The amazing Emily beats the odds again

Emily was discharged from the hospital early this afternoon ! She is feeling, looking, and sounding much better than she has in a while. Her pulse has normalized, her fever is gone, and her cough is much better. The cough is still there but it's so much better than it was leading up to the pneumonia diagnosis. Emily is going to be on antibiotics for 10 more days (I think) and will restart chemo tonight at %100 dosage. Today her anc was down to 2000 from 7000 yesterday so her white blood cell count is back in the range we like to see on therapy. The orders are for her to take it easy until next Monday and then she can likely go back to school. Given this swine flu scare/epidemic we are going to watch her exposure to sick people the best we can. Swine flu gives symptoms like viral pneumonia and having that on top of bacterial pneumonia wouldn't be good, to say the least. She ate dinner last night, really the first food she had had since Sunday, so that's a great sign too.

Tracy and I are so grateful for all the support you all have given us these past few days. We were really scared when this first happened and she ended up being hospitalized, every time we go through something new, the stress level is extra high and knowing people are thinking of us really helps.

I am working today so that part is back to normal. Both Tracy and I are really sad we are missing our trip to New Orleans, we would be in the air right now, but we know we made the right call staying home.

I am sure Haley will be happy we are all home too, she's been all over with different people watching her the past few days and while she can't express how hard it is on her, we know it is, and having big sister home will make her extra happy.

I will keep you all updated more regularly over the next few days as this pneumonia chapter resolves itself and we are back to our boring every day lives.

thanks again

Things are looking up, really likely a discharge tomorrow

They are preparing Emily's discharge papers, and baring a turn for the worse she'll be out tomorrow and even resuming her chemo. The main reason for keeping her was the high fever and low O2 saturation levels in her blood. The O2 saturation is already back at an acceptable level, %97 (she is usually %99 or %100 but yesterday was at %90), and her fever is going away, the last temp read was 99.7 degrees, so a tiny bit elevated but lower than the threshold for keeping her, as long as it doesn't spike again, it's very likely she'll be sleeping in her bed by tomorrow night ! At this point I plan to sleep over in the hospital with her tonight and head right into work from there, and meeting the family when I get home.

I am home for a nap before heading back in for tonight.

I am feeling much better that she's going to be back on track very soon. Emily is SO tough, I know she knows she's going to be fine, it's Tracy and I who worry most.

Talked with the doctors

The Oncology team made their rounds later this morning and I had a chance to meet with them and talk about what's going on with Emily. The good news is once she breaks her fever she can go home, and we are all hoping that will be tomorrow. She doesn't need to have a clear Chest X-Ray to be discharged, the Doctor explained that the chest X-ray will lag behind the actual progress of the cure, so in 10 or so days hopefully she will have a clear Xray. She will likely resume chemo tomorrow and be sent home with oral antibiotics. We are all cautiously optimistic it will happen.

Today my Mom came by for a visit with Emily which she liked very much. Since Emily isn't a big fan of hospital food, my Mom is going to make her some Mac and Cheese and a an Artichoke and come back down around dinner time to bring her a home cooked meal. Our good friend Erik brought her some Jamba Juice which Emily really likes and she's enjoying that now.

They haven't taken her temp in a while but she feels much cooler than earlier so maybe this is starting to break and the pneumonia is getting kicked out of her system. She also seems to be coughing a little less, but you can still hear "gunk" when she does.

thanks everyone for the positive thoughts for Emily and our family.

Tuesday's update from Packard

Emily is still in the hospital, and this morning had a fever of 103. They are treating the fever with some Tylenol and she is a little more comfortable with it and the fever lowered to 101 after taking the medication. We got some results from tests yesterday and we are happy that she tested negative for RSV and Swine flu. We were a little worried since we had been in San Diego the US epicenter for this swine flu outbreak that she may have contracted it, but at least we don't need to worry about it, for now. She is still on 2 antibiotics for Pneumonia and I thought she looked a lot better when I arrived this morning, much less red in her face.

She is in a total isolation room, meaning anyone who visits or comes in to treat her has to wear a mask, and the medical staff wears an extra gown. She also is unable to leave her room, so she can't go up to the play room or go on walks. The play room staff knows of this so they sent someone down to bring Emily some art supplies. She is pretty much just sitting around and watching TV with lack of much else to do. She keeps telling me she misses school, especially Math, so we are going to have her teacher drop some school work by our house for her. It makes me so happy she actually misses doing school work, cause when I was a child I would have done anything not to have to do it. She's just a fighter and am amazing girl who is making the best of her situation and wants so much to just live a normal life, I wish she could.

