Anthony is back in for chemo #10. So far, he is handling it well. They did a CT scan this morning and found that there was nothing on his lung. It was just the patch in his chest that showed up on the chest X-ray. I am going to make sure that they send this scan over to MSKCC so that everyone has the same information this time. The chest X-rays taken at RWJ have been sent to MSKCC and vice-versa. So, in addition to Maria correcting many things with the insurance company, we now have to act as liaison between the two hospitals to make sure records are exchanged. This is in addition to the may times I've repaired things in the hospital for them. Maybe *we* should be getting paid.

We're finally home! His WBC was 800 this morning and we left at about 3 PM today. They gave him a 24 hour antibiotic just to be sure, though. We got a chest X-ray and echo-cardiogram as prescribed by the protocol just before we left. We got a call later tonight from Dr. Pan telling us that the radiologist that read the X-ray said that there was something that he couldn't identify in Anthony's chest, that it might be a recurrence and they recommend a CT scan to be sure. Dr. Pan said he was positive that what they saw was the wedge and patch that was put in his chest in-place of the ribs and does not suggest a CT scan. Since we had the surgery at Memorial Sloan-Ketterning, the radiology dept. at Robert Wood Johnson did not have post-operative X-rays to compare with these new ones. All they had were the pre-operative X-rays which showed nothing in his chest. Dr. Pan called Dr. LaQuaglia (the surgeon) and described what was on the X-ray. Dr. LaQuaglia immediately said it was the patch that he had put-in. I don't see why Robert Wood Johnson did not ask for a copy of any of the 10 post-op X-rays of Anthony's chest that were taken at MSKCC, or why we can't just have this X-ray sent to Dr. LaQuaglia to have him take a look. On the one hand, I would hate to make Anthony do a CT scan if not necessary; but on the other hand, I am a very paranoid person and would like to have the CT scans now in addition to the ones at the end of the treatment. Oh, well... all I know is that I won't sleep very well until we clear this one up now.

Still here....White Blood Count is still 400 after 4 days in the hospital. We're now on day 5 and still no neutrophils. This is very depressing. At least with the 5 day chemo, you know when you're getting out. This uncertainty is excruciating. I don't even get my hopes up anymore in the morning when they get his blood count. I think Maria is more depressed than I am. I have to come back here next Friday for the 5 day treatment again...aaaaagh!

Well, here we are back in the Hospital. Anthony got a fever early Saturday morning (3 AM) and we had to come in through the ER. Needless to say, I didn't get much sleep that night. We were looking forward to going to Kristie's wedding on Saturday, but of course we didn't get to do that. It was very, very dissapointing , since Maria and I have not been out together alone since June. Anywho...still here on Monday night just waiting for some neutrophils to be created. Let's hope he has some tomorrow morning.

We went over to Memorial Sloan-Kettering yesterday to talk to Dr. LaQuaglia, Anthony's surgeon. He felt the area where he removed the ribs and said it feels good and solid. He was happy with the outcome of the surgery and said that because the resection was of the anterior (front) portion of the ribs Anthony has less of a chance of getting scoliosis than someone who has the posterior (back) section of ribs removed. He also said that later in life (teens), that the area would be less noticeable if the pectoral muscles were larger. So Anthony will have to do lots of push-ups and pumping iron. We can also be referred to a plastic surgeon much later if Anthony wants to have the area reconstructed or cosmetically improved. It doesn't look bad to me, though.

Dr. LaQuaglia also gave us a copy of the pathology report on the resected tissue. There was no sign of tumor cells in the area where the needle biopsy was performed. There was no sign of tumor cells in the margins (end parts) of the partial fourth or fifth ribs that were removed, or in the distal fifth rib (far end portion) that was removed. The only place that there were still some viable tumor cells left was in the small core of the tumor that was left in the intercostal region between the fourth and fifth ribs. The chemotherapy response was grade II (80% necrosis), or there were still microscopically viable tumor cells left. I had originally thought, from seeing the CAT scans, that the resonse would have been grade I, or total necrosis, but there were still some microscopic traces of the tumor left. I just pray that those tumor cells didn't go anywhere else before they were removed.

We went to the Metropolitan Museum of Art afer the hospital. Emily and Anthony had a great time looking at the sculptures and paintings. Sarah slept most of the time.

It looks like we're finally going home at 9:30 PM tonight. Anthony had his Broviac (central line) replaced yesterday. He had to have general anesthesia, intubation (breathing tube), the whole works. Everything went well. I told them to call me up in the room (I gave them the extension) BEFORE they woke him, but people just don't seem to listen. They called a while after they sent him up to recovery and said they couldn't find us. Hello...I GAVE them the extension before I went up. I wanted to wait outside the OR, but they wouldn't let me. Anyway, it was easy to find him in recovery by just following the screams. He's a very feisty kid. He's also an amazing kid. He had no pain killers at all after the operation and didn't complain a bit about pain. I looked at the site today when I changed his dressing and it looks like they closed off the old site with a couple of stitches and put the new line about a centimeter above that site. So he has a new incision and a couple of stitches and didn't complain about pain...he's pretty amazing.

