The journey continues…

Dealing with life’s daily interruptions are grueling when you have a sick child. Especially when “daily interruptions” can mean trips to the ER. Anyone who has been through the journey of caring for a child with cancer can attest to the fact that a family experiences many levels of loss along the way. The process of loss does not begin with the death of a child. In fact, personal losses for parents and siblings begin to pile up early, from the beginning of therapy to the final outcome of treatment. From the first day of treatment, daily life is irrevocably changed by the demands of caring for the sick child, and everyone in the house feels the pain. Siblings experience a great deal of uncertainty and anxiety, based primarily on the absence of their sick sibling and one, or possibly both parents, due to long hospital stays, or late night departures to the emergency room when chemo’s side-effects kick in, demanding treatment. Parents lose individual time with the healthy siblings, family dinners get skipped, school and special occasions get missed. It’s all part and parcel of the great amount of time that has to be devoted to the sick child, and the sacrifices that come with this reality. Siblings are acutely aware of the absence of their parents. What we wanted most to avoid was becoming isolated from our healthy children. Making sure they were involved in the care of their sister was an important way to stem the feeling of loss and isolation, and keep everyone together. How much that helped Abbigail’s two brothers I can’t be sure, but at least we are trying to keep our family normal, in an otherwise abnormal situation. While it’s important to focus on the healthy kids and how they are feeling, keeping a close eye on your spouse and their feelings is of equal or possibly greater importance. Given the difficulties and time constraints caring for a sick child can put on a relationship, it’s easy to grow apart. Most of the time, mom is one place, dad is another. I know this is a reality in our experience, the loss of personal time together in just about every aspect. The challenge is to try and restore some of the intimacy and private moments, while still dealing with the constant pressure of caring for your family. Ultimately, depending on the progression of the disease, there will be lesser, or greater losses the family will experience. Communicating with Matthew and the boys on how everyone is feeling, trying to keep us close, both emotionally and physically, is the goal, hopefully mitigating some of the loss that caring for a Abbigail has brought to our family over the last three and a half years. 

Today Abbigail and I are cuddling beneath a bright pink Barbie blanket, enjoying each other’s company, but it isn’t in the comfort of home and it isn’t surrounded by our loving family. We are in hospital. The boys are back home with Daddy trying to carry on with the daily chores and coping with the daily losses implicated when Abbigail is in hospital, and Mama by her side. 

Our family has been blessed this past month with the gift of time. We were given use of a home in Orlando, which offered our family the opportunity to drive down to Florida and have unplanned, uncharted time together, without treatment interruptions, or medical appointments. Abbigail was well the time we were away, with the exception of a few days of cough and cold, and she was able to have her NG tube removed, as she now eats well enough and is able to take her medications orally. She turned five years old during our trip and had the time of her life; splashing her toes in the water, enjoying breakfast with Sophia the First (child princess from Disney) and spending each day with her brothers and both parents without exceptions. There were no hospital visits and no additional medications or blood to be drawn. After countless beautiful sunny days with Mickey and his pals and so much pool side fun, we hit the highways for two days to get back home. We chose to detour 12 hrs though, which gave  us the chance to visit with close friends in Memphis. They have been relocated there for almost a year now, seeking life saving treatment for their daughter, Abbigail’s best friend, Phoebe. This entire trip, as busy as it was, truly was a huge break for our family, an opportunity to be together without planned interruption, a blessing beyond comparison.  There continued to be small daily losses as Abbigail still suffered from the sometimes debilitating OMS symptoms, which made the day to day struggling at best, but in the end it was magical.  Once all of the roads were behind us and we finally saw our fields, local farms and neighbours, we were relieved to be home and back to our comfort zone. As amazing as the ignorance has been this past month, we knew that this serene feeling of freedom from the diseases that have festered our lives for years, was likely over. 

