Thursday, January 9, 2014

01.09.96 - Getting an Upgrade

Tuesday
 
Trading In My IV 
Despite how much I endured to get an IV, it was only temporary because it wasn't long before I received an upgrade! It's kind of like going from that beat up car your parents gave you in high-school to your first, new, drive off the lot car- not only can you drive somewhere in fashion now but you won't have to plead with it to start in the morning. I was going to be the proud owner of one brand-new double-lumen, Broviac catheter! No more annoying attempts to get blood out or for that matter, needing warm packs to ease the pain of blood and platelet transfusions.  


A little cancer patient showing off her Broviac.

There's a reason you always see tubes and IV poles in photos of cancer patients- it's because they're always hooked up to something. In my case, it was going to be A LOT of things. When you are scheduled to have multiple concoctions pumped into your body around the clock for the next few months, a Broviac is a great option. It allows nurses to pull blood easily without having to use a needle and makes the administration of fluids, drugs, and blood products as easy as possible- all of which I required.  


Surgery

I was a little nervous as I was prepped for surgery. The doctors "expected that I would do great" but there's no guarantee when you're getting general anesthesia. I was transfused again overnight with my second bag of PRBCs to make sure my counts were adequate and I could afford to lose a little blood.  

As I got ready to head to the OR at 11:15 am, the overwhelming feeling of nervousness suppressed any feelings of hunger. My parents smiled and tried to assure me that everything was going to be fine, but I could sense that they were more nervous than me. How could they not be? I convinced myself that I had some control over my outcome but they knew better, as parents usually do.  My parents knew that they had little control and that my outcome was largely in the hands of my physicians. As I left the room, my nurses hooked me up to another pack of platelets that transfused as I was en route to the operating room.

I remember the OR being cold and everyone being way too nice. The next thing I remember is waking up with tubes hanging out of the left side of my chest. Although I was in the OR for less than an hour, it was a big procedure. "It's official," I thought as I woke up with a pain in my left arm, "I am definitely sick."

In hindsight, I had no idea how bad it was going to get but that naiveness permitted me to mount a pretty good mental attack on the disease.  After the thought of death startled me earlier in the day, I managed to safely pack it away somewhere so that I could regroup and prepare for battle.  After all, tomorrow was going to be a big day...








Wednesday, January 8, 2014

01.08.96 - A Day of Preparation


Monday

The Morning
It was early Monday.  My teachers, friends, and even my little brother were boarding buses and getting into cars to head into school.  Our neighbors warmed up their cars before embarking on their chilly Monday-morning commute.  The big news story from the weekend was a huge blizzard that paralyzed the East Coast from Washington to Boston.  My big news story- cancer.  


Sledding at the Capital building.

The Secret
Nothing seemed to have changed as everyone went about their normal routines. "I shouldn't expect a change though- we haven't told anyone."  Aside from my doctors, the AML diagnosis was a secret that only my Dad, my Mom, and I shared.  My little brother knew that "Hil is sick," but that was the extent of it.  At some point, my parents would have to make The Call to school but for right now, it was a secret.  To be honest, I'm not 100% sure why it was a secret but I didn't challenge my parents.  Eventually, I would learn that a cancer diagnosis is in some ways like winning the lottery.  It's so rare that no one ever expects their friends or family to 'get picked.'  This ends up providing a certain window for the affected party to square away any logistics before letting the word spread (i.e. insurance policy, leave time, finances, etc).  


The Drive
As we drove from my house to Children's Hospital, I wondered how my friends would respond to my absence.  "Oh, she must be sick today," I figured they would say.  Being sick though, was something I never did.  In fact, I was 'Miss Perfect Attendance' every year (with the exception of the Jewish High Holidays).  Not one sick-day and then... Leukemia.  

"Will I still be able to play softball this summer?  Will they let me take accelerated classes next year?  Am I going to lose my hair?"  Somehow it was the hair thing that hit me the hardest at first. Maybe it's because I was 12 or maybe because a bald head is all too often a sign that someone is dying... "Dying? Am I dying? I feel sick but not dying sick."    

