Day 13

Alex went with us to the hospital today, since it's a light day with only a finger prick to get blood counts. Lucas fussed not because he was physically hurt by the finger prick, but because of the fact that he was in hospital seeing the same doctors that "messed with" him. He must have thought that he would never needed to come back. Nurses assured us that kids would get used to it and eventually establish a positive bond with the medical team.

Lucas's blood count was pretty good - hemoglobin 10.4 and platelets 79. ANC = 341, which puts him still in the "significantly increases the risk of infection" region. But at least he doesn't need blood transfusion as his hemoglobin stays above 8 and platelets above 20.

We also got some good news from his initial bone marrow aspiration. The DNA index is 1.23, which is higher than the 1.16 magic number. Meaning "Aneuploid Blast Population (DNA Index=1.23) Studies show ALL with DI >=1.16 correlate with better response to treatment)". It is not significant enough to change his risk category, but it is still pleasant news. The Cytogenetics result is not out yet.

Alex had a small but effective talk with the psychologist, who conveys the message that a 4 year old can understand.
(1) Lucas is sick.  It won't be passed from person to person like cold or stomach bug. (Alex added: "Yes, it's not caused by virus."  The psychologist smiled and applauded. )
(2) Lucas is sick in the blood.  The medicines used to fix Lucas is strong.  It's so strong that it might make Lucas lose hair or throw up.  But this cannot be passed from person to person because it's caused by the strong medicine that will fix Lucas.
(3) Lucas needs to go to hospital often for treatments.  When Mommy and Daddy are taking care of Lucas and not there for Alex, there's somebody who will take care of Alex.  Sometimes it's Grandma, sometimes it's friends of Mommy and Daddy
(4) Alex gets mad when Mommy and Daddy keep focusing more on Lucas.  It's okay to be mad.  Alex will use words instead of stumping or hitting to let Mommy and Daddy know that he is mad.   Mommy and Daddy will listen and try their best to make him feel better.

And more questions answered:

(1) Shivering could be caused by low blood sugar, a side effect from the steroids.
(2) Should encourage him to drink Pedisure, chocolate/strawberry milk, juice... basically anything with added sugar to keep him blood sugar level steady.
(3) No tapering off steroid is necessary.  Stop Decadron after tomorrow (day 14).  Stop Zantac after 2 additional days.

The next appointment is next Monday for IV chemo.

Who sent this cute stuffed toy?  Lucas likes it very very much.  Thanks a lot!