Andre: MTX 6

We are back again from MTX 6 (July 19-21).

The first bit of good news is that Radhika has not needed ANY pain meds for 3 weeks. Dr. Forscher was very happy about that when he saw her on 7/19, since it shows that the cancer on her spine is shrinking better than any scan could. The strength in her right hand is close to normal again, and Forscher joked that he would need to be more careful now, because she has enough strength to hit him. Both Dr. Forscher and his nurse Susan think that Radhika has a good chance of pushing this cancer into remission. In fact just the day before they had a visit by somebody who had metastatic osteosarcoma 10 years ago and is doing fine now, and Susan sees no reason why Radhika can't be like that.

For us this means we can now fully focus on making the remaining side effects subside. Even though we had a good run-up to the treatment (the week before was quite carefree, and after her accupuncture appointment on 7/18 we saw "Cars 2" in Horton plaza with Mira) some work remains to be done on that front, especially with anticipatory nausea. Unfortunately Radhika started getting queasy already on the drive up from San Marcos on 7/19 and she was nauseous as soon as we got to Cedars at 3PM and vomited before they even gave her the chemo. On top of the unpleasantness of this experience the acidity also really burned her throat. Fortunately she was able to fall asleep during the MTX itself, and as soon as it finished I told the nurse to give her Benedryl + Reglan, the combination that always knocks her out. She slept so soundly that we took her to the car in a wheelchair around midnight, somehow I got her up the stairs at the apartment, and then she slept until almost noon the next day. After the nurse visit that day she actually felt well enough for us to finally stroll around Beverly center (a mall just across from Cedars) and eat a baked potato.

We hydrated Radhika for a full 2000ml on 7/20 and on 7/21 even though the pump ran until midnight on 7/20. Having our own hydration pump really takes the pressure off of Radhika to drink so much to flush out the MTX, and she was able to clear the MTX after just 36 hours (typically it takes 48-72 hours) so that we were able to drive home on 7/21. The next morning Mira rejoined us from her stay at the Abreu's: Thanks again to Beth, Joe, Jillian and Hailey for all the fun and swimming.

Right now we are planning to get ready for the next round. It was supposed to start today, but already on Sunday Radhika decided that she didn't feel quite up to it and so we postponed it until next week Monday, 7/25. Radhika was supposed to have a two week break after that round, but we decided that a break of one week before and one week after would be better for her. Also, since 8/24 is the date when Mira's school starts again, we decided to move the MTX that was supposed to begin that day to Monday of the week after. Here are the new starting dates

• MTX 7: 1:30PM Monday 8/1
• MTX 8: 2:30PM Monday 8/15
• MTX 9: 1:30PM Monday 8/29

The next big round (7 days of IFEX) will probably start around 9/12, which is still far enough away that we can't really worry about it too much. The plan right now is to focus on managing the MTX:

• sensible food, a few supplements to support the GI tract, massage, accupuncture, foot detox and a colonic in preparation
  
• Ativan to help with the anticipatory nausea (as suggested by Susan)
• Bendryl+Reglan as soon as she gets into Cedars and right after the MTX to make her sleep through the treatment -- hopefully this will allow us to skip the decadron, a steroid she currently gets for nausea that may contribute to the depression she experiences the days following treatments
  
• 2000ml hydration each on the 2 days after MTX to flush it out again

One thing that is difficult right now is that what she can and want to eat and drink is a bit of a moving target: some times she likes only water, then it is coconut water or certain types of juice. With food it is even more difficult, because sometimes the healthiest foods don't agree with her (raw food is hard to digest) but she will crave a burger (it helps with her red blood cell count.) We are lucky that we have found the Boost Plus, since it has a lot of nutrients and calories, is easy to digest for her, and she even likes the vanilla taste.