June
13th 2004
Tonight,
Sunday, we find ourselves on the eve of the last intensive treatment period.
This final block called “re-induction” takes a total of 7 weeks and is the
most rigourous so far; it is intensive on two fronts, firstly because the dosage
level of the medication is higher than Philippa has had so far and also because
the frequency and combination of treatment is tougher. It is always a nerve
racking experience each time she starts something new because you never know
what to expect especially when you have had the experiences we have had to deal
with. Some of the medication is new and some we have seen before but the dosages
of the known ones is higher this time. Before I go into detail about the next 7
weeks I will take a moment to look back at the last block.
Philippa
started the second block of treatment about 6 weeks ago, this treatment is
designed to clean and treat the central nervous system. The base drug is called
MTX or Methotrexaat and is given in a 24 hour intravenous drip. In order to
protect the kidneys and the liver, Philippa was taken in the day before for
hyper hydration when she is hooked up to an intravenous drip of saline and
glucose to saturate her body with water and get her organs working at maximum
capacity. The next day the MTX drip is started and two hours later Philippa is
given a spinal injection with a cocktail of drugs called a Triple; just as
before this is excruciatingly painful and she has to lie flat for two hours
afterwards to ensure that the drug goes to her brain and to prevent ill effects
from the difference in spinal pressure. Thank goodness they administer the
memory loss medicine to prevent her remembering how painful it was. The next
morning the MTX is in her body and the process of ensuring that her urine
remains at a constant pH begins, this is controlled with sodium bicarbonate via
her IV drip and her fluid intake is also kept artificially high. The next
morning a blood test determines whether she has a sufficiently low level of the
MTX to go home. Philippa had a total of 3 of these treatments and came through
each of them remarkably well. Although she has a minor liver disfunction after
the first treatment, this was back to normal by the time she was due for the
second treatment. After this CNS block she was given a week and a half to
recover and we have just had a medicine free week, the last in a very long time!
Tomorrow
Philippa starts back on the Dexamethason (Dexa) but in a higher dose. The dosage
levels are determined by the fact that this is a medium risk protocol (treatment
schedule) instead of a non-high risk protocol. The last level was 4.5 mg a day
and this time it is 7.5 mg a day. How this will affect Philippa we have no idea
but suffice it to say that she was crabby, emotional and very, very, very hungry
on the lower dosage – most people say “Hungry ? How bad can that be?” Well
her record was 7 slices of bread for lunch in one sitting. That’s how bad it
can be! The Dexa is daily for 3 weeks at full strength and is then reduced week
by week so that she comes off it gradually for another 3 weeks. On Wednesday
this week we are due in the AMC hospital for several reasons, the first is a
broad spectrum blood test to check all of her blood values before the major
treatment begins, the second is to do a heart ultrasound to check the heart
function in connection with one of the medicines she is due to receive. This can
have an adverse effect on the heart and so they always check in advance to see
whether any problems already exist and also to have a reference point should
anything happen. After this has been done we will go to see the oncologist to
have a talk about what we can expect in the first part of the re-induction
treatment. Then Monday June 21st Philippa goes into hospital over
night for the first of a combination treatment with Aspiraginase and
Adriamycine, the second of these drugs is the one that can affect the heart, the
first she has had before.
During
her last stay in hospital René spoke to the oncologist who told him that she
had sent some of Philippa’s tissue to other anatomical pathologists who had
informed her that they had found “ T-cell markers”. I don’t fully
understand what this means yet but it has implications for her Central Nervous
System. In order to achieve CNS protection the oncologist has added two extra
treatments to her schedule from a protocol that is still in a developmental
stage. If you consider that the prognosis has improved from 5% recovery for
acute lymphatic leukaemia in 1972 to above 80% today then it is understandable
that treatment is constantly being developed.
Although it means that Philippa’s treatment is even more intense we are
glad and grateful that the oncologist is so careful and does not believe in
taking any risks.