We are now deep in the trenches of learning what is coming next for Elizabeth as we head into the third phase. Like I said, "we live in a world of phases right now."
Each of her phases last 57 days. Elizabeth has four more phases (this phase is included in that count) before we hit the maintenance phase which is a five week cycle consisting of 87 days per cycle. To break it down and use math, which I am NOT good at, we have 228 more days before we hit maintenance and once in maintenance we have 435 days which brings our grand total of days before she no longer has to take any pills and is bustin out of Children's...... 663! You can also see why I am very cautious when her counts are down and that no one even thinking they are sick come to visit. It is already such a very long time for treatment and any delay just adds to that 663 days.
I am really not that anal of a person that I actually count out days like this but a lot of people were not understanding how long this protocol or treatment is and pretty much thought she is out and not understanding that she is NOT out, not for a long time. I hope every one has longevity for their prayer life because this is a long journey but one we will celebrate with great joy at every prayer answered.
On to information about the Interim Phase I.
It actually starts tomorrow if you count the GFR test. Glomerular filtration rate (GFR) which is a measurement of the amount of glomerular filtrate (a substance similar to blood plasma but without proteins) formed in the kidneys each minute. It is used to evaluate the kidneys’ ability to remove waste products from the body.
The GRF and checking for persistent protein in the urine (proteinuria) are believed to be the best way to diagnose early kidney damage. This is extremely important because the high dose Methotrexate is damaging to the Kidney and can cause Renal (Kidney) failure. Elizabeth has been receiving a smaller dose of Methotrexate in her spin since the beginning of her protocol but this is an extreme high dose.
If Elizabeth's counts are in order, platelets 75,000 and ANC 750, she will officially start her Interim Phase I on Feb. 3. This phase will be a four day hospital stay with 10 days out and will continue with this cycle for the duration of her 57 days. She will be receiving a high dose of Methotrexate. This chemo will be given through an IV and will take 24 hours to receive. On day 29 of this phase, her platelets need to be at 75,000 and ANC of 750 to continue on through the phase. If they are not up to those numbers, she will wait until they reach the numbers and then continue on through the phase; hence a potential delay.
With this chemo drug, she will need a new drug called Leucovorin (LOO-koh-VOR-in) which is an active ingredient in a drug used to reduce the toxic effects of folic acid antagonists (substances that block the action of folic acid), especially the anticancer drug methotrexate. It is also used to treat anemia. Leucovorin is a form of folic acid, a B-complex vitamin that the body needs to make red blood cells and to function and stay healthy. Leucovorin is a type of chemoprotective agent and a type of chemosensitizing agent. She will receive a series of shots through her IV starting 48 hours after her high dose Methotrexate.
If I thought that the ARAc was tough on her counts, WBC,RBC,Platelets, and ANC, I think I have a new thought coming towards this Methotrexate. I believe this one will be the winner for complications. I must admit, I have held off on this update because I am scared of it; I am scared of what this phase will hold for Elizabeth. I feel it will be one the most visual for people and for Elizabeth. I pray I am wrong like I normally am. :-) Now you know why I do not read ahead. I let God lead me one day at a time...no I stand corrected....one minute at a time. He lights my way and I could not survive without him or in any other way.
Elizabeth will still be on the chemo drugs Vincristine (a 15 minute IV drip,) Mercaptopurine (6MP pill given at home,) and the IT MTX (interthecal methotrexate or spinal.) She will have the IT MTX procedure on day one and day 29 of this phase. LIz will also have a bone marrow biopsy on day 1, Feb 3 (hopefully). This will be to check her remission level.
Here are some specific to pray for:
That her remission level, amount of leukemic cells in the bone marrow, is lower than her .02% at the end of November.
that side effects are minimal:
nausea, emesis (vomiting),mouth sores, renal failure, hair loss, extreme low counts in her WBC, RBC, Platelets, and ANC, rash/hives, diarrhea, muscle weakness, headache, pain in abdomen
Pray that her spirits continue to soar and she continues to stay positive.
All the patients and families on 5A of Children's Hospital
May God bless you as he blesses the Lothrop family.
In his care,