Phase 4: Delayed Intensification

Posted Posted in Diagnosis & Treatment, Phase 4: Delayed Intensification

Delayed Intensification (DI) is considered to be the most difficult phase for most kids undergoing treatment for ALL. Roughly put, the first month of DI is like the induction phase (steroids again!), while the second month is like the consolidation phase. In addition, they introduce new drugs like Doxorubicin. In our kid’s case, due to severe allergies to PEG-asparaginase, she had to take 24 chemo injections of Erwinia, which made it more difficult (12 in the first month, and 12 more in the second).

Thanks to a combination of nutritious food (and green juice), positive attitude, eagerness to finish the intense frontline therapy (and good luck!), we managed to complete this phase with minimal chemo holds and complications. Details to come soon.

Tips for kids

Posted Posted in Helpful resources

It’s heartbreaking to see kids struggle with cancer treatment and cope with the sudden disruption of their life. It is very challenging on every front — physically, emotionally and mentally. But it’s remarkable how resilient and graceful kids can be despite the chaos! So hang in there, all will be well… Here are some things that have helped our kid stay safe and positive through this trying period (sorry for the long post).

On the physical front:

  • Keep the house clean, change linens every couple of days, if not, every week.
  • Wear a mask whenever near visitors or while stepping out.
  • Avoid visitors if they have a cold, cough or other germs.
  • Use soap or hand sanitizers liberally (we put one in every room so we don’t forget).
  • Help kids stay active — a 1/2 hour walk in the neighborhood, or turn on their favorite music and dance! It helps the muscles stay strong, and prevents walking disorders.
  • Nutrition is important, unfortunately oncologists don’t talk enough about it. This is a long topic, but a couple of things to remember:
  • Ensure that kids get enough protein (around 1g per pound of body weight)
  • Since they can’t take food supplements during the frontline treatment, try to get the good stuff in through fruits (e.g., kiwi, orange, lemon are high in vitamin C) and rainbow colored vegetables. We ‘ve been juicing (carrot, mixed greens) everyday for the last 5 months, and it’s helping our kid overcome some of the side effects of chemo…

On the mental / emotional front:

  • Assure them that although their life sucks now, they will be *fine* as soon as the treatment is over. Often, kids (and we!) just need to feel assured that all will be well. Call fairytales cliched, but they are so assuring with their happy endings. We watched movies and shows that reinforced this message (e.g., Cinderella suffered, but she remained brave and kind, and eventually lived happily ever after; similarly with Beauty and the Beast; Peter Pan…). For older kids, try Harry Potter, Narnia, Never ending story, Lord of the rings… Movies are a fun way to reinforce messages like “never give up”, “all will be well”, “believe”, and “there will be a happily ever after”…
  • Most kids turn to iPad or TV or video games to cope with the suffering. This is fine initially, but too much iPad = iMad = iSad = iBad. Instead, consider trying various fun activities to keep kids engaged and distracted from the pain and boredom. This post has some ideas on how to wean…
  • During chemo, even normal day-to-day chores like brushing, eating food, medicines, walking etc can become challenging. This post has some ideas on converting boring rituals to colorful jewels and stickers, and helping kids choose good activities. Be creative and try your own incentives! 
  • Find ways to laugh and relax. Our kid loved art — she generated oodles of art and we decided to fill an entire wall of art. That was her way of staying busy and creative. Music and dance can also be very relaxing.
  • Books can be an awesome friend, by opening up a world of comfort and imagination for kids who are struggling with disruption of their life. Here are some books that work well for 4-10 year olds. 
  • for kids that enjoy food, try DIY food projects — our kid loved watching cooking shows on Youtube, and we baked a lot of healthy treats from ginger almond cookies, cakes, to popsicles and ice-creams with different fruits and nuts. Get those young chefs out! (and be prepared to deal with a messy kitchen). This FB post has some stuff that our kid tried. 
  • DREAM! Make a nice wish list of all the things your kid would like to do once the treatment is over. This could be anything from a trip to Disneyland, sleepovers with your best friend, to traveling to exotic places around the globe. (Don’t worry about whether it’s doable, just get them to dream and *want* to try their best to get well soon).
  • Tell kids that it’s completely OK to feel mad, angry and upset that things are not the way they want… Discuss how they might express themselves better. We found books like “Calm down time”, “Little Dinos don’t yell”, “Little monkey calms down” etc to be quite helpful. Reading it daily helped reinforce better ways to handle their emotions… We even made up our own calm-down song. We would just hug each other and sing this song until our kid calmed down 🙂 We also had a cool down spot (built a DIY tent near the bed) and put her favorite stuffed toys near it, so that she could self soothe…

These are just some ideas that have worked for us. We are sure there are many more. Let us know what worked for you!