Today I think the plan is to just be medicated and to wait until tomorrow and do another chest XRay to see if she can go home, but I am not certain they may do some tests today, I haven't seen a doctor so far. The nurses are all the same as when we used to spend much more time here, so at least they are all familiar faces and everyone LOVES Emily so they stop in to just say hi, even if they aren't assigned to her directly. If you have to go through this it's nice to have friends on the inside who care about your child. Packard is really a great hospital, even though some people like to slam Stanford, I think if you are ever faced with something serious you'll gain a new level of respect for the people who work here, even if you have to deal with some B.S. from time to time.

Last night when I went home I felt really sad, I don't want to be overly dramatic but I can't help but worry about what's going on here and I am fully aware of the seriousness of the situation. I feel much happier being here with Emily, so I can care for her and be part of what's going on, it gives me less time to think of "bad" outcomes. Today I am staying with Emily while Tracy gets some sleep at home. this afternoon Tracy will come back for a few hours, and then I plan to sleep here with Emily tonight. One GREAT thing about the new Oncology floor is private rooms and a full sized bed for the parents ! No more "sleeping chair" hell. I have two laptops so I leave one here and one at home so I can stay connected. While Emily watches TV I blog, Facebook, or just surf the net.

I will update this afternoon or evening.

Latest Update : They are keeping her for at least 48 hours.

After a roller coaster night and morning they finally decided to keep Emily in patient here at Packard for I.V. antibiotics and observation.

This all started last night around 2:30 in the morning. Emily woke me up and told me her tummy "really hurt". I could tell by the way she looked that she was going to throw up so I helped her into the bathroom. She threw up and we all went back to bed. We had given her chemo around an hour earlier and thought it was just a side effect. Then around 3:30 am she woke us up again because she needed to throw up. This time Tracy observed that she had a fever. We were concerned because we had been in San Diego about a week ago, and that's where the swine flu had spread so we were worried she could have swine flu. We called the Oncologist and she told us that if we were worried we could come into the E.R. for a work up, so Tracy and Emily came in, and I stayed home with Haley. I will be honest that I really didn't think anything was going to be wrong, because our last few trips to the E.R. have been uneventful. Around 6:30am Tracy called me to tell me they had diagnosed Emily with Pneumonia, about the last thing I expected to hear. She had a fairly large area effected on her left lung on the lobe. I kicked things into gear and made arrangements to drop Haley with my Mom so I could join Tracy and Emily at the E.R. Just after I dropped Haley off with my Mom, I got a text message from Tracy saying they were going to give her I.V. antibiotics and send her home, so it was sounding like it wasn't going to be as serious as we thought. I guess it would be around 8:30 am at this time. Then between 8:30 and 10:30 the doctors were going back and forth about whether she would be admitted or was going home. Her sugars in her blood were low, her potassium was high, and her O2 saturation was on the low side. All of these factors plus the pneumonia ultimately made them come to the conclusion that she needed to be admitted for 48 hours. So, here we are in 1 North at Stanford in an isolation room.

As nice as the new Oncology floor is, we really hoped to never have to be in-patient in it. It is nice, all the rooms are private and Emily is feeling pretty well, all things considered. Since she no longer has her port, she has an IV and is having to deal with additional needle sticks, but she is being very brave and it's going well. Right now as i type this she is eating Chex Mix and watching Zach and Cody on the Disney channel.

Later today the Oncology team is going to do a full exam on her to really assess where we are and how long she may need to stay.

I talked with the Dr. in the hall and asked him what the drill was and what was going to happen. I also asked him if he thought this may be a relapse of the lymphoma. Of course he couldn't say much definitively but here is what he said. First of all it's great news that she is not neutropenic, what that means is Emily has some white blood cells to fight this on her own. She is also on two I.V. antibiotics (Vanco and Ceftriaxone) which they can give large doses of since she is here in the hospital, which should really knock this as well as it can be. He characterized her pneumonia as "fairly large". He said he suspects it is not a relapse of Lymphoma but can't be totally certain, but said since she is in maintenance he really doesn't think it's her cancer coming back. He suspects is bacterial and not viral pneumonia so can be treated with antibiotics. He seemed to be pretty calm about this and told me "it's not uncommon to see this" and his voice cued me to not worry too much.

So, that's where we stand, hopefully she will bounce out of here quicker than expected but right now it's wait and see.

Needless to say, Tracy and my vacation is on hold, in fact Tracy is not going for sure, and I am pretty sure I need to cancel as well. We were going with a group for a friends 40th birthday and that's the only reason I am even considering still going, but I know I would worry the whole time, and if Emily weren't getting better I would kick myself forever for not being here.

Last update until we know more

They keep going back and forth about if she needs to stay in the hospital or not. She definitely has pneumonia, a pretty large on on her left lung lobe. She sugars are also really low, and they are not sure why. She also has low O2 saturation, meaning she can't get enough oxegen on her own, it's borderline. So we are letting the doctors in the E.R. work with the Oncology team to determine what we do. Tracy and I would prefer they keep her over night but we'll see what they decide. Since the news keeps changing i am going to wait to blog until we know a lot more.

