Still Processing

I wanted to type up my blog last night but in all complete honesty I had to deal with my emotions first.  I feel bad talking to my sisters about it because they have a lot going on in their lives too right now.  I don't want to add it on.  Although I can already hear, don't be ridiculous.  I am upset because I sat down to realize this statement.  "Don't worry, we have a lot of drugs we can use."  In their attempt to comfort me when we were first diagnosed I would get this statement.   Yes, it made me feel better.  No, I didn't expect to cry when we had to switch drugs.  I realize all the stuff they are injecting him with now could potentially be causing different side effects.  I don't mean to fret but its my job.  So this is what we are starting next week.  They said we don't have to overnight it but we do have to be admitted because it takes over 8 hours.

Rituximab

Rituximab

(ri TUK si mab)  

Trade name: Rituxan^®

Chemocare.com uses generic names in all descriptions of drugs. Rituxan is the trade name for rituximab. In some cases, health care professionals may use the trade name rituxan when referring to the generic drug name rituximab.

Drug type: Rituximab is a monoclonal antibody. (For more detail, see "How this drug works" section below).

What this drug is used for: 

• Treatment of certain types of non-Hodgkin's lymphoma.
• Treatment of chronic lymphocytic leukemia (CLL).

Note:  If a drug has been approved for one use, physicians sometimes elect to use this same drug for other problems if they believe it might be helpful.

How this drug is given:

• As an infusion into a vein (intravenous, IV), over about 6 hours.  The time of the infusion may be shortened, depending on whether or not you have received this drug in the past, or how well you tolerate this drug.
• Medications may be given just before the infusion to reduce the occurrence of infusion-related symptoms.
• There is no pill form of rituximab.
• The amount of this medication you will receive depends on many other factors, including your height and weight, your general health or other health problems, and the type of cancer you have. Your doctor will determine your dosage and schedule.

Side effects:
Important things to remember about the side effects of rituximab:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration.
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.

The following side effects are common (occurring in greater than 30%) for patients taking rituximab:  

• Fever and chills (see flu like symptoms)

The following are less common side effects (occurring in 10-29%) for patients receiving rituximab:

• Weakness 
• Nausea
• Headache
• Cough 
• Runny nose, shortness of breath, sinusitis (see cold symptoms)
• Throat irritation (see cold symptoms - pharyngitis)

A serious but rare side effect of rituximab is potential for a severe infusion reaction, typically with the first infusion (during infusion or within 30-120 minutes of infusion).  You will be given medication prior to the infusion to decrease this reaction and monitored carefully during the infusion.  If signs of reaction occur, the infusion is stopped.  In most cases, the infusion can be restarted at a slower rate once symptoms subside.

Other rare but serious side effects:

• Patients who have had heart pain or irregular heartbeats in the past may experience this again.  If these occur tell your doctor or nurse, so that they can be treated. 
• Rapid destruction of cancer cells can cause disturbances in metabolism leading to kidney problems.  
• If you have questions about this information ask your doctor.   

Not all side effects are listed above.  Some that are uncommon, occurring in less than 10% of patients, are not listed here.  You should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor:
Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.5º F (38º C) or chills (possible signs of infection)
• Shortness of breath, chest pain or discomfort; swelling of your lips or throat
• Confusion

The following symptoms require medical attention, but are not emergency situations.  Contact your health care provider within 24 hours of noticing any of the following:

• Develop a rash or sore joints
• Nausea (interferes with ability to eat and unrelieved with prescribed medications)
• Vomiting (vomiting more than 4-5 times in a 24-hour period)
• Other signs of infection, sore throat, cough, redness or inflammation, or pain on urination

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting rituxamab treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). 
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking rituxamab.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category C (use in pregnancy only when benefit to the mother outweighs risk to the fetus). 
• For both men and women: Do not conceive a child (get pregnant) while taking rituxamab. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.

Self Care Tips:

• Rituximab may cause temporary low blood pressure.  If you are taking medication to reduce your blood pressure, check with your doctor or nurse as to whether you should take it as usual or not before the infusion.
• You may experience shortness of breath, feel flushed or dizzy during the infusion. You will most likely receive medication before the infusion, and you will be closely monitored during the infusion. 
• For flu-like symptoms, keep warm with blankets and drink plenty of liquids.  There are medications that can help reduce the discomfort caused by chills.
• Drink 2 to 3 quarts of fluid for the first 48 hours after each infusion, unless you were told to restrict your fluid intake. 
• This medication infrequently causes nausea. But if you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. Sucking on lozenges and chewing gum may also help.
• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
• In general, drinking alcoholic beverages should be avoided.  You should discuss this with your doctor.
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and testing:
You will be checked regularly by your health care provider while you are taking rituximab, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) may also be ordered by your doctor.   

