Sunday, April 2, 2017

Jaunary 2017 MRI

In January we made the trek to Boston for Emmett's routine follow up MRI.  Since Emmett finished his second round of proton radiation therapy in January 2016, all of his follow up MRIs have been in New Mexico.  It's been wonderful to be at home here in Albuquerque for the past year.  However, it was time to visit the doctors in Boston again, and so we headed that way in January for an MRI and a round of other follow up appointments.

Emmett made it through the entire MRI without sedation!  This is the first time he's done it in Boston.  We continue to be so proud of him for the bravery he shows in the midst of continued medical exams, tests, etc.  He continues to be our Brave Little Lion!

The scan was clear!!!  We were so excited to hear the news!  I can't impress how anxious we get about these scans.  It's almost like life stops when each scan arrives.  And you hope and pray that it starts up afterwards.  How blessed and thankful we felt when we received the news that all looks good!  Additionally, given that he finished radiation over a year ago, the doctors said that we can now space the scans out to once every six months instead of once every three!  This is such exciting news for our family!  Instead of buying life three months at a time, we'll get six months!  That seems like a lifetime!  What's even more exciting is that fact the that if the doctors are comfortable spacing out his scans, that can only mean that they are getting more comfortable with his overall prognosis.  And how exciting that news is to us!  The other good news from this trip was that Emmett's hearing is still perfect.  That's great news too!

As we walked out of the hospital that evening, I was completely overcome.  We've had the opportunity to be overcome with many different emotions at times since Emmett's diagnosis.  What I was overcome with as we walked out of the hospital that January evening was inexpressible gratitude.  And what a wonderful thing to experience, as inadequate as it makes you feel!  We feel so blessed, so thankful, so fortunate...and yet so inadequate and so undeserving all at the same time.  We still having our sweet Emmett with us while other families have lost their precious loved ones.  Why Emmett's been allowed to stay while others were called home no one in this world can answer.  But how grateful we are that he's still in our charge, for whatever reason.

We express our thanks to God for this blessing many times a day.  And pray for those who are still suffering, and for those who have lost their loved ones.  How precious are your little ones!  Love and appreciate them each and every day!  For each day is a miracle!

Sunday, October 2, 2016

MRI Results - Sept 2016

Emmett's latest MRI was 9/20/16.  We opted to do this scan in New Mexico again.  This scan included both the brain and spine, and Emmett again did the whole thing unsedated!  We're so proud of him!  At this point the doctors will probably stop scheduling sedated scans, so that means a whole lot less anesthesia than he's been getting up to this point.  And the scans are so much shorter unsedated, and there's no recovery afterwards.  So we love it.

We got the results on Monday, and things looked great!  The doctor said that she couldn't even find the spot without help of the radiologist because it has reduced so much.  And it didn't pick up any contrast this time.  So that's all awesome news.  We believe the team in Boston will be very pleased.

Last year at this time we were in Boston waiting for the doctors to decide what to do about this spot, and things didn't look promising.  AT/RT recurrence is generally incurable, and they were very upfront with that fact.  And here we are, a year later, back in Albuquerque, enjoying General Conference from the comfort of our own home, and from all appearances Emmett is doing great.

Words can't express our gratitude for the blessings of heaven we have received over the last year.  Every day is a miracle, and we've enjoyed another year!  And we will keep praying for more.  How thankful we are for those of you who continue to pray for our family; we feel the strength and the blessings of your prayers every day.  Thank you all for your continued support!  God bless you all!

Summer fun in the mitten!

Thursday, June 16, 2016

June MRI

Emmett had another MRI this month (6/2/16).  Everything looked stable!  What was really exciting about this MRI is that Emmett did the entire thing unsedated!  The anesthesiologist tried to talk us out of having him attempt the scan unsedated.  Two scans ago he did a brain MRI without sedation, and that scan was 30 minutes.  But when it was time for his brain/spine/brachial plexus MRI in April, they insisted he wouldn't be able to lay still for two hours and they talked us into sedating him.

But this month I put my foot down.  Sure, if he got restless during the scan they would have to start over -- they want him to stay in the same position until after they've taken the images with contrast at the end.  But that was a risk I was willing to an effort to reduce the risks and discomforts my son experiences when he's sedated for a scan.

We've been briefed endlessly on the dangers of sedation, but the doctors seem to forget about (and minimize) those risks when it's MRI time.  I understand when a child is young there's no other choice -- but Emmett's growing up!  And when we deprive him of electronic stimulation at home, there's no limit to what he'll do to keep the "movie goggles" on in the scanner.  And we decided to take a chance and give it a whirl.  And it's a good thing we did.

