The New Year arrives!

Today is cycle 8 of the triple whammies and since the last update a lot has happened. After radiation was done, Tim experienced progressively worse side effects which included the sore throat, loss of taste, sunburn and peeling, and the ear drum being irritated. Tim lost a lot of weight since the combination of a sore throat and lack of taste made for virtually no appetite. He went just below his starting weight but has since regained a substantial amount of it back.

To administer the radiation the beam has to go through the body on the way to the site. Although the dose is done from 9 different angles to avoid as much collateral effects there still is a lot. That’s why the throat lining became very inflamed. Tim described it as having splinters in his throat. Throat pain like that is hard enough but when stomach acid goes by, it gets very acute. Something had to be done for both the pain and the nausea leading to vomiting. This time we took both the pharmacological and mental approach. There was potential that the sore throat was from a yeast infection and so an antifungal was prescribed for that. Also to get some immediate relief a topical anesthetic was also prescribed. The combination was successful. Within just a couple of days, Tim’s throat was feeling really good. And his taste started to come back so eating got back to normal.

Tim’s ability to recover continues to amaze me. There is definitely a lot in play; simply his youth and overall general health, the mental disposition he has, and of course the prayers on his behalf. There are so many of you who are constantly petitioning God for healing on Tim’s behalf, it is really amazing to see things actually happen that defy earthly explanation. For instance, in the follow-up visit with the radiation oncologist when Tim reported that his taste was pretty much back to normal, that was very surprising since the expectation for this was several months, not several weeks. I’m happy to report that Tim is now back to a more reasonable 132 lbs having quickly gained back the lost pounds from not eating.

The other approach we started to take was dealing with the mental aspects of anticipating chemo treatments. Tim had started to build the anxiety levels up to the point where he would start to feel nauseated several days before treatment. This was even for treatment that normally does not induce nausea. Simply having to go the clinic, getting his port-a-cath accessed and drawing blood was training his mind. The clinic of course has some help for this and Tim has been seeing a hypnotherapist to help him with the anticipatory nausea. He has been to three visits and now has some tools to deal with the feeling of nausea.

This looked like it worked this time around because Tim has not thrown up for this round of chemo.

For this round we are back to the 2.2 g/m^2 of cyclophosphamide (the higher dose) along with dactinomycin and vincristine. The first two are the ones that whack the bone marrow and production of white blood cells. So this time we talked with a colleague of our oncologist about the use of Neulasta to boost the kind of white blood cells needed to fight infection, neutrofils. Tim had very low neutrofil counts last week at 100/micro-liter, but had already recovered to 2,200 in the next week. So in the end, after consultation we’ll skip the Neulasta for this time. We’ll monitor the neutrofil counts and see if they go really low and if so, we’ll use Neulasta for round 9. This is a pricey medicine at about $3000 per dose. It is a protein made by E. Coli that have been genetically altered to make it. It is a stimulant for the bone marrow to specifically produce neutrofils or as Tim’s oncologist calls it “fertilizer for the bone marrow”. Tim has had no issues with low neutrofil counts (they would primarily be a fever), so this is likely a good strategy to avoid administering drugs that may not be needed.

So, welcome to the New Year! We are now in the second half of treatment and through a few more issues. I’m hoping that the remainder of the journey now becomes easier for Tim. He’s through the radiation and has some tools to deal with the nausea. In February, we’ll have the six month set of diagnostic tests to conduct and that will be a milestone to celebrate.

--bob