February 18, 2005
Avalon begins Delayed Intensification
Sent: Friday, February 18, 2005 1:00 PM
Subject: Avalon Feb 18, 2005


It occured to me, that since Avalon has 26 months of chem - I'd better start putting the year on
the email.  Yep, that's pathetic!

Well, it has officially begun...the worst part of all of this.  First, some background info.  
Chemotherapy for ALL (Acute Lymphocytic Leukemia) is divided into specific phases:  
Induction, Consolidation, Interim Maintenance - Delayed Intensification - Interim Maintenance,
and finally Maintenance.  We've already completed Induction, Consolidation and the first part
of Interim Maintenance.  Yesterday, Avalon began the worst phase - Delayed Intensification.

Delayed Intensification is an eight week section of chemo during which chemo agents are
significantly stronger than during other phases.  In addition, these drug phases continue
non-stop - no matter how bad her blood values go, and no matter how sick she may become.  
Its just muscle straight through, no stopping.  Not surprisingly, we were warned from the very
beginning, that this is the time when most children go through a couple of hospital stays.  
They won't say "all" children, but we've been told repeatedly to have the bags in the car.

The D.I. actually consists of two distinct four-week periods - each with their own set of drugs.  
A child cannot begin a four-week section unless their ANC is 1000 and their platelets are at
100,000.  The first four weeks consists of three weeks of drugs, then a week "off" to recover
blood values.  Then two weeks of drugs, followed by two weeks "off" to recover blood values.  
If a child's values don't recover in the allotted time, then the next phase of treatment is
delayed until they do.

Avalon started her D.I. with flying colors.  Her ANC was a whopping 7750 yesterday!!  
Basically, she's got lots to fight with this week.  Yippee!  She'll definitely need it - they hit her
hard yesterday.  She started the day with a typical blood draw, followed by a spinal tap and
spinal chemo.  She chased those with infusions of Vincristine and a new drug Doxorubicin.   
Last night we began the latest round of steroids.  This time, she'll take steroids for seven
days, rest for seven, then take them for seven more.  Why does she need to "rest"?  Well, the
dose is twice what she's had before and her body wouldn't be able to take this high of a dose
for 21 days straight.  And lest all of this sound too simple, we have her normal twice daily
mouth treatments, stool softener, and the added bonus of Zantac for the duration of the
steroids.  Wouldn't you just love to be her?

The biggest side affects this time will be from the large amounts of steroids.  Vincristine isn't
new to her - its the one that makes her pull her hair out and only eat BarBQue potato chips
and salsa.  Doxorubicin is new and has the lovely side affects of nausea, hair loss, mouth
ulcers, and potential heart muscle damage...so its been a "fun" addition.  The steroids will
actually be our biggest short-term demon.  This high of a dose will not only cause irritability,
sleeplessness and feeding frenzies - but we get to add in bone and muscle pain.  I can't wait
to see how the nausea from the infusions mixes with the feeding drive from the steroids.  
When you're warned to expect days of screaming...you know its going to be an interesting
month.  I haven't decided if its a good or bad thing that we're not drinking people.  I'll let you
know in a few weeks...

All told, yesterday went smoothly.  Avalon is definitely starting out with great numbers and
good general health, so we have high hopes of staying out of the hospital.  We will, however,
also being staying out of the general public - so expect us to embrace the hermit lifestyle even
more than usual.  Hey - maybe I can take the time to make Avalon some cute hats...she's
going to need them!  Grammo has a great "head" start (admit it, it was a good pun) - she's
made a couple of cute ones.  

So that's it for now.  We're basically just waiting on her to turn into "cranky Sue" and hoping
like heck we stay out of the hospital.  We've been there a little too often lately! (but that's the
next email...)

Love to ALL of you!!
Alicia, Nick, Aurora, Ambrosia, and Avalon
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