5 Months of Chemotherapy

After spending most of June in the hospital Dee still had 5 months of chemotheraphy to look forward to. The weeks rotated depending on the cycle so that on some weeks she only had to go in for chemotheraphy on Monday. Then there were the hard weeks that she had to have chemo everyday but they were typically followed by a week where she only had to go in for blood tests. Depending on which of the four chemos she was getting some weeks she felt almost normal.
One of the drugs that made her sicker than any of the chemotheraphies was actually supposed to protect her stomach from one of the chemos. The first time she had to take it at home in pill form, she was sick within the hour. She spiked a fever and she couldn't keep anything down so she couldn't even take the next pills that she was suppose to have. Since she had just gotten out of the hospital the fever and throwing up really freaked us out. We went to the ER and they ran all these blood tests and cultures to see what was wrong. She ended up having to spend a few days in the hospital because the chemo had lowered her white cells again. They couldn't find anything so I started researching this new pill she had taken. I found out that it was being tested as a chemo drug in Europe which told me that it was a pretty nasty drug. Also the rare side effects were fevers and vomiting. After the trip to the ER happened the next time, we got the doctors to give her the drug intravenously which helped because she no longer had the vomiting. By then we also knew what over-the-counter meds the ER used to fight the fever so we just kept a log of her temperatures and gave her the meds at home. She hated going to the ER and being stuck in the hospital so this made her feel a lot better.
The chemotheraphy didn't get any easier as time went on, it got worse. Her bone marrow bounced back real good most weeks but every so many weeks her red blood cells would get so low that she had to have a transfusion. She had to have the white blood cell shots every couple of weeks and those always caused her a lot of pain as the bone marrow increased white blood cell production.

Still she was in great spirits when her last day of chemo came along and it was a good day for her. Here is a picture of us on her last day of chemo in 2006. I had broken four bones in my foot the day before which is why I'm in a wheelchair.

Chemotherapy

In all of Dee's CT and PET scans, they have never found a tumor so there wasn't anything to surgically remove. The lymph nodes had only been removed to biopsy and it just spreads to the lymph nodes not start there. The only course of action was chemotherapy (not counting the person in Mexico that had some miracle cure that her sister wanted to send her to). They started by cautioning us on the chemo. They only had the chemo regimen that they give children for this cancer to go from and they told us that they had never given it to an adult before. They said that no adult was expected to survive the chemo but it should give her 6 months to 2 years more on her life. Dee was up to trying it so they started the treatment immediately.
Her treatment started on Wednesday June 14th with a dose of Vincristine. Vincristine is considered a plant alkaloid chemotherapy and it is used in adults to fight a number of different cancers and blood disorders. She was on so many different chemos at once we can't say for sure what side effects were from what drugs but her hair started falling out almost immediately so we think the Vincristine helped. Vincristine attacks cancer and good cells alike by stopping cells from dividing and spreading.
Let's take a moment to explain some terms that I will using a lot when I talk about Dee's chemo: Cycle - All of Dee's battles have involved chemotherapy that is given in cycles. Day 1 of Dee's first cycle started with the Vincristine mentioned above. A cycle typically includes certain days of chemos and the certain days off of chemo. Dose - A dose is just a treatment of chemo. Some doses were simply pushed in to the blood stream with a syringe. Other doses were a bag of chemo that ran into the blood stream over a longer period of time. Chemotherapy drug names - Almost all drugs have multiple names, in this blog I will be using the names that we got familiar using.
On day 1 of cycle 1 Dee also got a dose of Cytoxan and a dose of Dactinomycin. Cytoxan is often used in adults to treat breast cancer, leukemia, and ovarian cancer but it is also used with many other cancers. Cytoxan is considered an alkylating agent and it interferes with the resting phase of a cell's cycle to prevent cell division. Dactinomycin is used to treat many different types of sarcoma cancers in adults. It is also considered an alkylating agent and it also works to stop cells (cancer and normal) from dividing.
Day 8 of cycle 1 was for another dose of Vincristine and Day 15 was for yet another dose of Vincristine. Cycle 1 ended with a 5 day break.
Cycle 2 started at the beginning of July with a dose of Vincristine and a smaller dose of Cytoxan. It was also the introduction of a new chemo drug, Topotecan, that was going to rotate cycles with the Dactinomycin used in cycle 1. Topotecan is a bit different because it is classified as a topoisomerase 1 inhibitor. It is typically used in adults for resistant forms of ovarian cancer and some types of lung cancer. Small doses of Cytoxan and Topotecan were also given on days 2, 3, 4 & 5 of cycle 2. Then Vincristine was given again on days 8 & 15. Cycle 2 ended with a 6 day break.
Cycle 3 was a repeat of cycle 1 and cycle 4 was a repeat of cycle 2. These cycles continued to rotate until the end of cycle 7 when the doctor stopped the chemotherapy.
These brutal cycles of 4 different chemotherapy drugs is what almost every child that has rhabdomyosarcoma goes through although the number of cycles varies in every case.