He was in the scanner for an hour and a half, and when he came out he was dripping sweat and his face was red where the movie goggles had been, but he was a happy camper who could walk straight and eat right away and was ready to return to his day.  And we were so proud of him!

No more fasting, less anesthesia, and more movies!  Win, win WIN!

Way to go Emmett!  We celebrated the best ways we know of.


We have yet to hear from the doctors on their recommended path forward.  We expect to go to Boston for consultations in the next few weeks, and probably will stay for some follow-on treatment.  But for now we're celebrating another good MRI!

Monday, May 23, 2016

MRI Results

Everything looked fine on Emmett's 4/28 MRI!  This MRI only included the spine and brachial plexus as those weren't included on Emmett's 3/3 scan.  They did note one spot at the C6 level that might be questionable, but looking at previous scans they can see the same thing all the way back to 2014, and it's unchanged today, so they're not overly concerned about it.  (We think this might be the same spot near Emmett's primary tumor that the Boston calls a "tethered spine" and has been watching closely?)  Emmett's next scan is 6/2, and that scan will include the brain, brachial plexus, and spine.

Because there weren't any tumors identified in the scan (yay!), Emmett is still not a candidate for the EZH2 study.  This is the study we've been hoping for because it has no significant side effects.  This means that any treatment we consider at this time will likely have a negative impact on Emmett's quality of life, and that's never fun.  If Emmett were experiencing symptoms from a tumor currently, it would make the decision to put him through harsh treatment easier to make.  But as it is, it seems the doctors are really reluctant to make him sick when he's so healthy otherwise.

The one thing that's become clear to us is that there's no clear, best path forward in the doctors' minds.  In some ways that's a good thing; it means Emmett is doing well and things look good enough that it's hard to justify making him sick.  At the same time, we do wish that the best treatment plan to help ensure Emmett's long term survival was more obvious.

Thursday, April 28, 2016

MRI's Over

Emmett completed his MRI this morning...and the boys are watching iPad together again.  On our way home.  More later.

Sunday, April 24, 2016

No news is good news!

Sorry it has been a while, but despite being a few months, nothing has really been happening.  yay!!

We came home the day after radiation ended back in January, thinking we would have a few weeks at home, an MRI then right back to Boston.  But, as scheduling usually goes, it took 2 months to schedule an MRI (which in the end, he did UNSEDATED!!!!  His first ever!  It was only a half hour and only the brain, but still, that was huge!  Had we known he wouldn't need anesthesia, it probably could've been scheduled much sooner).  Then to get results back...another few weeks.  In fact, it took a full month to hear back from our team.  Here are the results of 'the spot:' UNMH compared it to a different scan, so they concluded no change.  MGH, where Emmett did proton radiation, concluded about a 20% shrinkage and clean auditory nerves now.  Dr. MacDonald, our radiation oncologist, was pleased with those results she said and strongly recommends a systemic therapy now.  DFCI, our main team, reported they see 50% shrinkage and concluded that the spot is very radiosensitive and hope for continued shrinking.  Initially, when we saw UNMH's results, we were excited because if it hadn't responded at all to radiation, that strengthens the case that it is NOT cancer.  Because of that news, we felt that we would be done with treatment for now and just continue to watch and scan like normal.  However, just a few days later, that peace was brought to a quick end with MGH's news.  I mean, shrinking for cancer is good news, but 'probably not cancer' is obviously better.  But we were very happy that the doctors were seeing good results from the radiation. We are back to considering our next treatment.  Dr. Chi is still not as strongly convinced we need further treatment as Dr. MacDonald is. 

