Shifting Protocol

Tim had his 5th dose of cyclophosphamide this last week. Since he is in radiation therapy as well, the dactinomycin was skipped but he is back on vincristine. So as expected, this time was a double whammy. Since school was out for parent/teacher conferences on Thursday and Friday, Tim’s appointment was scheduled earlier in the day on Thursday at 1:30. The plan was to visit the clinic, get blood drawn, go to radiation, have the discussion with the doctor and then be admitted to the oncology floor. However, no beds were available in the hospital! The alternate plan then became come back on Friday morning and see if we could get through the treatment at the clinic. Of course Thursday’s radiation dose was administered on schedule.

Perhaps because it was Tim’s regular oncologist’s turn for the free weekend, or the protocol changes at this point, but his dose of cyclophosphamide was upped to 2.2 grams per square meter of body surface area from 1.2 g/m^2. This meant going from a dose that had been about 2.1 grams to over 3.9 grams. This is the nasty drug, the one that makes one throw up. So of course Tim did just that within 30 minutes of treatment. However, a new sequence of anti nausea treatment was tried this time. He got a new drug in the same class as Zofran called Aloxi. This one has a very long serum half life and so the 0.25 mg administered is supposed to last 3-4 days. As a comparison, Zofran is taken every 6-8 hours. He also got a motion sickness patch behind the ear. Even with the Aloxi, he threw up so he got a dose of Ativan to calm things down.

The good thing about Aloxi is that is seems to not make Tim have a “funny” feeling in his stomach and it does do a good job in the anti nausea department. Since the initial incident, he’s been fine. I think we might have to adjust the food intake to better align with the chemo administration or maybe have the Aloxi given 60 minutes prior rather than 30 minutes prior.

The other advantage is that he was in the clinic which is a much better place than evenings on the oncology floor in the hospital. In the end, he was able to go home at 9:30 PM so we didn’t even have to stay over night. The bad thing is he has to at least go to the oncology floor since the clinic closes at 5 but this time it was just to give the remaining two doses of mesna and send him home. He seemed to prefer doing things that way. If we can convince the clinic of the same, then he would still just miss school Friday’s every third week but can sleep in his own bed. That really helped because by the time we got home, the urine output had been reduced so he wasn’t getting up every 90 minutes to go to the bathroom. That makes for a poor sleep experience in the hospital when we stay there on Thursday evenings.

The weekend went really well with no nausea attacks and pretty normal set of activities. We even got our hopefully last leaf raking event in. But he’s a tired pup now and will get his 10 hours of sleep in tonight.

Radiation picks up again tomorrow. We’re already 4 sessions in, just 16 to go. Sometimes things seem to move pretty fast, other times when I think we’ll be doing this until June, it seems so far away. And I’m sure there will be more surprises like this last week where flexibility was the key attribute to possess.

--bob