Friday 31 July 2015

Blog: July 2015


30th July

Last month I managed to take Rafael to school for 1 period so that he could participate in the school photos. 

He even had a hair "trim" (read: tidy up the mess)!!

He's missed out on the last 2 years photos and we really wanted a new one!!

Love it :-))))




28th July

Rafael made it to 5 days without needing a platelet transfusion!! His level today was <10 and if we'd tested yesterday, it probably would have been the same ;-) 




Thankfully he didn't have any big bleeds, just a bit from his gums when he brushed his teeth and was able to hold out until today, saving us and extra trip to RCH

We met with Dr Michael afterwards. Rafael's future treatment is now in the hands of the Ethics Committee. A meeting is being scheduled to discuss Rafael having a type of Bone Marrow Transplant called a Haplo Identical. The donor is from one of the parents. They have been using it at RCH for Leukaemia patients, but never for Neuroblastoma. Hence the ethics committee requirement!! Fingers and toes crossed!!!

He had a wonderful, friend filled weekend

He went to a sleep over party at his friends house, it was just around the corner, and although he fell asleep early - declared it the "most fun I've had in ages!”

On Sunday another friend came to visit. Even though Rafael was very tired from the party, they happily sat on the sofa and chatted and played with the pugs


22nd July

Rafael is obviously feeling much better

He went to his favourite cafe for a pizza lunch and managed to squeeze in a bowl of ice cream too :-) 



21st July

Rafael is home :-) 



Due to his low white cell count, the doctors were being super cautious and kept him in for one more night

He had another chest X-ray yesterday and all signs and symptoms are of a viral infection - he's still coughing a lot

He had another platelet transfusion yesterday. As expected, the Lutetium is knocking his counts

He has to take another medicine to try to avoid a fungal infection. The longer a person has no white cells, the higher their risk of infection increases

20th July

Rafael is still inpatient, but he is much better and still fever free

He even has 0.06 neutrophils today! I know, that's a tiny, tiny amount but we'll take it

The doctors are being super cautious and keeping him in for one more night.
He had another chest X-ray today. All signs and symptoms are of a viral infection - he's still coughing a lot

He needed another platelet transfusion today

As expected, the Lutetium is knocking his counts

He's developed a banana craving ;-) 

19th July

Feeling better - fever free and hoping to go home in the next day or 2 


18th July

Rafael is inpatient again :-( 

Yesterday afternoon he spike a 39.7C temperature and that meant that we had to take him straight to ED. At least he gets a "go straight to the front of the queue" card

When we arrived, his heart rate was very high and his blood pressure very low

He also had blood in his urine

We spent 10 hours in ED waiting for a bed on a ward

In that time, they gave him 3 bolus' of fluid to bring his BP up as well as a platelet transfusion.

We finally went to a ward at 3:30 am and he had a blood transfusion and another one today. I think we finally got to "sleep" around 4 am

Since then, he has been having fluids at 100 ml/hr. Consequently he is very puffy now! He asked me to take a photo so that he could see what he looked like

At one stage this morning his BP dropped even further and they nearly called the M E T team

Thankfully when he rolled onto his back it picked up a bit

We were moved to Kookaburra ward later as the nurse to patient ratio is lower as they felt he needed more nursing care in case the BP didn't improve.

Gabriela & Dom came in the afternoon and he did perk up a lot, he even got out of bed and sat on the sofa for a bit

He tried to eat some lunch, was enjoying it and then coughed a lot and that made him vomit

At least he just continued on and ate the other half ;-) 









16th July

Rafael managed to walk into the hospital yesterday without me needing to use the "vintage stroller" that he no longer fits into ;-)

He seems a little better :-) 

He told me that it's not every day, but maybe every second day that he's feeling less pain :-( 

He received a huge dose of radiation last week and it's really taken it's toll. 

Hopefully he can turn a corner soon!!