How this drug works:Rituximab is classified as a monoclonal antibody.  Monoclonal antibodies are a relatively new type of "targeted" cancer therapy.

Antibodies are an integral part of the body's immune system.  Normally, the body creates antibodies in response to an antigen (such as a protein in a germ) that has entered the body.  The antibodies attach to the antigen in order to mark it for destruction by the immune system.

To make anti-cancer monoclonal antibodies in the laboratory, scientists analyze specific antigens on the surface of cancer cells (the targets).  Then, using animal and human proteins, they create a specific antibody that will attach to the target antigen on the cancer cells. When given to the patient, these monoclonal antibodies will attach to matching antigens like a key fits a lock.

Since monoclonal antibodies target only specific cells, they may cause less toxicity to healthy cells.   Monoclonal antibody therapy is usually given only for cancers in which antigens (and the respective antibodies) have been identified already.

Rituximab works by targeting the CD20 antigen on normal and malignant B-cells.  Then the body's natural immune defenses are recruited to attack and kill the marked B-cells.  Stem cells (young cells in the bone marrow that will develop into the various types of cells) do not have the CD20 antigen.  This allows healthy B-cells to regenerate after treatment.

Since Gary just came off Cytoxan, we need to give his bone marrow a chance to recover.  

Rituxan

We are back from our appointment.   We are starting Rituxan next week.   Processing............

Labs and Swelling

Yesterday we had labs.  They were suppose to be the day before but God orchestrates. The day before yesterday I decided it was too rainy to go anywhere.  I didn't want to leave the house.  So I didn't.  We woke up yesterday though, and rain or not, we had to go to Seattle for labs. (Pictured above of Seattle Childrens Hospital).   Gary had a funny start to the day.  He came down, said, "Mowning Mom".  We exchanged kisses.  He crawled up onto the couch to watch cartoons.  All was well.  He watched one episode of Dora.  So 30 minutes had gone by.  I glanced over at him to see a slightly different looking kid.  His face was swelling.  It wasn't dramatic but enough for me to notice.  I did an examination.  His fingers, especially his pinky were also swollen and a bit redder than usual.  This is always the fun part.  (Think I may have typed this very sentence before).  I need to try and figure out if we are just having a bad day or are we about to have a break thru flare.  MY definition of a break thru flare would be in regards to his medicines.  Up till today, he was looking great.  It was determined we would not run another cytoxan treatment to see how he did.  We are not even due for a cytoxan infusion if we were going to be continuing them.     Since I was headed to the hospital for labs anyway, I entertained going and pulling out the docs again (we pulled one out last month for his hemorrhaging capillaries in his cuticles).  I don't like doing this because I often get the "shrug"   and the "I dunno's", so what is the point.  As the day went on it didn't get any worse.  I didn't have a nurse or doctor check him out.  I did however call when I got home because something was just nagging me.  I called and left a message asking for a nurse to call me back with the results of his labs.  I told them I was a little concern with some swelling and active rash going on.  If his labs were ok, then I would give another day or two to see how he does.

They weren't good.

A few have popped up.  His ALD went from 6 to 11.  His AST went from 43 back up to 52.  His white cell count is really low but I am not surprised by that.  That is from the chemo's including cytoxan.  There were a few others that were up.  With the low white count just confirms with stomach flu going around school to stay out of the hot zone.  Anyway, we are going back in today at 3:30 for a clinic appointment.  I am not sure what   they are going to want to do.  Maybe pulse him with steroids.  Maybe give it a little more time.  It drives me batty trying to figure out why.  Is it sun exposure?  Is he so intolerant of the sun that I shouldn't let him be out there?  Is it really his disease breaking thru the meds?  ?   ????    ?????

