The last round....

Whooo Hooo!  Here we go - off to Vancouver tomorrow to begin the last round of this difficult, intense first year of Noah's treatment.  Bring it ON! I am ready. 
We will be in Vancouver for the next four weeks; this round he will get
ARA-C, Cyclophosphamide, Methothrexate (in his spinal fluid) for the first two weeks or so, and Erwinia during the last two weeks. He is supposed to get the drug that caused his VOD (Thioguanine, or 6TG) but he won't be getting that, thank God!  I am not sure what the doctor decided to do about that, he was considering two options: skip it all together, or give him a similar, better tolerated one, 6MP (Mercaptopurine).
 I kind of hope they decide to skip it, because 6MP is a real pain.  It has to be taken on a very empty stomach, two hours after eating and then after taking it, he has to wait one more hour before eating.  It is very difficult to find a good 3 hour window like that in a day.  I think if he has to take it, we will try as soon as he wakes up, then he can watch tv or whatever for an hour, then eat breakfast. I think that would be the easiest. 
Noah will take 6MP every day for the entire two years of Maintenance, so it is important to figure out a good time for it.  If you remember, he was on it in May when my sisters Denise and Julie came to visit us and we had to take the 6MP with us wherever we went or we would miss the opportunity to take it, so Noah had "Mall Chemo" and "Park Chemo" or "Whatever-We-Were-Doing-At- The-Time Chemo"  He took it all in stride and we tried to make it fun.  However fun not eating can be....
 It also causes a lot of mucous to build up in his throat, which makes him throw up.  He actually threw up every morning when he was on it.  I felt really bad for him, but I  told him it was good for him, now he will be better able to empathize when his future wife is experiencing morning sickness.  We actually called it that, lol! 
After this month of treatment, Noah should be able to start maintenance.  In my mind, maintenance was like a dream, where we would be able to come back to Smithers and our life would be normal again.  Noah would be able to go back to school, I would finally get my house clean, and we would only have to go to Vancouver for one day a month for the next two years.  In theory, this is what should happen. (well, maybe not the house thing - I have struggled with that for years, it really would be a dream if THAT happened, lol!)  I am trying to not get my hopes up, though, because a lot of the kids I know who have recently begun maintenance have not had smooth transitions.  I hear it takes about 3 or 4 months before the counts recover consistently for treatments to happen on their prescribed days.  Some kids have had such low counts they haven't been able to have any treatments for quite a while.  I have decided to expect a bumpy road.  I mean, nothing has gone smoothly for Noah so far, why should I expect this to be any different? : ) 
I have also lightened up about Noah returning to school this year.  He is doing fine and generally keeping up in his studies, so if he doesn't go back at all this year, and just rejoins his class for grade 7, we aren't going to stress about it.  The only class in which he may struggle is French, but he picked it up really quickly before and I'm sure he will again.  Tom can give him a crash course in the summer, so he won't be too far behind. 
Today when I picked up Noah's results from the lab, I didn't know what was going to happen; usually I can take one look and see if we are going or not.  For treatment, Noah's white blood cell count has to be  0.75 or higher (today it was 2.0) and his neutrophil (infection fighting white blood cells) count also has to be above 0.75. Today his neutrophils were at 0.7. He was short 0.05 neutrophils (X 1,000,000,000  if we are going to be exact)  I didn't know if that was enough to keep us here for another week or not.  After a bit of consultation, the nurse called and said we should come because probably by Friday he will be over that threshold.  We'll see.  So we are flying out in the morning and going to the hospital for treatment on Friday, for an all day affair. 
I will let you know how it all goes... to be continued....