Tips for parents

Posted Posted in Helpful resources

When kids are faced with a life threatening illness, it’s devastating for parents. Here are some things that have been helping us cope with our kid’s cancer treatment. (Often, kids are so resilient and graceful, that they cope faster and better than us, and inspire us with the necessary strength to march ahead!)

Medical front

  • Ask enough questions to the doctors and oncologists. No question is stupid…
  • Keep notes or a journal to record key observations and questions. My husband and I have a shared Google doc to keep track of various side effects, drugs, questions for the oncologist etc.
  • When overwhelmed (e.g., to enroll in a clinical trial or not), ask the oncologist or person in charge, “What would you do if this were your kid?”. We have often found that folks pause to think for a moment, and the answers are more sincere, and from the heart…
  • If doubts persist, get a second medical opinion. (We did and it helped!)
  • Once you are comfortable with the medical team, please trust the oncologists and build a good working relationship with them. Doubts and mistrust make it hard for both the parents and doctors… (Remember that the treatment period is long and that you may run into the same doctor multiple times)

Taking care of yourselves (Yes, it matters a lot!!)

  • The road ahead is long and tiring… Take it one day at a time. Sometimes, we’ve had to take it one moment at a time!
  • Spend some time taking care of yourselves. Listen to music, meditate, do yoga, go for a ½ hour walk, massage, an outing with a friend… It’s important for you to relax and rejuvenate too!
  • Eat on time and stay hydrated. The diagnosis and treatment can be so overwhelming that parents may tend to focus solely on the kid, while ignoring themselves. But remember that the treatment is long, and you need to stay healthy first to help your kids!
  • Think positive. This is easier said than done. As insane as things are initially, *Believe* that things will get better. Find your source of inner strength… For me, meditating and believing that our kid was completely under God’s protection and that He was taking care of her every moment, helped let go of the worries and gave me the strength to focus on what needs to be done…
  • Do not hesitate to consult a psychologist if depression continues…

Finding a good support network

  • Please don’t be shy to ask friends and family for help. Grandparents visited and stayed with us, providing emotional support and helping us with some chores, which was of great help! Sometimes, help can come from the most unexpected quarters. We got lucky with a couple of new friends who went out of their way to help, be it buying groceries, cooking a meal, entertaining our kid, or simply being available to listen and help…
  • Great if you could connect with parents of cancer survivors. FB groups like Childhood Acute Lymphoblastic Leukemia are good, and even better if you could connect with a couple of parents that you could call and discuss 1-1. Learning the do’s and dont’s, and best practices can be immensely helpful!
  • Good books like “Childhood Leukemia” by Nancy Keene are also very helpful. This was recommended by our onc and I found it very informative and helpful. It included excerpts from various parents, and covers a variety of topics from treatment overview, to drugs and side effects, to dealing with family, siblings etc.
  • Contact support organizations as needed for financial, medical and counselor support. Examples include Leukemia and Lymphoma Society, American Cancer Society, Candlelighters…
  • Reading stories and blogs about cancer fighters / survivors and learning from their journeys and experiences can be helpful too. (This is just one of several blogs out there.)

This list is by no means complete. Hope you found a couple of useful things! 

Support network — Friends and Family

Posted Posted in Support network

Kids can’t fight cancer alone. Nor can their parents. No matter how strong we may seem, a good support network of friends and family goes a long way in helping!

Grandparents visited and stayed with us to help, which was a boon in disguise. Uncle visited quite often, to read books and play games, which our kid enjoyed very much. We have been super lucky to find a couple of very good friends who have been going out of their way to help. We keep running out of words to thank them!

As parents, we found it very useful to talk to other parents whose kids fought cancer and had positive outcomes. Understanding the best practices, do’s and dont’s, side effects to watch out far, tips to overcome them, questions to ask the doctors etc were very helpful. Although our kid was young (five when diagnosed), we found the suggestions from adult cancer survivors to be quite helpful. For example, we learned about the importance of juicing, which has since become a daily routine for us. We also learned about the benefits of alkaline diet, RO water, increased protein intake and other tips to help overcome the side effects of chemo.

As odd as it may sound, we initially avoided online support groups and search engines as we found the deluge of information quite overwhelming. Frankly, there’s too much information out there with little quality control, ranging from speculations about likely causes of cancer, anti-cancer diet, to articles and posts about kids developing various complications, relapses, negative outcomes… We were already crazy busy helping our kid fight the side effects of chemo and overcome the emotional trauma, that we didn’t have the stomach for hearing negative outcomes. We chickened out and avoided online support groups for a while…

Later, when our kid was more stable emotionally and physically (around the Interim Maintenance phase), we ventured into online support groups. We found a couple of good online parent support groups on Facebook (e.g., Childhood Acute Lymphoblastic Leukemia) to be quite helpful.