"Wow, he looks good."
How kind of you.  You look good too.  Yes, it is such a nice thing to say.  What do I want to hear?  "Wow, he looks terrible." ?  No of course I don't want to hear that.  I have had issue with this for awhile LOL.  Because it is ridiculous to take any kind of offense, which I don't, but.    But I am the one griped by fear.  I am his mother.  I have to sit here and rationalize every whimper, every cry, every dot, every rash, all the swelling.  Rationalize it.  Come up with what it could be instead.   He woke up from a nap on Tuesday when we were suppose to get the labs done, crying and screaming, saying Ouchie.   He wouldn't let me touch him.  Nothing I did helped.  It reminded me of day one, when he would lay there and just cry and cry.  I feel helpless and worthless.  I rationalize it, "O  all kids cry when they wake up from a nap.  They are just mad because they are still tired."  Yeah, well add "ouchie" and clawing at your legs and arms and neck because you are burning and itching is not something all kids do.  But he can't put the words together because he doesn't even know how to make a proper sentence yet.  I can't wait for the day I will be able to ask him, "what are feeling, where does it hurt, what kind of hurt, what can I do to help you?"   And he will be able to tell me.

So I got it.  Instead of "WOW he looks good!", I prefer, "Looks like he is having a good day : ) !"

Methotrexate

Last week after Gary's methotrexate shot, he slept in a little, complained here and there about his tummy hurting.  Yesterday was his shot day again.  He slept till noon today.  He has been saying my tummy hurts.  I always thought we were so lucky because he didn't really show any signs of the side of effects, till now.   Nothing serious.   I thought last week it was just a coincidence but happen again this Thursday.  Thursday will have to be our new down day.

We heard from the doctors regarding the cytoxan treatments.  The question of whether or not we were going to do another cycle all depended on Gary and how he was doing.  His levels were good.  He looks pretty great as far as skin.  He does have a few bleeding scabbed up cuticles on a few fingers.  In my Dr. Mom opinion, I do think it is a good idea to not run another cytoxan treatment (no it has nothing to do the HELLisptal).  I do think the JDM is slightly smoldering.  Very low.  Very quiet.  That does concern me that over the next couple months without the cytoxan, we will just have another repeat of mild symptoms coming on gradually.  Like the small dots on the insides of his hands and all over his face.  Gradual weakness returning but not blaring, just enough to make me worry.  BUT we can't know until we try coming off the cytoxan.

Gary and I are on our way (sunblocked, hat, and sunglasses) to celebrate Earth Day and pull some weeds in our community.  Have a wonderful day.

A Year Ago Today

Today is April 19, 2010.  It was a year ago this day that the symptoms of Juvenile Dermatomyositis appeared.  Someone needs to come up with some protocol on what to do with these anniversaries.  I say celebrate.  Not celebrating the fact its a rare autoimmune disease or all the hospital stays.  I say celebrate we have made it thru it.  I think I will get him a cupcake.  Something that says, "good job baby, none of this is easy and you are so brave."   We also have D Day.  Diagnosis day.  Yes! We will be celebrating both.

His lips felt funny because they were swollen so he kept flexing them.  

Trauma

We had our over night infusion on Friday.  Gary did well.  He is starting to be a bigger boy.  He realizes that sitting still and cooperating while they jamm a huge iv needle into his hands, well is just not necessary.  I am so proud of him.  He has found his fight.  He kicks, grabs, twists, turns, screams, yells, and cries.  He has always looked like a fighter but would really just gave his little hand over.  He would still cry but never really figured out he didn't really need to just sit there.  It does stink for everybody else, well and him because we had to do a wrap down on him.  They take a blanket and swaddle him.  Similar to the way they wrap a newborn.  The best part of it all though is the prize box.  When the tears and the heavy after burn sighs had passed, he picked himself out Seattle Mariners hat.  He looked so adorable in it.  The got his meds going which made him sleep and sleep. We struggle with his blood pressure all night.  Usually its to high.  This time it was to low.  At one point it was 95 over 25.  They kept a close eye on him.  A doctor came in at two to look him over and listen to his heart and repository counts.  It started coming up here and there.  I began to wonder if they gave him a little too much benadryl intravenously.    My favorite part was our roommate.  I feel bad that for all the families that are forced to share small rooms.  The baby cried nearly all night.  It was actually a bit traumatizing for me.  We had the inside of the room, the side without the bathroom.  Which meant if Gary or I needed to use the bathroom we have to go into there side of the room.  Literally walk thru there space to get to the bathroom.  I used the bathroom out in the hall so I didn't have to disturb them.  Then every time someone would go in or out of the room, they failed to close the door.  All night long.  We were in a busy part of the hall so I was forced to get up, over and over and over again to close the GOSH DARN DUMB SMELLY DOOR!   I was losing it.  But it was only for one night, so I held it together.  Unfortunately that just deepens the pure hatred of having to be there.  I pray that the SCH expansion eliminates ALL shared rooms.  Especially when they think it is a great time for a weigh and measurement check of a sick baby just happens to be at midnight.  Strip the poor thing down to nothing once she is sleeping.  Yep!  I would scream too baby girl.  Anyways, I still don't think I have recovered.  On a much happier, lighter note, Gary's appointment when well.  His levels are good.  He has only two that are still elevated, but only slighty.  His strength has returned since we began cytoxan.  So it seems to be his drug of choice which is not the greatest because its not exactly good for him.

