Tuesday, October 28th, 5:30 a.m.

Some additional details from Deb:

As Cat noticed, Lizzy's results came back ALL, which is the easier of the 2 kinds of leukemia to treat...except "easy" is not the right adjective... More on that in a bit...There are 3 indicators of high risk ALL:

1) Age - Anyone less than 1yr. and over 10 yrs. is in the high risk catagory. Liz is 14, so that does make her in the higher risk. The doctor explained though, that this means given the same treatment as a 1st-10yr. old, the risk is higher, but with more intensive treatment for Lizzy's age group, the results are the same. So, this is not a major concern b/c she will be recieving the more intensive treatment.

2) If her blood counts were way high on admission, she would be in a high risk catagory. They were not over the limit, so this did not apply.

3) There is a "genetic marker" that, if it is postiive, will put Lizzy in the high end of high...regarding risk of relapse. The results of that marker will be back in 2-3 days. The induction on chemo is the same whether the marker is present or not, so they will begin chemo in the morning. However, if the marker is present, it will present the need for more intense treatment, and Lizzy will be at an incresed risk for relapse.

Christine said, a few times, that she is afraid people will forget to pray. Specifically, she is asking for prayer that Liz does not have the genetic marker...If you have a chance, please email her and let her know you ARE praying that the marker will not be present.

As Cat mentioned, the Lothrups have decided that they will consent to a clinical trial. The trial is NOT a blind study, and puts Liz at no risk. It is a comparison of 2 treatments, both of which have the same positive effect in treating ALL. The research is doing a side by side comparision of the side of effects of each treatment. It is a national study over 3-4 years with the intent to study close to 2500 patients. Children's hospital will likely have 2-3 hundred patients involved.The main difference in the 2 courses of treatment is that one course is done in the out patient clinic every 10 days or so, and one is done on an inpatient basis for 2-3 days every 4 weeks. Randy and Christine will have a 2 hour meeting with the doctor tomorrow to get their questoins answered.

The doctor noted that ALL is rare, and there are about 2,000 cases per year that are diagnosed....(seems like a lot to me...) He is a very sincere doctor who offers his time and sincerity. When he told Randy and Christine that ALL is rare, he quickly noted that this fact is not even relevent for them, since their daughter has been diagnosed. The course of treatment, given either option is about 2 1/2 years. The phases are outlined and the days numbered. For instance: Phase One lists the 1st month of treatment on a day by day basis. It details what meds Liz will be getting and when, and if they are by mouth, IV IM etc...

The common side effects are many: nauseu, vomiting, mouth ulcers, potential hair loss, etc.... These side effect are about 20% likely. There are other, more difficult, side effects that have a 10% likelyhood, and even a third, worst cataegory that has a 1-3% likelyhood. It is going to be a very rough road, and Liz will have many days of feeling absolutley awful. There will likely be many long days, and even longer nights. There is nothing easy about this treatment.

As noted already, get a flu shot (not the nasal aerosol) if you think you may be visiting in the future. DO NOT visit if you have even the smallest thougth that you may be sick, and be sure to wash your hands.

All it all it was a very hard, long day with the procedures and the decisions that need to be made. Christine said she is feeling better though, just having some kind of direction to go in. (Although she is holder her breath waiting, and praying for the results of the 3rd marker). Lizzy seemed tired, but in good spirits...eating mac and cheese, french fries and gator aid....= ) Chemo begins in the afternoon...PRAY!