Here are the options we're considering for those who like details or are reading this blog in search of direction for their own child's treatment.  The first is a study from the company Epizyme, who has produced a new drug called EZH2.  This is Dr. Chi's research and is not traditional chemo, but a new type of drug that is hopefully the way treatment is going in the future.  Instead of defining cancer by where is occurs in the body, they are defining tumors by what they genetically have in common.  For ATRT, it is an INI-1 deficient tumor.  This gene normally is what codes for tumor suppression, or what recognizes tumors and then tells the body to squash it.  So you can imagine if you have a mutation or genetic error in this gene, then your body does not produce the right proteins to send the signals to squash the tumor and becomes very problematic.  What this new drug does is hopefully treat this deficiency.  (At least this is my basic understanding)  They have given the drug to 5 adults and 4 of them had shrinking; 1 of which had the tumor totally gone.  We are told this is HUGE success for such an early study.  Fast forward maybe 2 years and they are just giving this to children now:  6-12 children worldwide have taken it starting in February.  The side effects so far seem to be mostly tiredness.  This was funded NOT by any donations to the Jimmy Fund but entirely by a certain team for bike ride fundraiser, headed by an incredibly enthusiastic mom who already lost a child to this disease.  Janet Larkin O'Shea and her team, Team Lick Cancer, have raised around $250,000 (yes a QUARTER MILLION DOLLARS!) each year and give it to Dr. Chi.  THAT is how needed research for children gets funded.  Thanks to them, we have options for treatment as this point.  She said when her daughter was sick, they would do radiation on the little spots as they popped up and do some chemo here and there, but there really weren't options.  Emmett was a pedal partner for this team 3 years ago and will be again this year!  I thought we had a post on the PMC, but apparently we don't because that was a pretty busy time of life.  I will put that on my to do list.... 

While we are excited about the new EZH2 drug, we are a little hesitant because really, who wants their kid to be a guinea pig and work out all the kinks of a new drug?  And also, the whole purpose of this particular study is to find out the dosing, which means, how much can they give a kid before the liver and kidney or other organs start having problems.  Just in this last week, we have heard that 3 of the kids on the study just dropped out because their tumors grew.  Which makes us hesitant.  We also found out the adults that did well had solid (body) tumors so the drug could easily get to it.  With a brain tumor, a drug has to be able to cross the blood brain barrier, which is made by divine design to be hard to cross, thus protecting your brain.  Maybe at a higher dose it will be able to and if we join the study, it will hopefully be a little bit higher of a dose.  This is what I mean by working out the kinks.  Emmett's quality of life right now is AMAZING and completely asymptomatic so we are drawn to this study because it seems that immediately it will have less impact on his quality of life.  The children are closely monitored and the drug is given daily orally at home.  But we would still have to be in Boston for 1-2 years (you have to be in clinic to get the drug very regularly and get your check ups and lab draws....  They do offer this study in Denver, so if we choose to go this route, our doctors have agreed that we could work with Denver, too, which is a 6-7 hour  drive away.  That would be a lot of road travel, but it could be done and would allow us to be home much more without the expense of having to fly to Boston).  Right now he does not qualify for this study because his pea size tumor is now half that size thanks to radiation and if it continues to shrink they are not sure it would be from radiation or the new drug, so it wouldn't give accurate study results. More on this later, but he has an MRI this week and if new spots are found on the spine, then he would qualify.

Second option right now is called the Vienna study, and -you guess it-comes from Vienna Austria.  It is traditional chemo, and while it is called a study, it is not really, so it could be given at any hospital that is familiar with interthecal chemo, which I don't know if UNMH is, but we would not choose to do chemo at home anyways, so that doesn't matter.  Dr. Chi said that although it is chemo, it's not nearly as harsh on the body as the chemo he has been through.  However,  it is 'labor intensive'/time consuming, in her words.  Part of it would be interthecal chemo, which is the one they put through his Rickham Reservoir right into his brain.  This is done 5 days a week, every third week and obviously  has to be done in clinic.  It involves systemic (IV) chemo, interthecal (brain) chemo and radiation, which he has already had.  This is about a 1 year protocol also.

The third option, which we haven't considered as much so I don't know as much about is Alisertib, which is St. Jude's research baby right now.  We have heard of other families on it with mixed results.  Also pretty new and not readily available, but possibly we could get it in Boston, but Dr. Chi would have to apply for compassionate use.  I believe it is not 'traditional chemo' (which I define to mean drugs that kill any quickly dividing cells-cancer, hair, throat lining, etc...) but I think it is being used in conjunction with chemo.  I guess another option with this is possibly going right to St. Jude in Tennessee for this.

Last option would be to wait and see...?  Dr. Chi says they do 'spot-weld' small tumors with radiation sometimes and don't do further treatment.  But the haunting question from Dr. MacDonald always remains "But if it has traveled to his brain, where else is it traveling?"