Abbigail was due for her follow-up MRI on her liver lesions only two days after returning home. Wednesday, May 27th, she underwent sedation for the umpteenth time and had images taken of her abdomen and pelvis, with the focus being on her liver. After two days of waiting for results, we arrived to hospital again Friday the 29th of May to hear that her tumours have now doubled to an astronomical number of 60+ spots confined to her liver. This is not only puzzling to her team, but also very concerning and worrisome. Abbigail is continuing to pave her own way and write her own story about Neuroblastoma, relapsed disease and living with OMS from infancy through childhood and we will keep following and supporting her with all of the hope and faith that we can muster. 

That Friday also turned out to be one of those unimaginable moments in a parent’s life, when they hold their child tightly, fearing the worst, but knowing that life is a gift…that this child is a gift that can be taken from us at any given moment. That moment of surreal fear brought nauseating feelings to our clinic room Friday morning as Abbigail threw herself to the floor in agonizing pain only mere minutes after showing off her talented dance moves. 

Abbigail appeared to be in septic shock as her body temperature rose well above 40 degrees Celsius and her heart rate jump to 175, forcing her bloodpressure to plummet down hard and fast. This brought on severe headaches, uncontrollable shakes and shivers and confusion. Abbigail was suffering from sepsis, what was once called blood poisoning. It was quickly determined that Abbigail’s entire system had been “showered” in bacteria when her lines were flushed post blood draw. It turns out Abbigail likely had her central venous lines too close to the pool in Florida, where bacteria came into contact with foreign and vulnerable object in her body. She was immediately started on antibiotics, cultures were sent off to the labs for analysis and we were transferred from the day unit care to inpatient, where we would be for the coming weeks. 

So again, here we are cuddling, well actually she’s snoring now, and although it has only been a few days, it feels like a lifetime.  We have so much uncertainty to face and far too many unanswered questions for both infectious disease and our oncology team, that taking it day by day even sounds and feels insurmountable. 

February 23rd…

On the floor, covered in sanitized mats for her own protection from both germs and her unstable stature, nail painting as we pass the hours until her MRI. This will be her second MRI in two days. It’s been 2 full days of strictly IV fluids, no food or drinking, since February 21st at midnight. As she gazes at her pretty pink nail polish, I can’t stop thinking about what today will bring. Yesterday was my most difficult day as a mother; I laid my limp child in the arms of a stranger and watched them tape her eyes shut and connect her to a breathing machine, before entering her into the MRI machine. A parent’s worst fears were began at that moment and little did we know, that we were going to be the main characters of this awful nightmare. That was my worst day as a mother. Today will be different. How could today possibly be any worse I asked myself…

That was three years ago. To the day. February 23rd 2012.

I can’t remember much these days, my brain is constantly on overdrive, but I can recall exactly what I was doing, at this very moment, three years ago.

I remember what the doctors were saying behind the curtains, the fear in my husband’s silence, the tears rolling down our baby’s face as we held her down for the tenth time in two days, my heartache as they poked and prodded her tiny frail and shivering body over and over again. I remember it all. I can still hear my little boy’s voice over the phone, wondering why, for the first time ever in his 4 years, that his mama and dada had to abruptly leave him without any idea of when we would return with his baby sister. I remember not wanting to take too many pictures of this ugly new world because I didn’t want to have to remember any of it. I will never forget the 4 doctors who walked into our isolation room, shut the door behind them and lowered the volume of the Young and the Restless I had on in the background. It was 4:56pm. Abbigail was finally able to eat something after two long days of sedated tests. These doctors’ faces no longer appeared puzzled. What was once a mystery to almost every discipline in the hospital, was no longer. They now knew…what had been haunting our dear girl’s body all this time, had been found that morning. Although in complete shock, I finally was able to be honest with myself, because in my heart, I already knew. So here I was, alone with Abbigail, teaching her how to hold her fork all over again, and these 4 doctors, no longer puzzled as they smiled at Abbigail, and I noticed that yet again we have a new face in our room, whom we haven’t met yet. Neurology was no longer in the room, neither was genetics. This new gentle voice introduced himself, tagged with his profession, and that is all I needed to hear for our world to change forever. After days of sedation, hours of uncomfortable tests, over a dozen IVs and recounting the last months and days of our lives to every doctor and student in the building, four words is all it took. “I am an oncologist.” I have often wondered how these doctors could bring such terrible news to families day after day. “We found a mass on Abbigail’s kidney that has taken over her left adrenal gland,” he explained, “she has cancer and we need to remove it,” as they handed me the box of kleenex, and I remember Abbigail’s precious little baby face staring up at my tears, not even two years old yet, surely wondering what was mommy upset about. “She has cancer.” The entire time they were talking, explaining and trying to reassure me, all I could hear was “Cancer, she has cancer.” I must have blacked out for a few minutes, because the next thing I remember thinking to myself was how will I tell Matthew. He was on his way back to the hospital with our 4 year old to spend the weekend together. When he walked into our room, I didn’t have to say anything. The cold air, my silence and the way I held and looked into Abby’s eyes, he knew…