Thank You

We raised $235.00 dollars in honor of me turning 30 again. Thank you to everyone for my birthday presents  : )!

My Favorite!

Three Shopping Days Left

My Birthday

Normally I don't go around telling people, "hey, guess what it's my birthday!".  I find that irritating.   I also find it irritating when it is your birthday and you don't tell me.  You can't win, so don't try.  Did I just let the cat out of the bag?  Surprise, I'm a brat.  Don't worry, I drive myself crazy.  So its seems like just yesterday I was turning 30.  One blink and BAM I am 30 again.  What do you know.  Now I know you have all been counting down the last 365 shopping days to my birthday.  I know what to get me?  Hmmmm!  I have a wonderful birthday gift you can give me.  (I know how kind of me to make it so easy on you).  In honor of my birthday consider making a donation towards my run in June.  Click HERE  to make a  donation to help find a cure for Juvenile Dermatomyositis.  Now if I run into you, don't let it get all awkward when I ask, "soooo, where's my present?".  You will be able to say I got you a present.  I am helping finding a cure.  Well won't that just shut me right up. And if you really feel like getting me more, *shrugs*,  I will take a case of wine and a case of wrinkle cream.  Great Thanks.

Easter Re-cap

Easter was good.  Gary had a lot of fun during our egg hunt.  He got a head start before all the older kids.  I had to hop around early in the morning.  I was went to bed at 1am the night before, helping the Easter Bunny out.  He likes me because our initials are the same,  E.B. : ).  Up again at 6am to hide them.  With wet hair and a towel on my head hiding eggs in the yard.   The kids had to wait until dinner to hunt them.

Last week I did post on the Cure JM board about some brown spots in the cuticles of his fingers.  This was on  Friday during the lab draw.  After discovering the tiny spots and over grown cuticles I had the rheumatology staff hunt down a nurse or a doctor to come take a look.  See if they had any input.  Naturally I tend to freak out at anything new or returning.  Especially in the middle of course of cytoxan.  The spots I knew what they were.  I didn't need them to tell me.  They are hemorrhaging capillarey vein in his nail folds.  A disease activity indicator.  One of the disease indicators that is.  The cuticles are overgrowing again, like in the beginning when we were first diagnosed.  So it is not like I haven't seen them before.  I have calmed way down over the weekend.  I was concerned especially when the doctor that did come out to look at them asked if he hit his fingers on anything.    As always I am nice and forgiving.  But then my inner dialog starts when the logic is processed.  Wow.  Really, did you just ask me that?  I know everyone has a process.  She was super sweet for coming out to the lobby to see us but our only answer was "I will email the last person you saw in clinic."  I thought of pushing more but we are the middle of cytoxan like I said before.  His labs are great, his strength is good, and the rest of his skin is on and off.  Not much more to be done right now without changing or adding or increasing something and in my Dr. Mom opinion, I don't see that being necessary at this time.  But in the back of my silly mind thoughts like, 'is this new activity?  a sign of what is to come? is this the start or the end of a flare?'  Madness.  A symptom of being a mother is torturous thoughts.  You have to admit though, you can't blame given his past.  I have to sit here and think, next month could we have to go back in the hospital?  What if?  I have a fire extinguisher in my head.  I have pulled the pin and am putting that thought out.  Because it is a waste.  A waste of fear and anxiety.  My fear and/or anxiety will change nothing.  Even if it does happen.  My favorite however, is looking back when you are knee deep in it and saying, "remember that day at the lab,  uh huh, yep, told ya!".  Besides, lots of other stuff I can throw my fear and anxiety at like, oh, I don't know, earthquakes, or I got it! Bills.  Or how about money!  Yes, that gets my heart pumping.  And its not about having too much of it if you catch my drift. Ha ha.  That's a favorite.

Give it to God.  