To be honest, Emmett is doing absolutely great still and we are still very slow to call him in recurrence and have clearly not been overly anxious to get treatment started.  He will have another MRI this week because the initial MRI on March 3 only checked the radiation spot and not to see if it had spread down his spine or in the old tumor bed.  This MRI will be 4 slots instead of 1 like the spine is, so it will definitely be sedated.  They said splitting it up into shorter ones without anesthesia makes for choppy pictures and also means he has to have contrast injected into him 4 times instead of 1, which isn't ideal either.  We are very hesitant to disrupt his quality of life and are very hopeful he's still fine and will be just fine.  He's very bright and excited to be starting kindergarten in the fall and besides some weak muscle tone, really has no side effects from previous treatment.  We are hoping not to be pushed urgently into treatment and kind of hope radiation will just do it's thing and maybe do some more treatment just in case, but expecting him to be spot free and clean and life back to normal sometime. 

We're grateful for all the prayers and have loved being home some extra time.  We still really don't know where we will be in a few weeks, but are starting to expect that by early summer we will be headed back to Boston to discuss and start treatments.

Phew, enough of all that serious chit chat.  On to the fun stuff!!

Team Lick Cancer's Jersey

Family Photoshoot right before we left for boston in the fall-we had literally walked out of a doctor appointment and had tons of packing left to do to leave town the next day....but somehow between all the chaos we fit this in and we're glad we did

oldie but goodie
the whole team in 2013 at the end of the 2 day ride in Provincetown, MA

my numbers were way off-looks like they raised almost a half million dollars in one year!  That is the complete funding for this EZH2 study.  Absolutely amazing!  Janet is 2nd from the right and Dr. Chi is holding the check next to her

 Our Annual Winter Family Campout     

Matching Easter-they both fit in last year's clothes! Score!

Micah graduated from his neat internship

Showing off eating skills to his awesome and tough uncle
'Honey I shrunk the kids' garden

First suit!
on a bug hunt
brother love
Flashes of Hope (before we left Boston-photographers volunteer their time and do a free photo session and prints!  IN clinic, which is AWESOME because it's one less appointment and they totally accommodate you)
visitors at the temple
Breakfast in bed...i mean bath
Watching General Conference and taking notes
friends from az!!
top of Sandia Peak

'Big brother excavation co' and 'l'il bro wrecking co' how cute is that?  My sis is pretty sweet

Monday, January 18, 2016

Radiation ends, and a trip home!

Emmett's last day of radiation was 1/8/16.  He ended up doing very well throughout the whole seven weeks of treatment.  After getting his port-a-cath placed the week after Thanksgiving, he wasn't afraid of the sedation every day and actually looked forward to going in and getting his 'doctor nap' each morning.  Sometimes he would get hungry because he couldn't eat until after he woke up from sedation each day, but besides that he did very well.

The doctors want to wait six weeks before doing Emmett's next MRI to give the acute radiation side effects a chance to subside (radiation can cause inflammation of the surrounding tissues, and they want that swelling to subside before the MRI).  In the interim, they let us go home for a break.  We flew out on the 9th and have thoroughly enjoyed being back in New Mexico this past week!!  I cant't express how great it feels to be home for a while.  What a blessing and a miracle!

Emmett continues to do well clinically.  There's no indication that anything might be amiss.  We pray that's truly the case.

Emmett was excited for the plane ride back home and couldn't wait to see all his old toys and ride his jeep.  He was such a big boy walking through the airport with his own backpack that the proton center had given him as his graduation gift (he's been asking for one since before awesome it is for a child to want a practical gift for once).  We threw all his toys and goodies in his backpack and suitcase, and it was awesome.  I guess there are small benefits as your kids grow up.

However, there are downsides too.  The worst part of the flight home was when Emmett realized that the button on the armrest doesn't make the plane go up and down.  He's believed it controls the plane for years, and it's been the cutest thing ever to watch him wear out his fingers during takeoff and landing...but you have to take the bad with the good as your child grows up, and sometimes it melts (or breaks) your heart in the process...

I initially blew off his questioning, but he insisted: "No, come on Dad, tell me what the button really does".  So I eventually gave my big boy... *sigh* ...and the guy sitting behind Emmett cursed me for the rest of the flight.

Emmett had a hard time sharing the window with Clayton.

We're so excited to be home and look forward to enjoying what home life has to offer for the next month.  Afterwards we'll likely head back to Boston for some continued treatment, though exactly what that will entail is unclear.  The doctors want to be proactive in case this has spread elsewhere.  Dr. Chi listed five options we could consider before we left Boston, and we'll be weighing those carefully over the next month.

But for now, we're enjoying life and living it up in the Land of Enchantment!