Andre: MTX 7

Dear friends,

it is now half time on Radhika's chemo schedule, and we are grateful that unlike teenagers with primary Osteosarcoma she will not have to go through surgery at this stage, since we already dealt with that in 2006.

MTX 7 went much better than MTX 6. It started with Radhikas decision that 8 days between rounds is too little for her and we postponed MTX 7 to Monday August 1. That extra rest made her body and mind that much more ready for the next round. She used the time for accupuncture/foot detox/hydrotherapy to help her body mend, and on the day we were originally supposed to go for chemo we received an outdoor sectional couch from Costco instead. We spent time reorganizing the patio, and the result is awesome. It is like our house gained an extra room California style, that is outside. On warm days it is actually more pleasant to sit on the patio than in the house upstairs, since our patio almost always has a gentle breeze going.

We also made some small changes to the routine from MTX 6 that contributed to a better experience:

• Radhika had her Sancuso nausea patch already the day before the treatement, as recommended, but we simply forgot that the time before.
• We had lunch before leaving for LA, unlike last time when we cooked at the apartment.
• The Wendy's burger and baked potato sat much more solidly in her stomach than the rice with kale, which came right up last time at Cedars.
• We had an earlier start with a peaceful drive up to our apartment and dropped off our stuff before heading to Cedars where we arrived around 2:30PM. Eating out instead of cooking and cleaning made things go more smoothly.
• Susan had advised Radhika that Ativan works well for anticipatory nausea, so Radhika took it on the way from the apartment to Cedars and fortunately had hardly any nausea this time.
• Radhika started off on Benedryl+Reglan as the first drugs in the nausea regimen, so she slept through most of the time at Cedars. The fact that she had this combo before the MTX rather than after also meant that it was easier than last time for me to get her up the stairs in the apartment at night, even though it still felt like sleep walking.
• We hydrated her even more through her IV pump than the time before: 2000ml on Tuesday and Wednesday, and 1000ml on Thursday to flush out the MTX. Having the IV hydration really takes the pressure off having to drink so much, and we are thankful to our insurance that this is actually covered.
• I set my alarm for ALL doses of the Leucovorin rescue drug (6AM, noon, 6PM, midnight) and not just for the two night doses, since taking the day doses right on time is just as challenging to me as the night doses. That matters since according to Dr. Forscher going through MTX without Leucovorin would be like jumping out of a plane without a parachute.

The fact that MTX 6 was already not as bad as some prior rounds of MTX also meant we weren't as stressed about MTX 7, and we hope that this will carry onto future rounds even more strongly. Feeling less stressed, better prepared and more organized really helped make this go by faster. The only annoying thing was that in spite of the better start we did not get back to the apartment before 1:30AM, even later than last time. One problem was that it was a very busy day at Cedars, so the lab took at least an hour longer than last time. This didn't bother us much, since we were watching the Great Queen (we are now at episode 32) and Radhika had no nausea or acidity. The only problem with watching was that I didn't notice that the bicarb which kicks off each round was running glacially slowly through her IV pump. By the time we finally figured out that the pump was defective we had wasted a good hour or two. The rest of the round went fine, but it is amazing how these things can hold you up. I will pay more attention to the IV pump next time, and I will also make sure that compatible drugs are given concurrently rather than consecutively since not all nurses pay enough attention to these things. Fortunately, since I was more relaxed, getting home past midnight wasn't that big of a deal.

The next morning, Tuesday, Radhika slept like a log and I finally woke her up at 11AM for breakfast. Of course I had to give her the bicarb (which she had to take with yucky Vanilla pudding, because they were out of chocolate) and Allopurinol at 6AM, but she didn't even open her eyes for that. I used the morning to chop water melon, so that I could make her fresh water melon juice throughout the next two days. Together with the Boost plus this really helped to make her feel less nauseous, and it is more pleasant than drinking only water. When we got to Cedars for the 2PM blood work Radhika was actually in pretty good shape: we chatted with Susan who was also quite happy with her blood values and how well this round was going, and we started hydrating. We went straight back to the apartment where Radhika went to sleep for another 3 hours. After that we started the Leucovorin routine, had dinner, watched a bit, went for a small walk near the apartment and both had an early bed time.

Wednesday was a good day overall: we made it on time for the blood test at 11AM and Susan said that we should be able to go home early, so that we went back to the apartment for lunch and packed up. We got Susan's call that we were cleared to go on the way home: her values weren't quite perfect, so we had to continue the Leucovorin and hydration for another day, but that was no obstacle. We got home by 3PM on Wednesday, which is the fastest we ever made it despite two horrible accidents on the 405 a mere 5 miles apart (one involving a motor cycle, and the other an over turned car on the shoulder). Normally when we get back Radhika just goes to bed to sleep for some 12+ hours, but this time she went straight to the patio and enjoyed herself looking at the garden and resting. When she drifted off I went to Sprouts to buy some groceries and to UPS to pick up the iPad her PhD advisor had sent her. Doug West is really the best mentor and advisor anyone could hope for, and Radhika is having a lot of fun with the iPad, just as he said she would.

On Thursday she felt down and out because the chemo took its toll again, and Mira brought all her excitement and energy home that morning. She had a great time with Kim, Penelope and Helena, and they are already scheming what dance to perform at the next Diwali party. With all her energy it was good that Mira had a playdate with her friend Emily on Thursday afternoon, so that Radhika could get some rest, and that Ranjeeta brought some dinner and calming energy on Thursday evening.

On Friday Mira had another playdate with Emily while I went for a massage and Radhika went for accupuncture in Encinitas. In the afternoon Mira's counselor Kathlyne came for a visit. Friday and Saturday would have been great except that Radhika had some chest pain and still felt down, jucky and plugged up. However being able to spend time with our friends and next door neighbors Joe and Julie, was really nice and Radhika is feeling a lot better today. It seems like the bad feelings have passed again and we are looking forward to a great week at home before we go for MTX 8 on Monday 8/15. It is great when the biggest problem you have is that they seem to have reformulated the Boost plus! The taste makes Radhika nauseous now, but we hope that we will find an adequate replacement for that this week.