That was the fateful day; the culmination of all those weeks and months of wondering and worrying what was wrong with Abbigail. Nothing was the same ever again. Not our home, our family, our children, our marriage, even our hopes and dreams changed because from that day forward we could never forget…the life we lived,up until that day, changed drastically, with a few little words. It is often too painful to dream now, to hope and to plan for the future. Three years ago our world came crashing down on us. Matthew was sleeping in his car while I cried on a chair next to our tangled daughter in a cold barred crib. Three years ago we had to erase things off of our family calendar and replace them with countless hospital stays, chemo appointments and new therapy sessions. Although we lost so much that day, I can’t ignore the fact that we also gained so much too. Perspective. Strength. Understanding and compassion. New friends we can call family…and a closeness to one an other we never had before. Without all that we wouldn’t have been able to survive these last three years. Without all that we won’t survive the next three either. Cancer can be cured and Cancer may never come back for some but Cancer never leaves without a trace. It will always be part of who we are and how we live…sometimes bringing good and often times shedding light on the bad, but that is Cancer and we have adjusted.

This is going to hurt.

Three years ago we were told that we should have high hopes for Abbigail’s recovery and that with surgery to remove the tumour, and 6 months of chemo and an other 6 months of immunosuppressant therapy, that we should begin to see our little girl out of the hospital and off all of her medications and therapies. Three years ago we were naive and had the strength to hold tightly onto to hope.

Today is so different.

Today is three years after that day. Today we struggle to see any light at the “end.” Today we find it difficult to cope with the next hour, let alone the next treatment. Abbigail is still in recovery post transplant, she is systemically immunocompromised and she can’t attend school on so many levels. Today Abbigail is two months shy of being five years old and to an outsider, she appears to be barely two. Three years later, we still call CHEO home and spend more time there than anywhere else. Sadly, today, Abbigail is no closer to being that fearless and healthy sweet girl we saw giggling and running with her big brother so long ago. You could easily say that she is back to where she was three years ago, with the exception now that she has been through far too much over the years and is exhausted and has exhausted so many treatment options that were once full of hope. Today that “hope” that existed back then, even a after the devastating word “Cancer,” has slowly faded. Quite frankly, today Abbigail is in a worse position medically, developmentally and emotionally than she has ever been in her short life.