Rafael's counts weren't great

Unexpectedly he now has ZERO neutrophils again

That puts him in the highest of high risk groups for infection!!

He has been extremely lucky the last 7 moths to only contract 2 mild infections. We have to wrap him up in cotton wool again to avoid exposure to anything!!! Of course, this rules out school completely

We've been able to reduce his pain meds and ween him off the steroids.
We were meant to meet with his doctor yesterday, but after waiting 2.15 hours - I gave up!! I mean - seriously?? That's just insane. I'm too tired, too stressed, and too everything to sit and wait that long!!

Unfortunately that means that we have no follow up appointments booked

When I calm down, I'll write him an email and get back on track!

All we actually needed was another prescription and lucky for us I saw the Fellow in Day Onc and she wrote it out

11th July

Rafael received a wonderful surprise on Thursday afternoon. At one stage, we didn't know if he'd be well enough

In the morning he woke up feeling much better - until 11:30 when he vomited everywhere due to the radiation and then slept for 2 hours

His friend Eddie arrived just after 1:30 and Rafael was so happy to see him and even managed to sit up on the sofa and teach Eddie the "ins and outs" of Dota (??? some new game).

Soon, some students from Yr 5 & 10 at Westbourne Grammar School started arriving. Rafael was very happy to see the "big kids" because they also knew all the "ins & outs" of the game! He perked up a lot. Even his Principal Mr Barklamb came along

At one stage his friend Sam wanted to FaceTime and Rafael wasn't sure whether he should. Mr B said "yes, let me talk to him!" Sam got such a surprise and Rafael giggled a lot

Ms Rasen is an excellent singer and she brought along her boom box and managed to get everyone singing a special song for Rafa - he even sang along

I think it's a great song to describe our Warrior.

Sorry the quality is not great, I'm terrible at recording stuff!!


8th July

Rafael slept all night but woke up a few times for pain medicine.

In the morning he was feeling very tired and lethargic, with a few intense areas of pain.

He had a scan at Peter Mac and then we met with Prof Hicks. The scan showed that all of the Lutetium had been taken by the tumours and he was very pleased with that (& us too!!!)

He took one look at Rafael and said "He's showing typical symptoms of radiation sickness"

What the?? We've never heard of it and Rafael has never had it before

Fatigue, sweats, headaches, vomiting etc ...... It will pass in 24 - 48 hours

We then went across to RCH for transfusions if needed and to meet with Dr Michael. As Rafael had only had transfusions on Monday, we weren't expecting to need them and we were right

Rafael slept most of the day, wherever he could - during the scan, in the chair, waiting at RCH, in the car....

A quick chat with Dr M and we managed to get him to agree to up Rafael's doses of steroids for the next few days until the tumour swelling starts to go down.

As were were leaving, my friend and her daughter were waiting to meet Rafael, Gigi gave Rafael a gift and he agreed to taking a photo. It was the first time he smiled all day!!!!






7th July

Rafael coped very well with the Lutetium infusion, no problems this time

He was given a really high dose - 8 Gbq!! We weren't expecting that ;-)



Our friend Sophie drove to Peter Mac and delivered Rafael's lunch - Subway ;-) 


He was in a lot of pain when we got home (as expected), due to the tumour flaring.

He started to sweat a lot, was clammy, got the shakes and his temperature dropped to the low 35C’s!!!

We called his doctors and they wanted us to take him to ED. In typical Rafael fashion - he refused!!!

The Dr's told us to wait 1 more hour to see how he was, but Rafael finally fell asleep, so we left him be ;-) 

7th July

7th July 2008 - official diagnosis day

7 years ago today

We haven't stopped fighting since!

In the weeks leading up, Rafael had 2 surgeries and was inpatient the whole time.

In the days leading up, in the brutally honest world of oncology - the doctor said to us - "you can hope it's not Neuroblastoma" !!!!

I still hate him for saying that and I'm glad he's left RCH now! Who needs to hear that?