Inspired by the support groups, we started this blog and the companion page, Brave Kids Fight Cancer on Facebook, to help share our experiences and ideas to help kids stay positive through the long and difficult treatment period. Hope you find it helpful. Please join and let us know what worked for you!

Helpful books

Posted Posted in Helpful resources

As parents, we found the following books to be quite informative and helpful.

  • Childhood Leukemia, by Nancy Keene. This book might be a bit overwhelming, but I would recommend it if you are looking for an overview of the entire treatment, some side effects to look out for, useful tips etc. I especially found the excerpts from various parents to be very helpful. For example, after reading this book, I requested the nurses and doctors for EMLA cream before each port access or injection. About the book:
    “This most complete parent guide covers not only detailed and precise medical information about leukemia and the various treatment options, but also day-to-day practical advice on how to cope with procedures, hospitalization, family and friends, school, social and financial issues, communication, feelings, and, if therapy is not successful, the difficult issues of death and bereavement. Woven among the medical details and the practical advice are the voices of more than 150 parents and children who have lived with leukemia and its treatments. As many parents have already found, advice from “veteran” parents can be a lifeline.”
  • The emperor of all maladies, by Siddhartha Mukherjee. If you want to know about the history of cancer and how some of the drugs we use today were developed, you will find this book to be very engaging. I didn’t know oncologists could write so well! About the book:
    “Winner of the Pulitzer Prize, and now a documentary from Ken Burns on PBS, The Emperor of All Maladies is a magnificent, profoundly humane “biography” of cancer—from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence.”

Our kid loved these books, that gave hope and courage, while also being fun to read.

  • The jester who lost his jingle, by David Saltzman. Our kid developed a special connection with this book on laughter, especially after she learned that the author (and illustrator) was himself a cancer patient. She enjoyed reading both the English and Spanish versions. About the book:
    “David wrote and illustrated The Jester as his senior project at Yale University before his death from Hodgkin’s disease in 1990. His desire was to give The Jester, with its upbeat and hopeful message, to children facing serious challenges.”
  • Berenstain Bears book series, by Stan and Jan Berenstain. A lovely set of books for children on various topics ranging from watching too much TV, eating junk food, bad dreams, playing fair, being brave and kind, speaking the truth. As mentioned in this post, our kid loved to read and re-read them! About the book:
    “Stan and Jan Berenstain published the first Berenstain Bears book in 1962, and the series has gone on to capture the hearts and minds of children across generations and across the globe. In the 50+ years since “The Big Honey Hunt,” the Bear family has grown from three to five members; the Berenstain Bears have been translated into over a dozen languages; and over 300 million books have been sold worldwide.”
  • Wherever you are, my love will find you, by Nancy Tillman. This came as a beautiful gift around Christmas time. About the book:
    “Love is the greatest gift we have to give our children. It’s the one thing they can carry with them each and every day. If love could take shape it might look something like these heartfelt words and images from the inimitable Nancy Tillman. Here is a book to share with your loved ones, no matter how near or far, young or old, they are.”

Busy and happy with DIY projects

Posted Posted in Staying positive

Our kid went crazy with DIY projects — it kept her busy, creative, and distracted from the pain of cancer treatment.

Young minds (and old!) are happier when they are kept busy in constructive ways. After days of watching too much TV and iPad during the initial part of the treatment (see this post), our kid was getting increasingly bored, tired, and irritable… We realized that we needed to find new ways to keep her busy and cheerful, through the long treatment period of around a year. Thus began our venture into DIY projects!

Huge thanks to SaraBeautyCorner for her fun and engaging Youtube videos on DIY food, craft and gift ideas. Our kid loved watching them. We started picking fun projects from there, to try hands on at home.

Of course, the first DIY projects had to be food related (remember the hunger pangs from steroids in induction?). We baked our own healthy granola bars with nuts, made fruit kabobs, packed glass jars with fruits for snacks, baked ginger almond cookies, almond muffin cakes, and melted dark chocolate into different shapes — from dinosaurs to Fairy Godmothers — and had fun decorating them with different toppings.

Our six year old especially loved the Fairy Godmother chocolates. After returning from a week long hospital stay during her birthday, we celebrated by baking cakes and making these chocolates. She would close her eyes, and make a wish before eating each Fairy Godmother chocolate. The innocent joys of childhood!

As the steroid effects went away, the new set of chemo drugs during consolidation left her severely nauseated and uninterested in food. At this time, we switched to DIY craft and other projects. She enjoyed playing with modeling clay, melting crayons into different shapes, and making various patterns with melty beads.

As described in this post, she loved art related DIY projects and found them very relaxing. From drawing simple cards, to shrink art, sand art, stained glass paintings, sketches and acrylic, she enjoyed herself with oodles of art!