Update on Make a Wish

This past Sunday 2 Make-A-Wish volunteers came to meet our family.  It was very exciting.  They both were very nice.  They brought presents for all the kids to make all of them feel included.  Gary has been granted a wish.  It will just be deciding what that wish will be.  I had mentioned in a previous post I was concerned about Gary's lack of speech and not being able to clearly communicate what his wish would be.  To my relief, they were not concerned about this.  We have time to decide what will really make him happy.  Since we know him best, we get to have a lot input on his wish which is exciting.  We are brain storming things like outdoor play houses, or a playground that is sun protected or maybe both!  It was such pleasure having them at our house.  They will be returning soon to talk over our idea's.  Thank you Ken and Cherelle.

Birthday Pictures

Yesterday I took Gary to have his third birthday pictures done.  We get them done at Picture Me in Walmart because they have a background we have used for the past 2 years.   Continuing with our tradition, we went there.  They took some very nice photos.  It was actually pretty emotional.  It was this time last year, that I knew Gary as a healthy boy.  When there were no troubles or no worries about his future.  A few pictures she took were of him holding a football.  His little fingers wrapped around the tip of the football showing each red little finger.  Reminding me.  Almost yelling.  Those little red finger were causing me flash back of the past year.  Tears came to my eyes.  I didn't share with the photographer/sales girl what he had, or where we had been.  I kept it to myself as she asked how I liked each picture.  I had contemplated not having the pictures done because he woke up with a swollen face.  Puffy eyes, puffy lips, rashy skin.  But I thought you know, we don't get many clear days so I decided just to have them done.  He looked just fine in the pictures.  One of my favorites was a lite silhouette of him looking up to the left on a black background.  Think a few tears ended up escaping from my eyes at this point.  I felt a drunk happiness from being blessed with him.  I felt sadness for everything he has been through.  Then they started sobering me up with prices LOL!  I could spend 500 and get the gold package.  I laughed or rather cackled out loud, placed my hand on the back of her shoulder and apologized for laughing.  I told her that I had not planned to spend that kind of money.  They  do an excellent job of flipping to the next package, as if 400 and 300 or even 100 is any better!   ha ha ha   Sorry,  single income people,  supports 6 people.  I felt like asking can I put him back up there for a second a snap a shot with my camera?  LOL   I know,  cheap   cheep cheep.     So I ended up walking out without any pictures.  I will bring my husband back.  He's my bull dog.  He doesn't mind the award sales pitch being thrown.  He throws one all the time and is very good at it.

I also wanted to share that I had his haircut done before the pictures at Sport Clips.  He did so well holding still.  He was so excited to sit in the chair like a big boy.  The gal cutting his hair was very nice.  I immediately started explaining that he has had about a years worth of a few different chemo's.  So if she saw any spots or hair loss to let me know so we could discuss what would be the best haircut.  She looked him over and said it looked pretty good.  She was expert.  I explained he does not have cancer but a rare autoimmune disease.  She returned with connecting emotion that she too suffered from an autoimmune disease called Alopecia.  Where the body attacks hair growth?  So essentially she had no hair.  She was diagnosed at age 2.  It was nice to talk to her about her story.  She said that she had been treated for years and was done with fighting it. She was beautiful and to look at her you could not tell at all.  Full head of hair, I would never guessed it was a wig of any kind.  She was also a Grandma which I found hard to believe.

Next Overnight

So our next overnight infusion is on the 16th.  I can't believe it is already April.  We had labs on Monday.  He did well.  He got out of there quickly. We go back in tomorrow for another lab.  I have had a few nagging concerns.  The day before yesterday Uncle Bill went to lift him up into the air like he always does, and Gary immediately began screaming and crying  owie owie owie for a several minutes.  He would not let us touch his left side.  I gave him time to recover.  I am still not sure what happened.  I was concerned about a cracked rib or something of that nature.  But he started playing and wasn't complaining after that.  So I dont know.    It is the same thing with his ankle.  We have an xray order waiting at Children's because he keeps limping on it from time to time and it is bigger than the other one.  But he runs and jumps on it so hard to decide whether or not to shoot him with some radiation.  So again, I am not sure.  I will keep an eye on it.   That's what us mothers do : ).  Sometimes I wish my imagination was impaired.  Like the other night when I was running.  My husband, who is good Dad, took my daughter to her swim lesson, along with Gary.  I had this lovely image pop in my head, "oh no, what if Gary falls in and he is not paying attention, and now Gary is floating at the bottom!"    My best friend was there too so I put it out with that thought. She happen to call me as I finished up.  "Can you see Gary?"   "Yeah, he's right here."      Hee hee.