Emily will not need to be admitted

I am here at the hospital and they have decided that since Emily is not neutropenic they are going to give her I.V. antibiotics and then send her home with antibiotics for home. This may not be AS serious as we were thinking.

Emily was diagnosed with Pneumonia early this morning.

This is still developing so I don't have many details, but Emily woke up throwing up around 3:30 this morning. She also has a fever and a mouth sore. Given all the scare about swine flu and having just been in San Diego we brough her into the hospital.

While I was typing this Tracy called me to tell me the chest xray says she has pneumonia, which is VERY serious. I am heading into the hospital to be with them. She will be admitted until she clears this. I am so scared.

I don't think we are going on vacation this week.

I have eased my worry

I talked with Emily's NP today and she told me she isn't concerned about the high counts this week. So, I will stop worrying as much about it. you could tell in my post last night that I was obsessing on her WBC count, but with Prednisone I am told they see these high levels now and again.

thanks for the kind messages that you sent with concern.

Moving onto positive thoughts and looking forward to the weekend.

strange / troubling results from Emily's labs

Today Emily had her IV Chemo at the hospital. She also had her physical exam, which was pretty normal. Emily may have pink eye so they prescribed her some eye drops to knock it out. She also has a persistent cough, but it seems to be all in her upper respiratory tract. She still has some fluid in her ears too but the infection seems to have gone away. After her physical exam she got her IV chemo and blood draw. It went really well. So the hospital part went well.

The troubling results are the lab results. Emily's white blood cell count was really high, at 9.3 and as a result her ANC is 9000 which is through the roof. Why that is, is unknown and troubling to me. Her NP said it could be because of the eye or the cough. Prednisone also raises white blood cell count and ANC levels too, and she's on her Prednisone this week. It's a bad sign if ANC is really high, so I am worried that something else is going on. It's scary when something new happens, sometimes it means nothing and sometimes it is a real concern, I just don't know which this one is. This is only me worrying and nothing the doctors said this week, I just know what the levels should be and know this is way out of range. We won't really know until labs next week, so I will be concerned all week and just hope that next week the levels come down to a more normal level, which is around 2000. They also increased her 6mp dose to help suppress her levels. I hope I am worrying for nothing but wish I didn't need to at all.

This week we don't have much going on, just resting after last weeks vacation. Next week Emily will have her labs on Tuesday and Tracy and I plan to go on a vacation to New Orleans on Wednesday and the kids will be staying here with their Grandparents. I hope her levels return to normal so we dont have to worry while we are gone.

What a difference a year makes

We just got back from our spring break trip to Southern California. It was a really successful and fun trip. The first half I already wrote about which topped off with Emily getting to meet Miley Cyrus. The second half of the trip was spent in San Diego and we had a great time. We were with some friends the whole time who also have kids. In our group we had a 1,2,3, and 7 year old, so there wasn't much rest for the adults. We went to Sea World, Lego Land, and spent a day kicking around the pool and sea port village on mission bay. The weather was perfect, mid to upper 70's during the day and nice and balmy in the evening. The only bad part of the trip was the drive home from San Diego to San Jose, I think we found every traffic jam on the way up, but that's really not bad for a weeks worth of fun.

We were remembering last year and Emily was too sick to do anything but lay on the couch and watch me play video games during spring break. I can't say it enough, I am so amazed at how well she is doing and how resilient she is and how positive about her future she is. It really makes me enjoy our time together even more. It's almost sad to admit that but it's true.

This week is Prednisone and IV Chemo treatment for Emily on Wednesday. She is still on %100 dosage and we expect she will stay there when she has her labs on Wednesday. She will also be getting her monthly physical exam from Dr. Link.

Once I have a few minutes to get things organized I will try to post some new pictures from the trip, probably on Wednesday's posting to the blog.

Hannah Montana Day

Our trip is going really well. We drove down to the L.A. area and stayed in Santa Monica on the beach, from Monday through today (Wednesday) this week. It was a little colder and more windy than we hoped, but we've had a great time. On Monday night we met up and had dinner with my brother Nick. On Tuesday we played around at our hotel which was on the beach in Santa Monica. The girls swam in the pool, and Emily and I did a 3 hour hike on the beach, walking from the Santa Monica pier all the way to the Pier in Venice. We had a great time. On Tuesday night we went over to Tracy's sister Leah's house and had a nice family get together. It was Leah, Patrick, Nick, the 4 Peppers and Tracy's Aunt Sheila, Uncle Ed, and cousin Windy. Leah and Patrick live in Burbank and have a really nice home for entertaining, it was a fun night. On Tuesday morning we also had to have Emily's lab drawn and we went to a UCLA clinic to have that done, it was much easier than we expected.