During the winter, coupled with chemo, her lips went dry and started cracking. As she started exploring different colored lip balms in the market, we wondered why not make our own lip balm?! She loved the idea. Thanks to the recipes from the YouTube DIY lip balm videos, we  made our very first lip balm  with simple and good ingredients (beeswax, coconut oil, beet juice for coloring). It was so simple and easy, that she made several of these and started gifting them to her friends, doctors and nurses for the holiday season. I still use the one she gave me 🙂

We owe a lot to DIY projects! Thanks to them, our kid became a busy bee, eager to try new projects. More importantly for us, she was cheerful and distracted from the painful effects of chemo.

Phase 3: Interim Maintenance

Posted Posted in Phase 3: Interim Maintenance

Our two month long Interim Maintenance phase began in Dec 2016. Thanks to the season of joy and giving, we saw a marked difference in our kid’s attitude and energy levels. The excitement started with decorating our Christmas tree with ornaments. She then made a long list of her friends and family and individually wrapped 15+ gifts. We also did a lot of DIY food related projects. Like melting dark chocolate into different shapes (from dinosaurs to Fairy Godmother), and baking ginger almond cookies in cool Christmas shapes (gingerbread man, christmas tree, star, candy cane). It was her favorite snack, and a fun way to get more protein and good fat into her body. 🙂

One thing that I will never forget about this phase is our hospital stay around Christmas. As we walked into the hospital on the night of Dec 21, she wore her Santa hat and said, “Mama, I will listen to you and Papa and do everything the doctors, nurses and you say ‘coz I want to be back home in 3 days for Christmas Eve.” We knew it could take anywhere from 4-10 days to be discharged, but she was determined to go home in 3 days!

Despite the 24 hour chemo, frequent peeing (every 2-3 hours), 2 IVs (one from the port in her chest, and another from her hand), and disturbed sleep, she maintained a great attitude through the hospital stay. (Note to self: How on earth do kids manage to stay positive amidst such chaos? Wish we could learn!)

She surprised all of us with her strong determination to be back home soon — she drank plenty of fluids (water, green juice and nutritional shakes), ate as best as she could, read books, happily did arts and crafts with one hand, walked around the halls of the pediatric unit for 2+ hours each day, and chatted with nurses and other kids. The nurses smiled and remarked, “We see you wherever we go!”

We also had some pleasant surprises in store during this trip. The San Jose Sharks showed up on the next day and surprised the kids in the hospital with fun and gifts. Then came the highlight — Santa’s visit. She was so excited that she told every nurse and doctor about it for the rest of the stay!

One by one, we saw kids in the nearby rooms being discharged. It was Dec 24 morning, and still no signs of her discharge… The criterion was that the methotrexate level in the blood should be less than 0.4. Her levels were still 0.98 on the morning of Dec 24. There was no way we could make it home on time for Christmas eve…

Being one tough nut, kiddo wasn’t prepared to give up… She kept trying her best to drink fluids, walk her rounds, and think happy thoughts. We, on the other hand, were sad that she was going to be disappointed…

Then, something most unexpected happened. When the nurses checked again at 3pm, as if by magic, her methotrexate level was down to 0.39. She had just met the cutoff for discharge and we were back home for Christmas Eve. Hands down, it was the best Christmas gift ever! 🙂

In the following days, our kid developed some unpleasant reactions from the high dose methotrexate — she had severe sores on her lips (with pus), in her mouth and bum. Yet, she was in such high spirits during the Christmas holidays that she barely cried! She would cry while pooping, and in just a couple of minutes, be happily distracted and playing with her toys, or reading a book or doing some activity.

We were intrigued — while she was clearly in pain from the sores during this time, she suffered less ‘coz she wore a great attitude… What a lesson for us on the importance of a positive attitude and the difference between pain and suffering!

She continued eating and drinking healthy for the next few days. Her ANC was okay, and given the Christmas break, her friends were off school and she had 2-3 playdates, the maximum she’d had in 4+ months. What a treat!

Overall, Interim Maintenance was much easier than Induction and Consolidation phase, despite the four hospital stays. Thanks to her awesome attitude, we managed to squeeze in some fun even during the boring hospital stays. You can see some of it in this video — the emoji cap with hospital gloves as balloons is my favorite. 😉

Celebrating small joys of life

Posted Posted in Staying positive

People often get busy chasing big dreams and lofty goals — dream job, dream family, dream house, dream startup… Sometimes we get so busy that we forget to cherish the small things and celebrate the small joys of life.

Our kid’s cancer taught us that happiness is not in things outside, but in being grateful for what we have and making the best of it.

We learned to pause, savour the moment and appreciate the joy of small things… We built our own tents and pretended to camp, shredded paper into bits and made pretend snow in sunny California, talked goofy with Alexa, and did several things together — from baking, reading, art, board games, funny faces on snapchat, and silly singing to crazy dancing… This helped make our long and boring hospital stays and clinic visits more bearable.