Luckily for me and unluckily for my Dad, it was a normal Monday in Buffalo and people were driving into the city to go to work.  The other cars gave me an opportunity to suppress the scary thoughts and do a little daydreaming. Unfortunately, they did not make the drive any less stressful for my Dad. He had to prove his driving skills worthy yet again, but this time with the added challenge of dealing with angry Monday morning commuters. Fortunately, my Dad is an all-star and we arrived at the hospital ready to start a challenging 10-day battle in what would prove to be a much longer war.   
  

The Beginning
I was officially admitted to the 8th floor at 10:15am. Everything started off somewhat slowly. I had more blood drawn to assess my disease status, determine if I needed blood and/or platelet transfusions, and evaluate my titers for various viruses. Of course, I had yet another physical exam. After the ER visit, I was already becoming accustomed to the routine... Several deep breaths then breathing normally.  A somewhat painful massage of the huge lymph nodes in my neck and under my arms. I would show off the petechiae on my legs, then I would lay down and my enlarged spleen would be poked...  I didn't mind, because I knew at some point the assessments were going to be the easiest thing on my agenda.  Cue the first year Resident...

As you may know, once a med student graduates from med school (and passes the boards), they become a doctor and in most cases, a Resident. There is a first for everything and in this case, I was the first person receiving an IV from this resident. I'm certain that learning to start an IV isn't an easy task and I'm even more certain that starting your first IV on a 90 pound 12-year-old girl who was diagnosed with cancer 2 days prior is just a bad idea. But there I was, in need of an IV. I'll save you the painful details but to summarize, I was poked 4 separate times on the back of my hands. By the second poke, my parents were pretty annoyed. By the fourth poke, they were demanding someone else. I wish I could say I was a champion, but I think I lost that title as I sat on the edge of the bed grinding my teeth and shedding a few tears while the doc continued to twist the IV. In the end, I had a new IV to show for all of the pain and could start getting some much needed meds and blood products.


Protection from Chemo
"I need protection from Chemo? Wait, I thought chemo was saving my life?" My physicians explained that I would be taking allopurinol 3 times a day to protect me from some of the side effects of this first round of intense chemo. 

As I would learn over the next couple of weeks, treating leukemia was a bit of a game. The goal of first line cancer treatment is to kill lots and lots of cancer cells; however, killing this many cells in a short amount of time can be very dangerous. When the dead cells break open in the blood stream their contents get released into the blood causing the uric acid levels to rise. This can cause crystals to form in the kidneys and potentially cause massive kidney damage. My newest medicine, Allopurinol, worked to prevent the conversion of 'the cell guts' into uric acid and would help keep my kidneys working as much as possible. 

Looking Inside My Bones
When your bone marrow is sick, it needs to be examined.  Unfortunately, there's no easy way to examine bone marrow.  Blood counts give you an idea of what's going on with your bone marrow but oncologists don't like to give kids chemo based on an idea- they like to have something more concrete.  Thus, I had the privilege of experiencing my first bone marrow aspirate and biopsy.  I say 'privilege' because it truly was.  I was given so many drugs, I barely felt a thing (except maybe a little euphoric).  

With that being said, long before the drugs set-in I was putting on my game face. Doctors described the process to my parents and me- "A bone marrow aspirate involves sticking a long needle into the hip and extracting some bone marrow. Following the aspirate, a biopsy will be performed, where a cylindrical piece of the bone is removed." I was told that both of these assessments were necessary. The aspirate would help give more information about my leukemia including any unique cytogenetics, either good or bad (think chromosomes). The biopsy would help provide some insight into the "landscape" of my bones and bone marrow, and of course the leukemia.

The whole 'needle into the bone' thing seemed a little scary but my fear grew as I was told that it is 100% normal to hear "a crunching sound" as the small drill travels through your bone- ugh!  Like I said though, there was a very happy ending to this particular procedure mostly due to the power of sedatives and pain meds.  Although the procedure did not take that long, we would have to anxiously await the results for much longer.



The Calm Before the Storm 
Once the drugs wore off, the evening proved to be less eventful than the morning. Since my hemoglobin/hematocrit was low and because I would be heading into surgery in the morning to trade-in my IV, I was transfused with a bag of packed red blood cells (PRBC). Unfortunately, I was still stuck with my IV until the following day. IVs are smaller than central catheters/broviacs; therefore, the transfusion bordered on painful. On the plus side, my nurses were the bomb. They immediately placed a warm pack over my IV and the remainder of the transfusion was much better.