Today (wednesday) was a really big day for Emily, she was on the set for Hannah Montana, the Disney series which Emily is a big fan of. My brother Nick works for ABC TV and pulled some string to get us on the set for what they call a "Run Through", which is essentially a run through of the script with all the cast, producers, directors. We were the only non-cast and crew members on the set. We left Haley with Uncle Nick so she wouldn't be a distraction. We watched them practice an entire episode on the set, which they will start taping tomorrow with a studio audience. Emily got to meet all the cast members and sit with the directors and watch them practice. After they were done we got to walk around the sets and take pictures. It was really fun, and I'm not even a huge fan of the show. All the directors and cast were really nice and welcoming. Emily got to keep a copy of the script, Miley Cyrus signed a photo for her and she got some additional memorabilia from the show. She even got to meet Miley's dogs who were on set.

After we were done with Hannah we picked up Haley and are now in San Diego for the next 4 days with plans to go to Sea World and Lego Land.

Easter 2009

We had a good weekend. On Saturday we had a visit from my Mom and my brother Nick. Nick was up from L.A. and we will be seeing him tomorrow when we go on our trip to Southern Cal. Tracy's Mom also came to join us on Saturday too. Today all 7 of us got together for an Easter brunch later this morning. It was a nice relaxing weekend. Emily and Haley were visited by the Easter Bunny last night and opened their baskets this morning. Emily got a chess set which she was excited about. The girls also had an egg hunt. Tracy had to work this evening, but is getting off early at 7 instead of 11. Tomorrow we head off to Southern California and will be back in a week.

Happy Easter.

Emily is excited about our trip.

Before I get to the exciting news, an update on Emily's health. She either has a really bad cold or a small ear infection. Today her Oncology team decided to prescribe high dose antibiotics just in case, to knock this thing out. She still has a low grade fever and a lot of pain now in her ears. Her NP examined her and saw a little pink in her ear which could be an infection. When I went to pick up the amoxocillian the pharmacist said she questioned the dose because it was so high, we called the Dr. and in fact the dose was correct. So if this is an infection I imagine it will be knocked out quick. Since her ANC is high maybe this isn't a virus? She remains on %100 dosage of her chemo and since she isn't neutropenic she can have Tylenol, so we are doing what we can.

This Sunday is Easter and we will be having my Mom and Brother over for brunch and for the egg hunt.

Next week we are going on vacation. We are driving from San Jose to Los Angeles. My brother lives there and so does Tracy's sister. When we are there we are staying in Santa Monica in a very nice hotel right on the beach. Tracy and I have stayed at this place before with Emily when she was about 2 years old. We are going to hang out with Uncle Nick and Aunt Leah and Uncle Patrick. On Tuesday we are planning to rent bikes and ride along the coastline which should be fantastic. On Tuesday night we'll be going over to Leah's for a nice dinner with family. On Wednesday my brother Nick, who works in production for ABC TV has setup a really special surprise/treat for Emily. We are going to get to go on the set of Hannah Montana and watch them do a walk through for the TV show, probably Emily's most favorite TV show. She is SO excited about it. When I told her today after it was all confirmed she was so excited she teared up with excitement. What she doesn't know is she is actually going to get to meet Miley Cirus / aka Hannah Montana and get to talk with her. It's going to be really exciting for Emily, and while I am not such a Miley fan, watching Emily's excitement will be priceless. We are so grateful and appreciative to Nick for setting this up for us. After we watch the show taping, we will be leaving L.A. and heading to San Diego for 4 more days of vacation. While we are in San Diego we are also staying on the coast. We are meeting up with our good friends the Leary's from Tucson. David and I work together at Intuit. The Leary's have 2 kids, so it's going to be fun to get together and watch our kids have fun. We plan to go to Sea World, Lego Land, and also have a day at the beach. On Sunday we'll be driving back home.

We are looking forward to this trip. Emily will need to get labs drawn while we are on the road and we have found a lab in L.A. where we can get that done. This is the longest and farthest away we have been away from home since Emily was diagnosed. It's a victory for us that we are able to do it.

Trip to the ER, with a good outcome

Today Emily woke up with what she reported as a bad sore throat. We didn't think much of it since she has had a cold for a while. This afternoon she told us that it had got worse over the day. I asked her on a scale of 1 to 10, how much her throat hurt, she rated it an 8. So, I took her temperature and sure enough she had spiked a fever of 101. To add to this, Emily had been exposed to someone with Strep throat. Given all these signs we made arrangements to have Emily seen in the E.R.

When we arrived at Standford E.R., her fever was even a little higher. They took her right away and did a Strep test and took a CBC and blood culture, and urine sample.

The great news is the strep test came back negative. Her ANC was also over 2000, so she wasn't neutropenic. What she most likely has is a virus with a bad sore throat and fever. We will have to wait a couple days for the more complete strep test to come back with the blood cultures, but it is almost certain that it's just a virus. So certain that the Pediatric Oncology fellow on call, who knows Emily's case told us to continue with the chemo and to give Emily some Tylenol with codine and go to bed. We got home around 10:30 this evening and she went right to bed.

