Chemo 101 - Day 98

Knowledge is power, right?  The more happenings I can expect to occur vs being shocked by their arrival, the better.  Polly and I have learned that much of what we want to know ourselves (sometimes in huge volumes) about the cancer treatment won't necessarily change how she is being cared for, but.....and I say BUT, there are times when advocating for Ellie while at LPCH is an absolute must.  The doctors and nurses, as good as they are and as incredible as their work is, do cancer all day every day for hundreds of patients.  From my perspective, and I apologize for thinking like this sometimes....I am a little jealous they get to go home at night to their healthy kids/family and forget about this world for a while.  It is understandable that within the daily grind of their normal work day they on occasion can become a little numb to the emotional side of our plight, they can forget a logistical detail, or worse....give Polly or I the "oh, yeah THAT - happens a lot - no biggie" line when we firmly believe it is a big freaking deal.  BUT, on the parent side of things, this sometimes drives us bonkers.  Polly and I do not want it to be lost that her life is at stake and we do not always have it together during various "happenings" to be the cheeriest, most supportive people.  Everyone is human here and that is not lost on me.  So, the more we can learn and know about this disease, the more we can advocate and avoid surprises.  Most of all, knowledge helps bring a little more peace of mind.  And honestly, in a day to day atmosphere, you can NEVER get too much of that.


Chemotherapy drugs are tailored to specific types of cancers.  The goal is simple - attack the cancer cells, keep them from reproducing (via meiosis), and pave the way for a clean slate where new cells can grow and flourish.  As I alluded to in my last post, past treatments for leukemia used to hit the cancer hard with only a couple drugs for longer periods of time.  They found that the Leukemia became resistant to those drugs in effect learning how to fight back and make the drug ineffective.  Presently, the chemotherapy "cocktail" given to patients over the course of multiple years effectively sucker punches the cancer and doesn't allow it to gets its bearings to stand back up because its being bombarded from so many different angles.  In order to do that scientists and doctors had to figure out how to hammer the various phases of cell creation with specifically targeted drugs (You wouldn't send the Army in for a war being fought several hundred feet deep in the ocean, now would you?!).  Here is the basic arsenal of the past few months with lots of help from chemocare.com:

Mercaptopurine (6MP) - Mercaptopurine belongs to a group of drugs known as antimetabolites. It resembles a normal cell nutrient needed by cancer cells to grow. The cancer cells take up mercaptopurine which then interferes with their growth.  We give this orally to her nightly for periods of 2 weeks at a time during Consolidation.  It will be given every night for 8 weeks in IM.

Vincristine – Antimicrobial agents (such as Vincristine), inhibit the microtubule structures within the cell.  Microtubules are part of the cell’s apparatus for dividing and replicating itself.  Inhibition of these structure ultimately results in cell death.  Chemotherapy with Vincristine is most effective at killing cells that are rapidly dividing.  Unfortunately, Vincristine does not know the difference between normal and cancerous cells and thus both are killed at the same time.  “Normal” cells will ultimately grow back and be healthy with a small cost of side effects.  **Jeff's Add-on - This drug is awful.  It causes Ellie's limbs to tingle, joint pain, hair loss, and just overall irritability.  Our worries with Vincristine were elevated just today because she was so unhappy that she cried on/off for about 4 hours straight.  Have I mentioned I hate cancer?

Peg-L-Asparagenaise - All cells need a chemical called asparagine to stay alive. Normal cells can make this chemical for themselves, while cancer cells cannot.  The enzyme asparaginase breaks down asparagine in the body. Since the cancer cells cannot make more asparagine, they die.  Pegaspargase is a modified version of the enzyme asparaginase.

Methotrextate - Methotrexate exerts its chemotherapeutic effect by being able to counteract and compete with folic acid in cancer cells resulting in folic acid deficiency in the cells and causing their death.  This action also effects normal cells which can cause significant side effects in the body, such as: low white, red and platelet blood cell counts, hair loss, mouth sores, difficulty swallowing, diarrhea, liver, lung, nerve and kidney damage.  This is the drug that will be given in such a high dose four times during IM that she'll need to be hopsitalized while she processes it.

Cytarabine - Cytarabine belongs to the category of chemotherapy called antimetabolites.  Antimetabolites are very similar to normal substances within the cell.  When the cells incorporate these substances into the cellular metabolism, they are unable to divide.  Antimetabolites are cell-cycle specific.  They attack cells at very specific phases in the cycle.  This drug is the one Polly and I inject Ellie with at home.  The anecdote?  Piles of stickers she can put all over the front of her outfit.  Brings a smile everytime.

Cyclophosphamide - Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.  Cyclophasphamide is classified as an alkylating agent.  Alkylating agents are most active in the resting phase of the cell.  These drugs are cell-cycle non-specific.  This drug requires two hours of hydration via an IV for two hours before and after it is given.

Dexamethasone is a potent synthetic member of the glucocortoid class of steroid drugs.  It acts as an anti-inflammatory and immunosupressant.  The main effects of dexamethasone and steroids like it seem to be due to their anti-inflammatory properties and their ability to alter immune system responses. For example, dexamethasone helps prevent white blood cells from traveling to areas of the body where they might add to swelling problems (such as around tumors). It also seems to help with the treatment of certain blood cancers (such as leukemias) by causing some cancerous white blood cells to commit suicide.  This drug also causes huge appetites, swollen faces, huge mood swings.....and is generally an awful thing to have to take.

There are about 3-4 other drugs I have not listed that are on our horizon at some point in future phases.  The understanding that these side effects are temporary is paramount to being able to persevere through all of this. Needless to say, if there was a wish to be made here beyond the obvious one to make her whole once again....it would be for me to change places with her.  I would do it in a heartbeat.

Please keep praying for her well being.  We have been so fortunate to be "event free" for the most part the last month or so.  We hope to keep it that way.