Treatment

Diagnosis & Testing

In order for the doctors to make an accurate diagnosis Alex had to undergo several tests to find out exactly what was going on in his body. A pathologist took a sample of the tissue from inside the bump on the right side of Alex's neck to have it examined. They were able to determine the cells were malignant from that sample. Then it was time to find out exactly where in his body these cells were hiding. Alex had several more tests including an MRI, CT-Scan, X-Rays, Bone Scan and a Bone Marrow Biopsy. It was determined from all of those test that Alex had Lymphoma in the lymph nodes in his neck, spleen and a very small amount (3%) in his bone marrow.

Induction

Induction is the beginning phase of chemotherapy treatment. Most tests have already been run by this point and the medical staff is ready to begin administering the medications to fight the cancer.

Alex was admitted to the hospital on October 21, 1999. Since Alex's chemotherapy treatments are planned to continue over the course of two and a half years his doctor told us he should have a Port-A-Cath surgically placed under Alex's skin in his chest. The "port" has a small reservoir that is connected to a major vein inside the chest. This device makes it easier for the doctor or nurse to give Alex his chemo medications. Some of the chemo drugs can cause problems if they leak from the veins into the surrounding tissues. These kinds of problems are avoided by using the port because the drugs don't have to be put directly into his arms like the flu shots or immunizations we get. Plus, since he has to get treatments very often the port keeps Alex's veins health and he doesn't have to get stuck in a different place searching for a vein each time he goes to the doctor. When you look at Alex's chest you can see a bump about the size of the top off of a ketchup bottle poking out from his skin on the right side of his chest. We just apply some Emla Cream and cover it with a special band-aid called a tegaderm. That stays on for up to 4 hours and it makes the skin numb so when the nurse puts the medicine in he doesn't feel a thing. They can also draw out blood from that same place so he doesn't have to get poked to bloodwork either.

Initial chemotherapy medications included Vincristine, Doxorubicin and Methotrexate. These drugs are given to interfere with the growth of cancer cells which are ultimately destroyed. A drug called Zinecard is given to protect his heart from the harmful effects of the chemo medication. Medications taken at home include Bactrim (prevents pneumonia), Mercaptopurine (6MP-chemo drug), Prednisone (provides protection of allergic reactions to other drugs. Also prevents or alleviates nausea and vomiting.) These are given orally and he will continue taking them until the end of his treatment schedule.

The induction phase of chemo was by far the most difficult to endure. Emotionally for the whole family we were a wreck. Trying to figure out what was best for Alex and how he was going to react physically was excruciating. He demanded a ton of attention and we all truely felt sorry for him. He was being put through the most terrible thing we could imagine. He was in the hospital 4 days and when he came home he had back and leg pain from the bone marrow biopsy, soreness in his chest from the port implant and nausea/vomitting from the side effects of the drugs. It was just about a week before he would even sit up straight. He did not eat during his hospital stay and it really took about 2 weeks before he was eating more than a bite or two of any given food. Everything upset his stomach. Induction chemo treatment are continued weekly for 6 weeks. Headaches and vomitting were the major side effects. It would have been smart to carry a bucket in the car everywhere we went but we were lucky he got use to opening the door quickly. He kept one beside his bed and slept on the couch for a while just to be closer to the bathroom.

Induction Yields COMPLETE REMISSION!!!!

Consolidation

Consolidation therapy treatments started 7 weeks into treatment. From this point Alex was recieving his chemo once every 3 weeks and it became more of a routine for us. He also began getting a leg shot called Asparaginase at his clinic visits each week.

We began to recognize when he was going to be ill. He would get a headache and feel sluggish. There were many times we would sit for a meal and he would lay his head on the table and pick at his food. Although he wouldn't say he was feeling bad soon he would have a headache and that meant nausea would follow. Sometimes he would just go into the bathroom and sit on the side of the tub waiting. As soon as he threw up all the symptoms would dissappear. Once I gave him a snack of cantelope and it triggered and episode of nausea and vomitting. So the next time when he was feeling like he was going to be sick and it wouldn't happen I started offering him food. I offered him some cantelope and he took one bite and up it came. From that time on whenever he felt like that I would just go get the cantelope. It got to where he wouldn't even tell me he was feeling that way. He would just come ask if he could have some cantelope and I knew.

He lost his hair completely during consolidation too. He also suffers from occasional symptoms of Neuropathy which includes footdrop, tingling or pricking limbs-hands-fingers, skin sensitive to the touch or would complain he felt bad but couldn't really pinpoint the pain in a certain spot. Most of these symptoms have been illiminated by decreasing the Vincristine dosage.

Maintenance

Alex has successfully (and without any major incident, I should add) made it past week 34 which puts him into the Maintenance phase of therapy. He now visits his doctor every 3 weeks and if his CBC (blood count levels) are high enough he recieves his chemo (Vincristine, Methotrexate). I'm happy to say he hasn't missed one treatment yet. He takes Methotrexate orally at home on off-clinic weeks (20 pills), 6MP each night for 2 of the 3 weeks and Prednisone for 9 days (5 days is customary but Alex takes it for 4 additional days are for tapering because of back and leg cramps.) When he was taking it for 5 days and stopping it would cause him to have really severe back and leg pain. The tapering eases it to almost no pain or just barely any pain.

Alex has a spinal tap every 10-12 weeks to administer chemo medication into the spinal column and head and to allow testing of spinal fluid for any cancer lurkers.

Information on all drugs identified on this page can be found on the MEDLINEplus Health Information website at http://www.nlm.nih.gov/medlineplus/druginformation.html

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