It isn’t news to most; that we are still devastated that her last chance at controlling her OMS, with the dangerous and experimental stem cell transplant she underwent last fall, may not have worked as we hoped. We are still struggling to manage her symptoms and relapses of OMS with each illness that comes her way. Over the last few days we’ve watched her limp, fall and completely lose control of her motor function in her legs. It is likely caused by the UTI she got again last week, which activated her immune response and allowed the OMS to take over again. Her sleeplessness and exhaustion do not help with her behaviour and cognitive functions, she’s in constant battle, with decreasing moments of contentment with each day that passes. OMS is still very much present, active and destroying our beautiful girl’s livelihood. Today, much like three years ago, we are consumed with fear. Today, the lack of knowledge and information, much as it has been during this entire journey, is paralyzing most days. We’ve searched long and hard for information regarding OMS, it’s prognosis and treatment and we’ve connected and had Abbigail surgically and physically assessed by one of the only world leaders in this disease. Yet, here we are, three years later, no closer to remission and with far less options than we had before. Much the same has been for her Cancer. Almost three years after they resected her tumour completely and told us how rare it is, for a child with OMS and Abbigail’s presentation, to ever relapse with more Cancer of this kind, here we find ourselves.

Today we fear a third possible recurrence.

You may recall that since Christmas Eve, we have been trying to ignore the 9 new lesions within Abbigail’s liver. Since then, she has been biopsied, in two different locations, having resected 5 separate core samples of her lesions. She’s had an MRI and 2 ultrasounds, all which have brought up our worst fears all over again. The recent biopsies have not provided any definitive answers to date. All we have been told is that they are “unsuitable for pathological diagnosis” but that all of the cultures of the samples studied returned no bacterial, fungal or viral growth. Again, we are faced with the uncertainty and fears associated with that unknown factor.

Today, three years after hearing our daughter has cancer, we can’t help but fear hearing those words again. Abbigail is about to undergo one more scan, to see if these liver nodules have changed and what the next steps are.

Three years…our baby girl is almost five! I’m so proud! Please continue to pray for our girl and the far too many other little children and share this so that everyone knows KIDS GET CANCER TOO & CAN’T FIGHT ALONE!

That moment…

I packed two lunches this morning, zipped up two school bags and excitedly but emotionally photographed you and your big brother under the tree, as I did with him each year. I saw you proudly standing at the end of the driveway with your big brother; waiting for the bus, with a pink lunchbox in hand and a smile so radiant it lit the early morning dew. I anxiously stood outside your classroom, proud you were sitting quietly, attentively and participating as every other child was, all the while still partly saddened you didn’t call out for me. I drove away in tears as I noticed it had been hours I was stationed at your classroom door, and I thought of the years that past too quickly and how far you have come, and how hard you have fought to get to this day…this very moment. The day was long. I stood waiting for the bus to bring my babies home for an hour outside in the rain and wind…but I didn’t feel cold and I wasn’t wet. Finally the bus pulled up to our driveway, after what I felt was at the slowest of speeds possible, and I saw your pride and your excitement as you ran up the driveway; ponytails flailing in the wind and boots splashing in each puddle. You were happy. You were a typical 4 year old who was excited to be a part of something and accepted. Once the excitement settled slightly and you both sat down for dinner, it seemed as though your father and I couldn’t keep up to the stories both you and your brother had to share about your first day of school. You competed for airtime, both rambling about your classmates, rhyming off names and games played at recess. At that moment, we were so happy, so proud and nothing could have brought us down.

Then I woke up. On the couch, 11 at night and the TV playing some infomercial about a new anti-aging remedy. Then I realized we weren’t going to feel those joys, see those smiles or hear those stories. I wasn’t going to be that mom in my dreams.

Instead, I remembered I had to retake your temperature because you were warm and started to show signs of a fever at 9pm when I administered your nightly injection as you slept. Then there I was, trying so desperately to cling on, capture and remember each facial expression, feeling and joy that I had in that dream as I drove to the ER in the middle of the cold, damp night. That dream has been put down, left to the side and may begin to fade now as it comes to a screeching halt, crashing into our reality again. The reality that a fever tonight means that you will be examined and poked several times and for several hours before laying your head to rest as a patient on the oncology ward, because you are neutropenic; you have 0.0 fighter cells left in your immune system, opening the gates wide for bacteria, viruses and fungus to settle in your blood and take every dream you, me or your dad ever could have imagined for you. The fight didn’t end yet.

