Six months

Six months ago today, I carried Stella in my arms into the emergency room.

She was pale, underweight, and in so much pain she couldn't stand.  The leukemia diagnosis that Adrianne and I heard the next day was somehow both stunning and completely expected, like a punch from a bully.  The next week--Stella suffering in the hospital, the rest of the family nearly crazed with worry and confusion--was the most difficult any of us has ever endured.  The months that followed brought new challenges and fears--the chemo, the medical procedures, the adjustment to home schooling.  But we pushed through, fortified by knowledge about Stella's illness, treatment, and prognosis--as well as all the optimism we could muster.  We did (and will continue to do) our best to shield Stella from expressions of hysteria or pity, which we believe would have threatened her incredible resolve.

Today, Stella is strong and healthy.   She got the official all-clear from Dr. Carroll yesterday to begin Maintenance therapy and go back to school.  Real school.  Her school.  All day, every day.  On Monday she will once again be among her friends--playing in the schoolyard, goofing off in the lunchroom, going on field trips.  She can't wait, and neither can Adrianne and I.

As difficult as these past six months have been, we still feel incredibly lucky.  How many other kids have Stella's huge, selfless network of friends and family who have contributed so much time and love?  And how many of them have access to the truly world-class medical care that Stella has been receiving?  And, let's face it, how many kids possess the natural strength, smarts, humor, and grace that have allowed Stella to roll with the punches, and swing back? 

Stella is a marvel.  She is doing great.  We are all doing great.

*****

A few posts ago, I promised an explanation of the nuts and bolts of Maintenance, for those who are interested.

First and foremost, Maintenance is not particularly "hard," especially compared to all of the earlier phases of treatment to which Stella is accustomed.  She will still be taking medicine regularly, but not in the kind of doses that wreak havoc with her blood counts, physical appearance, or mood.  There will be no restrictions on her level of activity; in fact, the more rigorously she exercises the better.  It will still be a while until she can eat sushi (as she repeatedly reminds us), but otherwise she can pretty much do what she wants.  We will remain vigilant about keeping her away from viruses; every fever will still necessitate a precautionary hospital stay.

For girls, the Maintenance phase lasts about 20 months (boys need an extra year).  If you're counting on your fingers, we're talking about December 2010 for Stella.  The Maintenance phase is broken up into about seven cycles that last twelve weeks (84 days) apiece.  Each cycle will be identical to the last, with the exception of minor dosage adjustments that will be made as Stella grows.  She will only need to see the doctor once a month or so.  Here's how the 84-day cycle breaks down:

• Day 1: Intrathecal (spinal) Methotrexate.  Administered under anesthesia at hospital.
• Day 1: Vincristine.  Administered via IV (Mediport) at Hassenfeld.
• Days 1-5: Decadron.  Pill taken at home.
• Days 1-84: 6-MP.  Pill taken at home.
• Day 8: Oral Methotrexate.  Pill taken at home.
• Day 15: Oral Methotrexate.  Pill taken at home.
• Day 22: Oral Methotrexate.  Pill taken at home.
• Day 29: Oral Methotrexate.  Pill taken at home.
• Day 29: Vincristine.  Administered via IV (Mediport) at Hassenfeld.
• Days 29-33: Decadron.  Pill taken at home.
• Day 36: Oral Methotrexate.  Pill taken at home.
• Day 43: Oral Methotrexate.  Pill taken at home.
• Day 50: Oral Methotrexate.  Pill taken at home.
• Day 57: Oral Methotrexate.  Pill taken at home.
• Day 57: Vincristine.  Administered via IV (Mediport) at Hassenfeld.
• Days 57-61: Decadron.  Pill taken at home.
• Day 64: Oral Methotrexate.  Pill taken at home.
• Day 71: Oral Methotrexate.  Pill taken at home.
• Day 78: Oral Methotrexate.  Pill taken at home.
• Day 85 is Day 1 of the next cycle.