Since my platelets had dropped since Saturday and because I was about to have a surgical procedure, I was also transfused with my first pack of platelets, which lasted for another 2 hours.

It had been a long day and I had been made NPO (nil per os= nothing by mouth), so going to sleep that night wasn't too hard. My nurses had a steady stream of fluids hooked up to my IV though, so I had to tolerate the long tubes hooked up to my hand and the board keeping my wrist from bending due to the IV. I'm certain that first night wasn't easy for either one of my parents, especially since my mom would be sleeping in a reclining chair for the night.



    

Monday, January 6, 2014

01.06.96 - The Diagnosis

*Over the coming months I will attempt to share my personal experience with cancer.  As always, questions, comments, personal stories, and support are more than welcome.*


Exactly 18 years ago at this time, I sat in a patient room at the Children's Hospital of Buffalo.  No, I was not in one of those huge open areas where you are granted privacy in the form of a curtain. I was in a full-blown private patient room complete with multiple chairs to accommodate my family and any visiting physicians.  The special room was actually the fourth red flag of the day, that clued me in to the fact that something was very, very wrong.

Earning a spot in the ER patient room...
Earlier in the morning, I found myself at my regular figure skating lessons with my coach, Paddy (one of the most caring and observant people I know).  We were working on two particular jumps without much progress.  I remember continuing to fall and with each progressive fall, it became increasingly harder to pull myself back up.  Consequently, we ended the lesson early and proceeded to chat with my family that was looking on.  "Maybe it's jet-lag?" someone said.  This was somewhat plausible since we just flew back from seeing my grandmother and cousins.  Paddy recommended trying out Alka-Selzter's new (at the time) cold medicine.  Whether it was denial or shock, no one really wanted to acknowledge that cold medicine may not be enough this time.


A nerdy shot at my grandmother's, less than one
week before receiving the diagnosis.

Red Flag #1
We left my lesson and traveled to my pediatrician's office. Despite the fact that we had been there just a month prior, the visit went down much differently this time.  We explained to Dr. Lee, whom we had just met, that I was diagnosed with laryngitis in December but the symptoms had not improved; in fact, everything was much worse. My shoulder now hurt and I was having difficulties breathing.  Dr. Lee did a quick physical exam and obtained my medical history before leaving the room to get my primary pediatrician. "We're not sure what you have but we need you to get some blood tests so that we can find out."  "What could this be?" my parents naturally inquired.  A virus, Mono, Cancer, and AIDS were the options given.    

Red Flag #2
Although it was only a couple of hours of waiting after the blood tests, it felt like weeks had passed before my parents' received a call from my pediatrician. This was long before everyone had cell phones so the house phone seemed to echo throughout the house as the call came in. "Go to the Children's ER. I'll let them know you're coming," said my pediatrician. My parents emerged from the study where they had been scavenging for information on my potential ailment since we left the pediatrician's office.  "Hil, Dr. Vaughan called. He wants us to go to the hospital." 

Red Flag #3
My father drove my mother and me to Children's while my uncle watched my brother, who was only 9 at the time.  As we walked up to the desk in the ER, I remember looking around at the other kids waiting.  Some looked like they had been there for hours.  I had already spent the majority of the day sitting around, waiting.  "Sheesh," I thought, "no more waiting!"  Anyone who has visited the ER knows that the problem with emergency rooms is that it is a giant catch 22; the longer your wait-time, the less sick you are, and vise versa.  You don't want to be sick enough to be pumped to the front of the line without a wait.  In this case, we didn't wait.  The woman at the check-in desk kindly said, "we're expecting you."  I was triaged before all of the kids that had been waiting for hours, before the kids with bloody wounds, and even before the kid that came in on a stretcher.  That's when I said to myself, "I'm really sick." 

In the ER...
Once in my private room, we did a fair amount of waiting.  I had more blood drawn and a chest X-ray.  Multiple physicians visited me and scribbled down my history. I showed off the petechiae that covered my calves (small red dots that demonstrated my low platelet count), had at least ten people feel my enlarged spleen and the swollen lymph nodes that were now visible across the room. One of the nurses put an IV in, "just in case."  "In case of what?" I thought.  Most of the physicians would pull my parents out of the room and have a quiet conversation in the hallway.  I could hear the whispering but something internal prevented me from getting up and trying to overhear my prognosis.  I just knew the longer I waited to hear the bad news, the longer I could live in my blissful, happy place.