It is now almost 24 hrs after I awoke from that dream. I am sitting at your bedside, in an isolation room at the end of a brightly decorated but oh so dark hallway in the hospital, watching you lay lethargically, bruised from the overnight battle between neutropenic veins and the need for urgent antibiotics to avoid septic shock, and I see a glimpse of that girl, all dressed in pink with her princess school gear. A glimpse is all it is though, because now you are awake, unable to sit up because you are too week from the poisonous chemos given to save your life, unbalanced, uncoordinated, ataxic rendering you unable to walk, just as the first day we found ourselves in this room. You scream for “dew” which I know means juice and I am reminded that you won’t be sharing school yard stories tonight at the table because you lost your speech 2.5 years ago, before getting a chance to even learn your ABCs and we are in the hospital, far from family and even further from that dream than we were before I fell asleep.

Abbigail will be spending the next few days in the hospital, hooked up and trapped in to protect her fragile body from the many dangers that are outside these walls. Our flight is still booked for Monday, with the faith that our miracle is still within our reach. So now I lay holding my firecracker, praying that her body will begin to produce her own fighter cells and that she may become strong enough to board that plane to Toronto and begin the journey towards healing.

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Clear. As. Mud.

So many of you that have been closely and wholeheartedly following already know that Abbigail had an MRI last week that was supposed to simply show stability within her little body and her liver tumour. Instead we face more heartbreak, frustration and fear as it showed concerning and suspicious new activity within the marrow of her pelvis. Quickly an MIBG scan was scheduled, the radioactive iodine-123 was ordered and our worries heightened, stomachs turned and hearts sank AGAIN as we waited…waited for the scan itself And then waited for results.

Well, the MIBG report came back clear with no abnormal uptake of the radiotracer was detected anywhere. But what does that really mean? And how does it affect our thinking and plans going forward? The first thing to say is it didn’t entirely surprise me that the scan came back “clear.” Her last tumour (still present within her liver) investigated by MIBG didn’t positively light up on screen with MIBG uptake either. Today’s report is definitely a positive result, the best we could have hoped for; but at the same time (unfortunately) it’s neither remarkable nor game-changing. We still have these MRI images showing metastastic action in her pelvis, her liver is still home to a lesion and her body hasn’t been performing or acting in a way that would mirror a healthy child – something isn’t right and I promised my baby girl 2.5 years ago that I would never doubt my instincts again.

To help you understand our concern still, I will quickly explain that one of the many scans that Abbigail has been having regularly for the past 2.5 years is called an MIBG scan (meta-iodobenzylguanidine). This substance is usually picked up by receptors on the surface of neuroblastoma cells. For scanning purposes it has a radioactive tracer attached to it (usually radioiodine I-123) that can be detected by imaging equipment. It is probably the most specific, most accurate and most widely used of all diagnostic techniques for detecting neuroblastoma. Of course, like almost everything else it’s not infallible. Some children present with non-MIBG avid disease, or their neuroblastoma mutates to become such. Abbigail’s primary tumour, discovered within her left adrenal gland in February 2012, was MIBG-avid, however her liver lesion, discovered in February 2013, a full year post frontline treatment, was surprisingly not MIBG-avid, such as this recent highly suspicious sacral bright spot within her pelvis, which means perhaps Abbigail’s recent tumours are among the rare 10% of neuroblastomas that do not pick up the MIBG substance. Does this mean that her cancer has mutated? Is her neuroblastoma changing over the years?

Abbigail still has a lot of disease, her liver and pelvis are riddled with lesions and abnormal cells, as evidenced by various multiple scans. However, there is currently little evidence to show the activity within her pelvis, as evidenced by her recent MIBG scan. So now what? Do we allow a biopsy, PET scan or further treatment? The result of Tuesday’s MIBG scan is good I guess, but mainly because it would have been worse if there had been significant uptake on it, but as it stands, we can still hope and pray that this monster isn’t hiding elsewhere and until we investigate further nothing or no one can take that hope from us.