So, up to this point he has a puncture scar from the bone marrow biopsy on his back, a large scar where they opened his chest for the tumor removal, a pretty large scar from the chest tube on that same side, and now two scars on the other side of his chest from the Broviacs. Oh well, he be able to show off his war wounds later in life.

I think both Emily and Sarah were worried about him after he was wheeled up to his room on the stretcher. He was still kind of out-of-it and had the big bandage on his chest. They were both just staring at him with this concerned look on their faces. Emily stood there for a while and then disappeared out of the room. The next thing we know, she comes in the room with a picture she drew of her standing next to Anthony with hearts above their heads and the words "Get well soon Anthony" written on the side. It was very nice to see how empathetic she is. I think it is good to get her involved with Anthony's treatment, she knows he has something wrong with him and she feels like she is doing something good to help him. She is a good big sister.

Sarah does her part by comforting Anthony when he is screaming and crying on the toilet trying to move his bowels. She comes over, pats him on the back, or tries to make him laugh. It is funny that even at that age (18 months) that she is showing empathy.

Well....It's been an eventful couple of days. We came back to the hospital yesterday to start chemo. The Vincristine and Cyclophosfamide went in without a problem, then they started the doxorubicin. I thought everything was OK until I went to put on his pajamas and noticed orange stains on his undershirt and pants. I thought it was the orange-ice he had eaten earlier, but when I lifted-up his shirt, I saw the doxorubicin, which is also orange, was leaking from where they patched his tubes the day before. The nurses had to get out the chemo spill kit and we had to wipe him down and throw-away his clothes (very nice ones from the Gap). The doxorubicin can cause pretty nasty burns on the skin, but only a little spilled out. The line had to be clamped to prevent his blood from leaking out of the hole. They only have giant scissor clamps in this hospital, which meant he had to sleep with two of these monstrous things on his chest all night and had to have them on all day today.

The nurses then had to put in a peripheral line (in his arm) to give him the rescue drugs (MESNA and Zofran) over-night. It took them three very painful, scream and sweat filled tries to get the line in. He was exhausted after that and fell asleep, but he would wake up once in a while and say his arm hurt during the night (along with hourly unrinating).

They then decided to replace his Broviac, but this hospital is so short-staffed in anesthesiologists and radiologists that they couldn't schedule the Broviac replacement until tomorrow at 4PM. This means he can't eat anything from 8AM tomorrow until 4PM and has to have the giant clamps attached to him tonight and tomorrow. They wanted us to go home today, come back tomorrow at 4PM to do the replacement, go home again and come back Monday to do the remaining chemo. In the end, I told them I was not comfortable going home with these clamps on him, since if they opened in the middle of the night and we didn't notice, he could bleed to death. They then said we could stay overnight.

I was so unhappy, I asked to talk to the president of the Children's hospital. He came in and fed me the line about the hospital growing more quickly than they expected and told me about the national shortage of anesthesiologists and how they were trying to recruit....blah, blah, blah. I told him that his recruitment doesn't help me today with Anthony's discomfort. According to the nurses, anesthesia and radiology have been an ongoing problem here. Oh, well, at least I made my displeasure known. I will follow-up with a written complaint to the hospital president.

Well, we're not in the hospital as we expected. When we got to the clinic this morning, the nurse noticed that the caps that attach to his broviac were not staying on tightly and fluid was leaking around them, so they decided to repair the ends of his broviac. That entailed going into the OR (a sterile environment), cutting off the end of the broviac and splicing on a new one. Anthony was scared at first, since he doesn't have good memories of operating rooms, but when I (dressed in the gown, mask, and cap) started playing the Gameboy and showed it to him, he calmed down. Everything went smoothly, but they said you can't use the new line for 24 hours. So, we'll be back tomorrow to start treatment a day late.

We're going to the hospital in a few minutes. Anthony is always excited to go now that they don't have to poke and prod him too much. They just hook-up everything to the broviac and away he goes...

Tomorrow is the start of Chemo #9. Ever since we switched to 24 hour infusion of the doxorubicin, these cycles go pretty smoothly. His mouth and tounge hurt for a couple of days, but he doesn't get the mucositis as badly and can eat through everything.

On Thursday, we're going to follow-up with the surgeon at Memorial Sloan-Kettering. We will try to go to the Metropolitan Museum of Art afterward. We'll see how long Sarah can last.

I'll be writing from the hospital this time, so you should see an update tomorrow or Wednesday.