... And the bubble is popped.
The truth is, most adolescents live in a bubble.  They don't realize it at the time (just ask them)- that's the beauty of it.  It is only after the bubble is popped, that you realize how awesome the world is when you're blind to most harsh realities of adult life.  For example, say... CANCER.  That's all it took, the physician explaining that I had CANCER- and like that, the bubble was broken.  In hindsight, I really had NO idea how hard the road ahead would prove to be for me and my family.  But, I did know that there was a reason people were scared of the word "CANCER."  Dr. Srinivas Thandla, the amazing fellow who was on-call that night and continued to care for me in conjunction with my primary oncologist over the next couple of years, had the unfortunate job of breaking the bad news.  Only 500 children in the US are diagnosed with AML each year and I was one of them.

My own bed...
Although hospitals are open on weekends, physicians generally don't like to schedule major procedures for Saturdays and Sundays. Naturally, getting surgery and starting an incredibly intense chemotherapy regimen on a Sunday was not going to happen.  I would have to get surgery and start chemo on Monday.  "I'm missing school next week!" I thought, half excited.  The excitement would definitely fade come Monday, but at that moment it was my happy place.

Although it is not standard practice now, I was sent home to spend two more nights "in my own bed."  I kept thinking, "what's the big deal with my own bed? it's not a California king."  What I quickly learned is that this idea of spending the night 'in my own bed' had little to do with my actual bed.  It was the ability to sleep through the night without waking up every couple of hours for vital signs.  It was the luxury of being able to roll over without having to yank my IV or central catheter lines to move with me.  And most importantly, it was the comfort of just being able to go to the bathroom without having to wake up a parent, unplug my IV pole from the wall, and pee into a "hat" so that my "ins and outs" could be recorded 24/7.  I appreciated 'my bed' those two nights, but would grow to appreciate it so much more over the coming year.


A long and scary car-ride.
So it is January 6th in Buffalo, NY.  It was usually a cold time of the year, but it happened to be extra cold on that memorable day.  In fact, it was the coldest day in Buffalo since 1963, reaching a low of -11 C.  My father was given the terrifying task of driving his sick daughter home at 10pm.  Getting in a car accident is something that happens rather infrequently in most people's lives; however, when a car accident is something that simply cannot happen, it is all you think about... and a car accident just could not happen.

AML is a disorder of the bone marrow that affects your ability to produce blood.  In my case, my platelets (aka clotters) were at an unacceptably low level (normal range: 150-400, my value: ~30).  To oversimplify,  car crash = Hil possibly dies.  In the event that we got into an accident and I didn't bleed to death, I would need a functional immune system to clean out any scrapes and lacerations that I may have incurred.  Unfortunately, leukemia strips its victims of a functional immune system.  This sucks because you're filled to the brim with white blood cells (aka defense system) but they're all undeveloped and won't do any good.  It's kind of like having a drawer full of knives when you're trying to eat yogurt- the drawer is full of utensils, just not the right ones (normal white blood cell levels: 4.3-10.8, my value: >80).

It was usually a 30 minute drive from Children's Hospital to our house in the suburbs, but the drive seemed to last forever.  It was eerily quiet and no one seemed to be on the roads.  I guess it was due to the extreme cold (maybe no one could get their car to start), but I almost felt like this was the beginning to a movie and the film crew closed down the road.  

Is this a Special Occasion?
As we got closer to the house my parents asked, "Do you want to stop and get Burger King?"  My Mom and Dad tried to sound excited. Burger King was a treat; something for special occasions.  Was a cancer diagnosis a special occasion?  As a twelve-year old, I wasn't going to let a night of scary cancer talk stand in the way of me getting a Whopper and fries; this could be the last one I ever have. "Yes, please!"  

We got home and I was still in one piece - nice job, Dad!  I eventually went to bed.  I am glad I didn't know what was about to happen because I enjoyed one of my last nights of decent sleep for a very, very long time.


 

We're making progress in cancer treatment but over half a million people in the US lose their battle each year!
Help me raise $18,000 to celebrate 18 years cancer-free.  
100% goes directly to cancer research.