Julia had her 4-year old well check at the end of May. It still seems so odd to me to go to these appointments. When you've taken you're child to almost seventy "very not well" appointments in the past year, well checks are definitely a rarity. It's not even a place I am really comfortable any more. When the nurse starts the appointment and asks all the screening questions she asks at the end if we have any concerns. "Why yes, actually, quite a list." But all of our questions some how tie back to the cancer and cancer treatments. And pediatricians don't really specialize in that. They focus on the normal development. We know her normal development is great, but she now lives under the big shadow of being a cancer survivor.
The good news was she has gained nine pounds since last year! She maintained and actually lost weight during chemo, so this was great to hear. She has gained all of that in the last six months! I can actually see how that is possible. The child eats constantly while awake. Several other parents of oncology kids have said their doctors told them to expect the child to make up for all the food missed during chemo in the first year after. That has definitely been the case. After eating breakfast every morning at 8:30, she is crying and begging for food by 9:30. After that snack and another at 10:30, she wants lunch by 11:30. The afternoon is much the same. I've become a walking 7-11 with food and drink available at all hours and all locations. Cici's has become one of our favorite stops. I have NO IDEA where this child puts 7 pieces of pizza, 3 breadsticks, 2 bowls of noodles, and a salad! But for $2.99, I'll take it.
The crazy part is she cries when we get in the car if I don't hand her a snack! She seriously must have a hollow leg. Or maybe that's what's happening with all the empty space where they removed organs and stuff from her abdomen :) Sorry, cancer humor.
She has grown in height and weight and regained her color. They did repeat her CBC to see how she looked after her ear infection. She was still in the low normal range, but also had a bit of a head cold so we will check again in July to try and get a healthy level baseline. He said her abdomen felt great and her organs have shifted and settled into all the empty spots well. Such a bizarre thing to have to hear about your child. We are so thankful to be walking the road of healing with her. Staying on the remission road is a gift we will never take for granted.
Things were going along well with everyone until one Saturday morning in June. Carter had his last baseball game and end of season party. He is normally awake before 7 on the weekends. At 8:30 when he still wasn't downstairs we became concerned. repeated attempts to get him to come down were unsuccessful. When he finally emerged he was acting under the weather, but said nothing hurt. As I was helping him tuck in his shirt I noticed his neck was swollen. Not just a little, but visibly protruding on one side from jaw to shoulder. I won't lie and say my mind did not venture down horrible paths. That's life on this side of cancer.
We let him go to baseball and get his trophy. He couldn't throw because moving his arm on that side hurt too much. We knew something was wrong. We headed right from there to the pediatrician. She walked in the room, took one look at him and said, "Oh my gosh!" Thanks. You can think it but please don't say it. She decided to do a throat culture, sure that he must have strep. That would make sense. Negative. Time for the CBC. His bloodwork actually looked great. Good and bad. Good because nothing is blatantly wrong, but bad because we have no easy answers. She was at a loss for options, said it was probably viral and to bring him back if anything else happened.
He barely moved the next two days, the swelling got worse, he screamed if anyone came near his neck, but no other symptoms. Then his neck started to really hurt and the pain was spreading up into his head. So by Monday afternoon we were back at the doctor. Dr. Ravenel reassured me he thought this was definitely an adenovirus and he would have a tough week. He repeated the CBC and was satisfied with what he saw. Without my having to say a word, he said, "I know exactly what your thinking and why you are here and I would do the exact same thing of I were you." Thank you.
It was a long week. He had several really rough nights of screaming and no sleep from pain in his neck, headaches, respiratory symptoms, and throat pain. After a week he finally started to get better. He did well for about another week and then started complaining of his ear hurting. He has permanent tubes, so a traditional infection is not usually the case because the ear drains itself. By the next day, the entire side of his face and pillowcase were coated with dried, infected fluid in the mornings. I know. Gross. Time to head to the ENT. Dr. Kraus took one look and said he had a severe infection with pulsating fluid- yuck! He cleaned and vacuumed it out and put in a wick to help direct the ear drops. A round of zithromax, some strong pain meds, and antibiotic drops and we will hopefully be good as new.
Last weekend Julia woke up on Sunday morning and threw up. She seemed fine after that, but by the afternoon had upper respiratory symptoms. Hopefully just a cold. We've spent the week doing sinus rinses, decongestants, cough medicines, tylenol, and humidifiers. We were hoping to be almost done.
Today she was really fussy and clingy. We have her back in pull ups because her bowels are still a mess. She is re-potty trained to pee in the potty, but is only successful with the bowels about once a month. We were doing panties, but the poopy underwear was such a mess, so we put her in pull ups. She has done great with consistently peeing on the potty. Wish I could say the same about the other. It has been a real stumbling block for me to keep my patience in this area. It is a constant issue all day every day. She has no control, the smell is horrible, and it's a mess to change. GI has been great with her and so patient but they keep telling us this process takes lots of time. By time, they mean years, potentially. I really have to pray to wrap my mind around that one. It makes me feel so guilty for getting frustrated when it's not her fault.
Today I was helping her use the bathroom this afternoon and the pull up was soaked. Red flag #1. When she peed her urine was completely pink. Red flag #2. For the next few hours every time she peed she held my leg and screamed. Red flag #3. So back to the pediatrician. Thankfully Julia peed in the cup readily and saved herself a catheter. Her urine tested positive for blood, leukocytes, nitrites, and white blood cells. The doctor was concerned as to why she is getting UTIs. This is a huge "no-no" with having only one kidney. Her urologist has told us that many times. So hopefully the bactrim does the trick. The culture will be back in a few days. And they want her put back in diapers. So basically we are starting over... again... for the third time. Ugghh. I brought up her bowel issues, but he had nothing to offer.
This is one of those times I get so frustrated. Once your child is out of treatment you are really nobody's patient. The pediatrician does not specialize in cancer survivor care and every appointment begins with me giving all the medical info and answering all the questions- very one-sided. Julia sees the oncologist every three months, but is not in active treatment, so you get farmed out to different specialists. Sometimes this works, sometimes not. It's such a fuzzy area. I've heard so many other oncology families say this same thing after treatment. Most pediatric cancer protocols are cut (surgery), burn (radiation), and poison (chemo). The protocols are very outdated, but the best science has right now. There are long term issues and side effects from these harsh treatments, but the primary focus was saving your child's life. After that, the rest is very murky. So we will continue to press on and advocate for the best care we can get for her. She goes back to oncology and GI in two weeks and most likely urology again. Hopefully we can get a plan in place for at least some of these issues.
If anyone out there has had experience in this area of survivorship and has advice, we would love to hear it. Anything would be helpful at this point.