During this whole hospital visit Tracy was working upstairs on C2 and didn't get a chance to come down and visit, but Emily and I stopped back quickly on our way out. Both Tracy and I are extremely relieved that it's not an infection and are both happy we had it checked for peace of mind.

Wednesday Labs are in

Emily's lab results were good, her ANC was 1200 today, which means we continue at %75 dosage. She was either going to remain on %75 dosage or have it reduced, so this is the best news we could get. If she is able to hold above 1000 ANC next week she will return to %100 dosage. I really hope the cold season is over so we don't need to reduce dosage again for a while.

There isn't much going on in the Pepper family to report on the blog. The girls are getting excited about Easter.

Tracy is working more and more these days which is really nice financially, living on basically 1 income for so long was pretty stressful especially in this economy.

March Prednisone flash is over

Emily had her final dose of her March Prednisone flash last night. Today she is recovering from it. She has a hard time coming off the high dose usually the after she finishes. This month she handled the monthly Prednisone better than the past couple months having fewer food cravings and mood swings. Today her cheeks are red and she seems depressed but I am confident she will start to feel better tomorrow.

This weekend Emily went to a birthday party on Saturday and had a great time. Today she and I went to see Race from Witch Mountain, we both liked it.

On Wednesday she will be having her weekly labs and we hope to remain at %75 chemo dose if her ANC is high enough. Her protocol doesn't allow her to return to %100 dosage until she can maintain ANC levels for two straight weeks, if for some reason she drops this week its possible we could reduce dosage. The protocol for increasing and decreasing dosage is, 0-500 ANC = holding medication, 500 - 750ANC = %50 dosage, 750-1000= %75 dosage, 1000+ ANC = %100 percent dosage.

Great exam and xray results. (250th post)

Emily is doing really well. She and I had a fantastic ski weekend up in Tahoe. Emily experienced her first heavy snow storm as it snowed around 18 inches between Saturday afternoon and Sunday evening. Due to an issue with car keys ;-) she and I had to stay up an extra night and miss work and school on Monday. (I lost our car keys in the snow putting on tire chains.) I am still amazed that Emily and I got in two ski trips this season. A year ago I didn't picture her treatment going this well. Even looking back at photos from last fall, she really has bounced back to her old self.

Today was her monthly IV Chemo and physical exam. She also had her quarterly chest X-Ray. (every quarter she gets either a chest x-ray or a CT Scan.) The results of the chest X-Ray were great. The small mass of scar tissue in her chest is even smaller than last time they looked at it. It has gotten smaller and smaller each time they have scanned her. To remind you, this mass isn't a tumor but scar tissue left over from the massive tumor she had the collapsed her lung and displaced her heart when she was first diagnosed. Without doing a biopsy they can't say with certainty that it's not cancerous, but there are many signs that it is just scar tissue. Dr. Link says he sees this type of scar tissue often and he's not worried that it is anything bad. With 30+ years of Oncology under his belt, I trust whatever he says. Dr. Link was not there today, he is in Washington D.C. at a conference. We were seen by Karolina our N.P. who is our main contact for Emily's care. Emily's physical exam also went very well, no concerns. She had her labs drawn and her blood levels have really rebounded, her ANC was 2200, so we are going to increase her chemo dosage to %75 per the protocol. I hope with flu season winding up that we don't have to reduce dosage again for a while, but we will see.

On Monday night Emily had her meeting with the Make-A-Wish foundation. For now I am not going to share what she wished for, but once it is official I will let you all know. I do want to say something about Make-a-Wish based on some questions and concerned comments I have received. A child DOES NOT need to be terminal to receive a Wish. Before I knew much about Make-A-Wish I thought that was the case. One of my friends at work was also under this impression and wondering why I was so happy she was getting a wish. So, no worries many kids who receive Wishes go on to live normal healthy lives. You do need to have a malignant type of disease to qualify, which Emily has.

This is the 250th post of Emily's blog, thanks for following.

Ski trip to Tahoe.

Emily and I are up in Lake Tahoe for the weekend. We left Friday at noon and will be here until Sunday afternoon. Emily and I went to bed around 10 last night and were up at 6:15 so I could have her to Northstar at 8:45 for her lesson. We had bacon and eggs and orange juice for breakfast. We were on the mountain by 8:15 so we were able to hang out together in Starbucks before her lesson. She was a little nervous about an all day lesson but she did great ! She was with a group of kids her age and they were on the mountain from 9 - 3. While Emily was in ski school, I met up with from friends from work and skied with them. I picked Emily up after class and we drove home and went out to dinner. Tonight we are going to watch a movie. We are not going to ski in the morning so we can sleep in and head home after lunch. It is supposed to snow up to 2 feet tonight, so tomorrow's drive home may be tough.