It's been a non stop battle. We've had one 3 month reprieve (2012) where it looked like there was No Evidence of Disease (NED). Rafael is now battling for the 4th time

But this Beast, really is the worst! It just keeps trying to come back and take our son! In the famous words of Steve Dolling, it's "the Monster that lives inside our house"

These photos show each July over the last 7 years of Rafael's journey. He was 4 at diagnosis and is 11 now.

Compared to then and now - he is really struggling

His movements are slow and painful and he can't walk very far

He is very sad and spends all of his days when he's not at hospital at home alone with us and laying on the sofa. He has very little joy or fun in his life

We don't know what to do or how to make him happy and laugh again

He will spend today at Peter Mac receiving yet another dose of Lutetium, a Peptide Receptor Therapy. He was the 1st child in the world to ever receive this and up until now, it has always reduced his disease burden and gotten rid of his pain.

We are holding everything crossed for our Hero, our Warrior, that it once again helps him and gives him some quality of life back.

With hope

xxx










6th July

Early start today, platelet and blood transfusions = a long day ;-)

These are “top ups” ahead of his treatment tomorrow.



4th July 

Today Rafael was able to sit in the car in some sort of comfort, so we drove to saffron on the Hill for a visit :-) 



3rd July

I know I've said it before, I'll say it now and I'll say it again (many times) !!!
Thank you #TeamPeterMac

Next week we pass 7 years of fighting this BEAST!!! On his 7th Anniversary - Rafael will receive another dose of Lutetium at Peter Mac.

They scrambled the last 2 days to ensure his dose was included on the flight from Holland to Australia!!

Fingers crossed, hopes abounding that we can knock this Beast away yet again!!!


2nd July

Mr Menzies paid a visit this morning. Rafael’s friend Eddie was here too. They tried to play X Box for a little while, but Rafael was in too much pain and couldn’t get comfortable :-(




Angel Angela came in the evening and gave Rafael a very special massage to soothe his pain and aches :-) 


1st July 

A very tough week so far :-( 

Rafael had an impromptu visit to RCH yesterday to meet with his doctor to try to get pain under control. 

Dr Michael has also agreed to Rafael having another dose of Lutetium next week at Peter Mac :-) 

The meds are working, but geez - he's a zombie!

Today he was lucid most of the morning. Dom agreed to take Gabriela to the local tennis courts for a play "match". When Rafa heard this, he said "I want to come too, to play" !!! They also ended up playing Football (soccer) but Rafael was getting very tired by that stage

SOOOOO happy to see him off the sofa and willingly leaving the house

We are waiting for Peter Mac to contact us about doing local radiation to his spinal lesion to hopefully stop the pain (& pain killers!).






Tuesday 30 June 2015

Blog: June 2015

30th June

The last of a Meatball Subway going down ;-) 



Dr Michael had the bone marrow biopsy results and once again, they are not good. They are showing signs of blasts (not good ones) and the doctors think it may be MDS after all. There is an “abnormal population” of CD45 cells. They are going to do more testing and analysis.

29th June

I ended up calling the hospital and speaking to the Fellow as Rafael’s pain is unbearable and the combo doesn’t seem to be helping. He keeps waking up at night asking for more.

She faxed a prescription to our local pharmacy and that saved us a trip into RCH.

Rafael is now on Oxycontin, Gabapentin and Steroids as well as Endone & Panadol for breakthrough pain.

We’ve stopped giving him the Pericatin as he’s already taking too many pills :-( 


27th June

No platelets needed today!! Woot



However we still need to wait to see a Dr to sort out Rafa's pain meds. She prescribed Temodal, but when I text Dr M later, he said that he’s not very keen on using that pain medicine. He offered some other doses of the current ones. Let’s see how it goes!


26th June

Rafael received a very special surprise today.

He spent most of the morning on the sofa with his heat pack and zonked out by the Endone. Just before his surprise arrived, he fell asleep!

