mess started.

Sophie, up until now, was one of the most rambunctious and playful kids I have ever met. She loved going to the park, coloring, going for walks.. All of that stuff. She never was much of a fan of movies or TV aside from ‘her shows’ which consisted of PBS morning kids programming… a daily ritual. She was never a sick kid, and even when she did have a cold or any illness, she never let it keep her down. Still running, jumping on the bed, still playing and going 100 miles per hour.

On the weekend of October 20th 2012, Sophie started complaining of pain in her jaw.. She explained it to us as her face hurting. We thought she might have a headache or possibly be coming down with an ear infection.. Although neither of those things had ever happened to her.

Of course, your kids always get sick on the weekends, or after DR’s normal hours, so we decided to wait it out until Monday and make her an appointment if it persisted. It did. Saturday she developed a fever and was still in pain. We suppressed the symptoms with the usual Tylenol or ibuprofen dosage.. It helped for the time being, but by Sunday she was in real and terrible pain. She had stopped eating (she loved eating) because of her face pain, which by then we understood was in her jaw. So we decided a trip to the ER was in order. She had never been.

We arrived at the ER about 9 or 10 Sunday night. One of the first things they decided to do was draw labs. Blood. The nurses were nice and helpful, but terrible at drawing blood from a toddler. She was poked upwards of 5 times and had one blown vein before they got a good draw. This was traumatic for her as she had never had anything like this happen to her. But she liked seeing the blood.

The nurse would come back about midnight to tell me that they couldn’t find anything wrong with her. But her labs were of some concern and she wanted to send us home and follow up with our pediatrician in the morning.. This was a red flag. I asked what was concerning about the labs, and she said it could be a number of things.. One being leukemia, but not to worry about that yet. So the next day, 9am sharp, the pediatrician called us and said come in so she could take a look.. Another red flag. The dr said that leukemia was not a concern to her, she said it was most likely an abscess in sophs jaw that was causing the pain and infection that caused the fever, so she wanted to admit us back to the hospital for a cat scan and other testing.. So we went. Red flag number 3.

By this time we were pretty startled but confident in the dr’s opinion of the matter so we went for the tests. She was admitted to our local hospital at about 5pm. And tests were run. Cat scan, labs, vitals.. Then we waited. They drew blood multiple times saying they wanted to double and triple check their findings.. And then we were left alone for a long time.

We became increasingly worried as the time passed. By about midnight the nurse came in to tell us our pediatrician was coming in to talk with us. No scheduled kids dr comes in at midnight to ‘talk’ to a family.. So the anxiety ensued.. My wife became incredibly worried when she overheard the nurse at the station mention the word oncology on the phone.

You see, my wife lost her mother to breast cancer about 5 months ago.. So all of these blood counts and tests were eerily familiar.. But our little girl can’t possibly have cancer… Right? No, no way.. Something funky, but NOT cancer..

Finally the dr arrived. She came in the room and closed the door. She sat down and started to explain…

She apologized for not sounding more sincere about our concern in her office. She continued by giving us the news… Or rather dropping a bomb on us.. “I believe your daughter has leukemia.” She said. “The C-scan came back negative. Nothing wrong in her face or jaw.” She went on to tell us that she has no idea why Sophie’s jaw hurt, but it did lead them to finding the cancer in my little girl, so if not for that, then who knows. She told us they could not officially diagnose her in our hospital so she was going to rush us to Denver in the morning at 9am to children’s hospital Colorado for further testing.

As you can imagine, or if you are or have been in a moment like this, tears came in a flood. We could not believe it. How in the fuck did our little girl go from headache to cancer in 2 days.. No, no way. Wrong. Not possible. But it was…

9am the ambulance was ready. My wife rode in the back and I followed in our car. We live about 2 hours away from Denver in pueblo CO.. And that was the worst 2 hours of driving alone in my life.. Thoughts raced, tears, all of the worry and wonder surrounding the situation.

The dr’s at CHC wasted no time in getting us in, roomed and met. Within a very short amount of time they had Sophie in surgery for a bone marrow biopsy to confirm the diagnosis.. And they did. She was looked at and poked and stuck and all kinds of terrible shit. They have her a spinal tap or lumbar puncture to check if the cancer had moved to her spine and brain. Fortunately it had not.. But they have her a form of chemo anyway as a preventative measure.. All in all we were at the hospital about a week and a half, two weeks.. It was all so fast that we really didn’t have time to soak in what was happening. By the time we left she had two surgeries, one to instal a central line to sophs chest.. A medical port that she will use to receive treatments and some blood draws, meds and other such stuff. She had, I think, a total of 5 rounds of chemo and numerous blood draws and other tests.. It really was a whirlwind.

To date (week 3) Sophie has had one chemo treatment a week, and as far as we know, that will continue for a while.. But thanksgiving is week four, and the end of our first part of treatment, aptly titled ‘induction’. Sophie is on a terrible variety of medications to help and combat the effects of chemo. The worst of which, being dexamethazone.. Or steroids.. It has some awful side effects and I am so happy for her to be off of them come thanksgiving. But, the full treatment schedule will last about 2 or 2.5 years.. So this is going to be a long, terrible road we have to travel. Fortunately we have (or so we recently found out) a huge and amazing support system for our journey.. My little girl is being so tough and brave and willing to take this on, and that is good because she has to. She and we have no choice but to keep fighting this beast.. ‘Kill the germs’ as she puts it.

Ill write more about what we have gone through and keep you up to date on what we encounter in the future, but this about brings us up to speed.. There is so much more I want to and have neglected to say, but that will be another post.. Until then, my best wishes to anyone who has ever gone through, is going through, or will have to go through this, and good night.

-M