Emily's levels have come back

Emily had her blood test today and her levels are coming back, however they are keeping her on a reduced dose until they are up even more. Her WBC = 2.2, Hgb 11.9, Platelets 407K, ANC-1100. You can see her ANC has actually dropped since the ER visit on Saturday, so she is still fighting some sort of virus. She will remain on a %50 dosage. I expect her to be back to normal next week and for them to increase dosage, but you never know what is going to happen. Next week is her IV chemo and physical exam, along with her monthly flash of Prednisone. Prednisone causes your ANC to shoot through the roof, so it's very likely she will be back on full dosage.

On a more fun note, Emily and I are going on a ski trip together this weekend. Just the two of us. We are both really excited about it. We are going to leave at lunch time on Friday and ski Saturday and Sunday. I plan to put her in a lesson for some of it, and for us to ski together the rest of the time. It should be a fantastic trip. On the way home we are going to stop in Auburn to have dinner with Tracy's parents, Grannie and Grandpa Steve.

Overall things are looking better than last week.

Update on Emily and a primer on ANC

Emily is feeling much better after they were able to control her fever and throwing up last night in the ER. She felt good today and even went and played in the park for a little while. She was sort of on a high from the tylenol and IV fluids and felt much better. This afternoon she took a three hour nap, which was good. But she did wake up with a fever of 100.0, so she's still fighting something. We don't need to be concerned about the fever, unless we get a 101.3 or higher after 4am, if we were to get that after 4am we would have to go back to the hospital and have her cultures taken again and to test her ANC level.

Today I was asked why or how does this ANC level seem to fluctuate so much from day to day? For example it was 510 on Wednesday and then 1570 last night. What is ANC? To remind you it stands for Absolute Neutrophil Count. It is not a White Blood Cell count, but is the concentration of neutrophils in the while blood cell count. ANC equals the Total WBC count multiplied by the total percentage of neutrophils (segs plus bands). So you can have a high White Blood Cell count, but a low ANC, it's rare but it is possible. Emily's Chemotherapy is immuno-suppressive, The 6MP and Methotrexate lower the immune system by suppressing the bone marrow from making things such as White Blood Cells. When any of us gets a virus or bacterial infection, our ANC gets lower, but if you are on Emily's Chemo it can drop to dangerous levels, aka Neutropenia. That is what most likely happened to Emily, she was getting this virus this week and that on top of her Chemo lowered her ANC to 510. Then we reduced the Chemo dosage, as you will remember. So her marrow started to work more efficiently and her ANC levels shot up to 1570. That's still a pretty low level but once you get above 1000 your body can fight off viruses. The BIG worry in all of this is if she were to get something like Strep or something bacterial, and if her anc were lower than 500, you can have real issues, including a high risk of death. That's why she needs to be in a ER within 30 minutes of a fever, when she is neutropenic, so they can start IV anti-biotics immediately. So to finally answer the question, Emily's ANC fluctuates a lot because we are constantly trying to control it's range with the chemo, while dealing with external forces such as virus. ANC is the main diagnostic value for Lymphomas and many types of Leukemia.

3am trip to the hospital

Emily woke up Friday with a sore throat that didn't go away all day. Knowing that her ANC was 510 on Wednesday I was pretty sure we'd end up in the hospital with symptoms like that. Sure enough this morning at 3am she was burning up with a fever of 103.1. VERY high fever. We rushed her to the E.R. at Stanford so they could take blood and urine cultures, and to check to see where her ANC level was. Emily threw up in the car ride up to the hospital. I stayed home with Haley and Tracy and Emily went to the hospital.

They got seen right away. Her heart rate was also really high, at 150. They took her blood, and started an IV. They were able to access her vein on the first attempt which was nice. After they took her blood they were able to give her some tylenol. We aren't allowed to give her tylenol at home because it could mask a fever, but since they had taken her temp and blood, they were able to give her some.

The good news is she turned out to not be neutropenic, her ANC had shot back up to 1500, so she will be coming home this morning and can fight whatever she has here at home. They are keeping her a little longer to bolus some IV fluids into her to try to slow her heart rate a bit. The bolus was optional but Tracy and I both thought it was a good idea. If she has to go through the ordeal of getting an IV start, why not use it, and get the benefits of quick hydration.

To me it seems like every time we celebrate how great Emily is doing, we get reminded that she's not better yet, and we have a ways to go before a simple fever that most kids get isn't a big deal, for the next year at least they will be big deals. I am so pleased she wasn't admitted this time.

Not the best lab results today, we need to reduce dosage

Today was our usual day to get labs and we got results that were not what we expected. Em's ANC is at 510 which means she is borderline neutropenic and as a result we have to reduce her Chemo dosage. She's just 10 points away from full neutropenia we have to act as if she is. What that means is her immune system is over suppressed so reducing the dosage of her medication should hopefully get it back within the levels they like to see. You worry if it gets too low, and if it gets too high. If her levels drop anymore than what they read today, she would halt chemo all together and wait for the anc to regain it's level.