His school principal had arranged a surprise visit with a few of his friends. They came in the school bus and stopped at McDonalds on the way

Rafael's good friend Kane came inside first and tried to wake Rafa up. Rafael was very groggy, but happy to see Kane. When I told him that Kane had brought something special, he saw the Macca's bag and said 'Lunch"!
Then he saw a few more of his friends across the room

He had so much fun chatting and catching up! It’s the one thing he misses most - his friends!!!!

Mr Barklamb knows someone who knows someone and they arranged some signed Socceroos gear from Mathew Leckie. He was very happy indeed!!

Sadly his friends had to leave to get back to school. It really took it's toll on Rafa and he spent the rest of the day in pain and on the sofa. I managed to juggle his meds and get him some relief xxx








24th June

An early start today for bone marrow & trephine aspirates. They took some today from the front of his hip as well - it hurts




Followed by a platelet transfusion

We met with Dr Michael and he wants to try Rafael on a cycle of Temozolamide. Rafael hates those 5 little pills - arghh!!!


20th June

Rafael's girlfriend sent him a selfie



Today Rafael had another infusion of Zolodronic Acid, hopefully this will relieve some of his pain!

19th June

After a more intensive review of Rafael's scans last week, Peter Mac requested an additional MRI to look at a cancer spot on Rafael's spine that might be causing the pain??

Dr M and the team at RCH requested an emergency MRI and the response from RCH was 12th August is earlier date to book him in!!! WTF??? Serious??
As I've said before, and will say when my voice can be heard "Thankfully we have team Pater Mac on our side" !!!!

They have managed to fit Rafael in today for an MRI ♥♥

We don't know if Dr's Tim and Rod will be able to review the scan today, but they will soon have an idea if that spot is the main cause of pain. If the tumour is pressing on his spinal cord, they will request radiation immediately :-( 


Rafael hasn't made it to school much this year, a few periods here and there. The majority of his time is spent at home or in the hospital. He is very bored and doesn't enjoy his days :-( 

Every week, when possible, his school sends a teacher to go through school work with him and catch him up

He also has a tutor who comes each week or 2.

Given all that he's missed this year, we are very happy to read his Semester 1 report

Way to go Rafa!!!

"Rafael displays a beautiful, genuine personality and he brightens up the classroom. He is well-mannered, kind and very considerate of others, always interacting with his peers in a friendly, positive manner. Rafael approaches all activities with a positive attitude and he strives to complete tasks to a high standard. He has worked extremely hard from home to keep up to date with the Year Five curriculum and his results reflect this enormous effort. Rafael is a delight to teach and an inspiration to everyone who spends time with him.”

Ps: He received a "Below Average" grade for Instrumental - I guess that's because he's never been to class

16th June

Bleeding gums + lips = guaranteed platelet transfusion



Rafael also had a blood transfusion.

We met with Michael and convinced him to put Rafael back on steroids as they always help to relieve his pain.

Rafael will stay on the Endone and Panadol around the clock.

15th June

A delayed start due to the machine having "Mondayitis" 

The news was not good today

Mums & Dads instinct’s know best!

Rafael's pain has been very different this last week, in totally different places to the “usual".

However, his back pain is very intense. This morning he told me it was 10/10
He woke me up twice during the night for a heat pack and Panadol

We were holding out hope that he really had just strained a few muscles !!!

Nope

Rafael has many NEW spots of cancer!! Spots that he hasn't previously had! The GaTate scan from Friday and to a lesser extent, the I124 MIBG today, lit up a lot!

We had to wait over an hour today for the PET scanner to warm up. In that time, he was in agony sitting in the waiting room. Finally we saw Emily and asked her to warm up Rafael's heat pack and I gave him some Panadol. By the time he came out of the scan, he was feeling much better

he had Oxycodone before we left home, but it's not helping much

We had a long discussion with Prof Hicks afterwards. Poor Rod - he's had to give us confirmation of Rafael's relapses 4 times now!!!

