Dr. C

When you are a mother going our of her mind with worry, there is nothing better than a doctor who 'gets you'. I really think Dr. C, our leading doctor and head honcho over everyone else we see, is so great. Here is his reply, short of a few lines basically apologizing for the confusion.

1.  I'm with you. Sam should be in school, even when his ANC is zero. Yes, he may catch a virus, but that's not particularly dangerous to him. The infections that are dangerous come from inside (intestines) and from the

skin. Avoiding school does nothing to decrease that risk. The benefits of being in school (socially and educationally) far outweigh the risk of a virus. Yes, steroids lead to an increase in the neutrophil count. But,

yes, it doesn't really reflect a change in his immune status.

2. I just recalculated his dose and, yes, 7.5 mg twice a day is correct. There is a substantial increase in the pulse steroid dose when starting consolidation 2, for kids who had T-lineage ALL. Yes, there is an increased

risk of side effects, but it's balanced by an increased anti-leukemia effect. The only permanent side effects of steroids are their effects on bone strength, and I'm not worried about that one for Sam, as that particular side effect is very rare in kids under 10. At Sam's age, I worry about the effects of steroids on his mood. For what it's worth, it's "only" 5 days each cycle...

I feel bad that I haven't seen you much in the last few weeks. When is Sam's next appointment? I'll make a point of being there so we can talk more in person.

I feel so much happier now, I really trust he knows what he is doing (great success in general) so will trust this cycle to be as it should be. Of course, now Sam is definitely being affected by the chemo yesterday...grouchy, hungry and tired. He has red circles under his eyes and pale skin. The cycle begins with chemo into his port, including Vincristine which gives him neuropathy...it is not going to be a fun weekend. The good news is we know he picks up after the first half of the 3 week cycle. Now trying meds in coke...took an hour with lots of sadness and upset but Sam said it was a bit better. Once day at a time...