What does this mean? It means Emily can't be around sick people, and the best way to control that is to not have her around large groups. The tough part is tomorrow is the Second Grade performance which she is in, and really looking forward to, but really we shouldn't let her go. We are going to call her Nurse and see what she advises. Maybe she can go in for the performance and then leave? We will see. It's really upsetting that this is happening at all, not to mention right before something she is really excited about. It's also scary to think about why her ANC dropped to some pretty low levels. And the last time this happened, she ended up in the hospital. The roller coaster of cancer continues.

We will have to wait and see what happens, I had a nice break from worrying. We've been here before and I am hopeful she'll rebound soon. Let's hope she can make her performance tomorrow, it's going to depend on what the doctors say.

UPDATE: Emily's NP got back to me via email, and Emily WILL be able to be in her second grade performance tomorrow!

1 Year

Today is the one year mark of when Emily's life and our lives changed forever. March 9th last year was on a Sunday, and the day started like almost any other day. Emily had what we thought was an ear infection that wasn't going away, but we still let her go sell Girl Scout cookies in front of Albertons with her troop. I still remember not wanting to take her into urgent care because I was thinking that whatever she had "wasn't that serious." I remember the reaction of the Doctor at Palo Alto clinic reacting when she didn't hear Emily's left lung, and the alarm the X-Ray tech had when he saw her film. I also remember trying to take a picture of Emily on the stretcher as she was being loaded into the Ambulance, thinking it was almost "fun". I had no idea that we would be staying in the Pediatric Oncology floor that night. No idea really what Lymphoma was, and how this whole event would shape our lives. Emily's heart rate would climb to the mid 150's that day and stay there for 3 or 4 days. It was unbearable. I remember figuring out that she had a tumor by listening to the Doctors and nurses in the ER, and staying in denial about it. They were saying "her films aren't showing layering." I remember not wanting to tell her what floor she was being admitted to, because "maybe it's a mistake and she just has an infection" I remember her slipping and Tracy telling me "We are going to lose our baby." I remember going outside to take a break, and calling one of my best friends, Guy, who I knew would rally my network of friends, because I knew we were going to need support. I remember feeling scared and hopeless, and seeing that same expression on Tracy's face, and my Mom's face, and later when Grannie Carol and Grandpa Steve showed up. I remember walking outside of the E.R to a cluster of Televison vans and wondering what was going on, it was the same day that a Santa Clara Sheriff had fallen asleep at the wheel and killed two bicyclists. I also remember telling myself that there were people having a worse day that me, the parents of those two bikers. I remember going home very early on Monday morning, leaving Tracy and Emily at the hospital, and seriously wondering if I was ever going to see Emily alive again. To me, cancer was a certain death sentence. The next 4 to 6 weeks were the roughest I have ever experienced in my life, and I have had to deal with some pretty unpleasant things.

March 9th is just not a happy day for me to remember. However, there are a lot of amazing things that have happened since Emily has been diagnosed. We are blessed to have some of the best medical care in the world. Emily was able to go into remission on their first attempt, and to date she has stayed there. We were able to do a lot of things as a family despite dealing with Cancer, Blood Clots, and Chemotherapy. I feel like we almost did more things and were more out going than we were before her diagnosis. When I look back at our pictures from our Tahoe trips over the summer, Emily looks so sick, but she was still able to travel there, and to have a really good time. She went through so much during her first 9 months of treatment, she taught us all a lot about being brave, and how one can make the best of a truly challenging situation. She dealt with her baldness in a very mature and matter of a fact manner. I am proud of Emily, and also proud of Tracy, Haley and I, for the way we have dealt with this change in our lives.

I hope this next year goes as well as this past year. There will be challenges for sure and we are ready for them. I haven't said it in a while in the blog, but again I wanted to thank each and every one of you for keeping up with Emily's care, for your support of her and for Tracy Haley and I, we would have had a much harder time without it. I have posted 245 posting on the blog and had at least 30,000 page views on it. It's been very helpful to me to get my feelings out, and I hope it's been helpful and inspirational to you. This next year I plan to volunteer and give more back to help fight cancer, and raise awareness, I hope you do too.

Emily still at %100

Today was Emily's lab day, and her results were all in line to keep her at %100 dosage for at least another week. Her ANC was pretty low at 1100 but that's not neutropenic and hopefully will rebound a bit since it's close to the line you dont' like to drop below. She had a lot of nerves about getting her blood draw today since last week's chemo was rough, but she made it through like the hero she is.

Tomorrow night Emily and I are going to the Sharks game at the HP Arena in San Jose. I am looking forward to a great hockey game, we had a great time when we went before and I expect we will again. I love going to events with Emily and she's quite the Sharks fan.