Yes - this is his 4th relapse

He still doesn't have a functioning bone marrow, so that rules out a lot of treatment options. We are meeting with Dr Michael tomorrow to discuss everything. He has also asked for an urgent MRI to view Rafael's ribs/vertebrae.

He is taking pain killers around the clock and we will probably add more tomorrow.

The advantage for Rafa is that he also has "Team Peter Mac" on his side and by his side, every step of the way!

They are urgently trying to fit him in next week for a "palliative" dose of Lutetium as this has always been very effective in helping with his pain. We just need to convince Dr M to allow it

We are in shock as Rafael was in such a good place in March! All these months without any treatment at all (due to his marrow) has allowed this insidious beast to take over yet again

And that is what it's been like every time that Rafael has a “gap" in treatment
I did ask Dr M if this could be caused by the stem cell return??

Those stem cells were harvested back in 2008 when he still had a lot of NB in his marrow. Scientists believe that any NB cells collected, would not survive the freeze/defrost process. However, it's still an unknown. After all, it only takes 1 cell !!!!

Anyway, that's a "what if" question, we will never know.




12th June

Rafael had a GaTate scan this morning and was in so much pain trying to get into a comfortable position while we waited.



We didn’t see Rod afterwards as Rafael has one more scan to go on Monday and we’ll see him then. 

Sometime, the people that come into your life, by chance, just blow you away!!!

Tonight Rafael had a very special paediatric massage, by a therapist who is also specialised in Oncology massage!!

There are no trained paediatric massage therapists in Australia, just infant massage.

When her own sister was dx with cancer 2 years ago, she trained in Oncology massage.

Next month she will attend more training in Sydney to become a paediatric oncology massage therapist!!!

An Angel walks amongst us 

11th June

Rafael made it to school for the photo!!!!



His counts yesterday were even lower, this means there is no chance of him staying at school for any extended time

He has been in a lot of pain since Sunday (leg & back) and can hardly walk
He has 2 days of scans ahead - tomorrow & Monday.

The pain is not his typical cancer pain, more muscular, we are still feeling positive, although we can't breathe!!!!!

SCANXIETY is in overdrive!!!

The scan on Monday is one he hasn't had before and we are very keen to see the images

10th June

Rafa's special friend sent him a gift, hopefully he'll make them and put on some weight



7th June

YAMS has a new Ambassador - Michael Thwaite who is the captain of Perth Glory. He sent Rafael his own jersey, signed :-) 


6th June

Just a quick platelet transfusion today

5th June

A few weeks ago we met with Rafael's Endocrinologist. We originally started seeing her so that Rafael could be prescribed Zolodronic  Acid infusions for his bone pain. He now has these every 4 months.

She is also a great doctor to see and discuss Rafael's lack of adrenal gland and his short stature.

This time - she was very unhappy with Rafael's lack of growth

In the last 12 months, he didn't put on very much weight and therefore didn't grow!!!

June 2014 - Height 116.8 cm (3.8 ft) and Weight 19 kg (41.8 lbs) 

May 2015 - Height 118.4 cm (3.8 ft) and Weight 20.1 kg (44.3 lbs)

Therefore she has prescribed another drug called Periactin which is an antihistamine. One of the side effects they found was weight increase
He started this week. It works to stimulate appetite and we are hoping that it can kick start his metabolism! Otherwise he might end up with another feeding tube

This drug only works for ~6 weeks. Once we see it wearing off, we can decrease the dose and try to stretch out the use for as long as 12 weeks if needed. He just needs to put on some weight!!!

His neutrophil count was really low again on Wednesday and that meant he couldn't go to school either

They have School Photo's next Thursday and since he's missed the last 2 years, I'm really trying to get him there

Rafael even had a very small hair trim today (just in case!)

2nd June


Yep, platelet transfusion as expected