Overall Emily is doing great and so are Tracy, Haley, and I.

Monthly Prednisone

Today was the last of 5 days of Emily's monthly Prednisone blast. For whatever reason it really effected her this month, both in mood swings and eating binges. She ate so much her stomach is distended this month. And she was going from being happy to screaming mad almost in cycles. I am happy it's over for another 3.5 weeks. Prednisone is an amazing drug, useful for so many things, but comes with it's share of side effects.

Emily and I are seperating her cooking orders so she can start delivering them this next week. She and I are also going to another Sharks game this week which should be a lot of fun. She will also have her labs on Wednesday.

We are coming up on March 9th, which marks one year since diagnosis. I don't know how much that date means to Emily but it's a big one for Tracy and I. I think it's going to be a hard day and week for me. I am glad Emily is doing so well or it would be an even tougher day, but in a way I feel like a big part of me and our family was taken away on March 9th. I have and will remain to be positive about all of this because being strong is holding us together, but it's hard to do when the future is so uncertain. Should I be happy, scared, sad, probably all of the above.

On this past Friday I met with Sherri Sayer who is the Chief Government Relations officer for Lucile Packard hospital. She and I talked about ways I can volunteer to help with their initiative to get funding and approval for a new childrens hospital in the future. It's going to be a good project to work on and I am looking forward about speaking about how important it is to have a place like it in our community.

Monthly IV Chemo, High School Musical on Ice, Girl Scout Cookies, and Beads

Today was Emily's monthly IV Chemo, labs, and physical exam. Everything went really well, she had her exam first and both her NP and Dr. Link thought she looked great. Most of their questions were around how Emily is doing in school and if she is having enough energy to be running around and playing. They were really pleased that she was up skiing last weekend, and that she's doing so well in school. Her labs were in line with expectations so she will remain on %100 dosage for at least the next week. Next month they ordered a chest x-ray so we can have a look what is going on inside. Every 3 months she will either have a chest x-ray of a CT Scan to keep monitoring her. They do not plan to do anymore PET Scans unless they see something that concerns them in a CT Scan. Her labs and IV Chemo went well, but they had to poke her twice because they missed the vein on the first attempt. Emily was very brave as usual and we were so proud of her.

Tonight Emily is at the HP Pavilion in San Jose watching High School Musical on Ice. Santa had left her tickets in her stocking and tonight is the big event. She is really excited and her seats are on the ice so she will be up close to the action. After the ice show, one of the stars from High School Musical, Corbin Blue, is going to have a mini concert which she is also very excited about. I am sure she and Tracy will have fun.

We are picking up the Girl scout cookies, so if you ordered them from Emily she will be delivering them soon, also if you are still interested in ordering some, let us know. Thanks for all your support on the cookie sale, Emily was a top seller in her troop, and some of the proceeds go directly to her troop.

I sent a link of the video I posted last week to the founder of Beads of Courage. She was so moved by Emily's video, and wrote back to me to thank me for sending it to her. She told us that sometimes she feels so removed from the kids who are in the program and my video helped to remind her why the program is so important, I was glad I could show her just how important the program is to us. She also offered to send Emily a special "remission bead" and a Beads of Courage T-shirt.

Ski weekend

This weekend we were up in Truckee CA, which is very close to Lake Tahoe and right next to Donner Lake. Last weekend in the storm the area got multiple feet of new snow, which made for great conditions for playing in the snow and getting some skiing in. We were staying at a home which was perfect for a nice cozy weekend. We are so grateful to the Hansens for the use of their home !

When we arrived we all got on our snow clothes and went outside to play in the snow. The house had two snow ball makers, which I had never seen before. Emily and Haley had a lot of fun playing in the snow. We also made a "snow fort" which some shovels. On Saturday Emily and Tracy went skiing and Haley and I stayed at the home base. I love to ski but since Tracy and Emily are at the same ability level, we thought it would be fun for Tracy and Emily to take a private lesson together. Unfortunately Tracy twisted her knee so her day ended early, but Emily completed the lesson by herself and had a great time. She was so happy and proud of herself at the end of the day. It put the biggest smile on my face.

Today we woke up to snow falling, though it's a pretty warm storm so it's not sticking to the roads too much and I am expecting a relatively easy drive home. Having gone to college in Colorado I am very comfortable driving in snowy conditions.

Looking ahead to the week, this is Emily's week for IV Chemo and her monthly course of Prednisone. She will also be seeing Dr. Link and having her labs drawn.

Emily talks about her beads

I wanted to post a new video to the Blog, it's been a long time since we have done that. You can see from the video how great she is feeling these days.

Today she had her weekly labs drawn, and the results were in line with what we expected. She will remain on %100 dosage of Chemo. Her platelets were also high enough for her to go skiing this weekend ! She's going to do a half day lesson and then hopefully ski with me the second half of the day. I intend to get video of that too, at least some pictures.