I said earlier that I wasn’t surprised by the latest scan results. Although I didn’t necessarily expect the scan to be completely clear, I didn’t expect there to be significant uptake either (although it’s always impossible not to worry that something nasty is going to show up). My thinking was that Abbigail has had stable disease for the best part of SIX months now. If she’s got stable disease, it either means treatment has holding it at bay, or the cancer itself hasn’t been doing a whole lot. Reflecting on what treatments she’s had in the last couple years, I think her disease was in some form of hibernation. Maybe the multiple chemotherapies she had last year did enough to either slow the progression, maybe even stop the dividing of her liver tumour NB cells, but not enough to destroy any persistent undetected cells – Abbigail’s scan results aren’t consistent with responses that have been seen in some other children. We can only speculate because we can not monitor if they are not MIBG-avid, so at what point did her disease first became active again will forever remain a mystery, maybe it was never inactive at all and she has been fighting inside since that dark day in February 2012.

I’d love to believe that her NB has all matured, that the cells have divided as many times as they are going to divide, and that things are now just going to remain in this state, with no further surprises or undetected cells. But truthfully, deep-down inside, I don’t believe that for one minute. Maybe one day…but not today!

Even if I did believe it, consider this; the majority of children with neuroblastoma do achieve a first remission, their scans show no evidence of disease (NED), and yet of these children somewhere between 40% and 60% go on to relapse, the neuroblastoma comes back. Despite all the intense, destructive, super-toxic, treatments these children are given, residual disease still remains at the end of it. Too small to be detected using current imaging techniques, even the most neuroblastoma specific, the MIBG scan. Yet eventually this residual disease grows and multiplies to become a full-blown observable tumour, and relapse happens. If a child who shows NED has minimal residual disease that can’t be seen, in my own mind I have already decided that Abbigail has other areas of disease, not showing on any of her scans, but which nonetheless are active and which will, given time, result in new tumours forming. So we have to think about this, as well as what does currently show up on her scans today; the pelvis and liver disease. It’s why we put her through chemotherapy and soon a treacherous transplant. It’s why we are considering all sorts of treatments, such as cis-retinoic acid, a super high-dose of a vitamin A derivative, which has been shown to cause differentiation in neuroblastoma cells, turning them into mature cells that will no longer sub-divide. It’s why we’ve extensively researched our next move. Seeking at possibly getting Abbigail some form of immunotherapy, the antibody treatment that has proved to be a major breakthrough in the fight to prevent relapse in neuroblastoma patients. We know the harsh reality of this type of cancer, we understand the odds and despite all of our hope and faith, we can’t ignore what is right in front of us!

Abbigail will be back at the CHEO for her OMS treatment this week, at which point we will discuss in depth with her oncologist about our next investigative approach and possible treatments. Her amazing team at CHEO will be in discussion this week, so please pray they have answers for us. Until then, together we will face our reality here and continue on living life! All the while holding our breath, but never losing hope!

And so there you have it. I know my updates are becoming ever more complicated…but then so is the situation we find ourselves in.

Thank you for reading, sharing and praying as we struggle through this unpaved path.

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Paralyzed in Fear

Where to begin!?! We started the month in the USA searching for hope. We left home, boarded a plane with three spirited children, and went to meet the world leading specialist in OMS. He was supposed to provide s Arita, insight and give us a plan to bring home which would rid us of this monster that has stolen our beautiful girl’s innocence. While in Springfield the kids enjoyed some sight seeing of the town of Lincoln, we visited a small local zoo and we enjoyed some amazing weather. Abbigail’s big procedure was a spinal tap to reveal which cells exactly are being taken over and turning against her immune system. This test also revealed the extent of the brain inflammation as well as some other hugely scientific markers used to determine Abbigails prognosis and to trailer a treatment plan for her. The doctor was amazing and so was his staff. Abbigail enjoyed most of her visit and was the talk of the hospital in her super scrubs!

After a week long stay, we went home an waited for news on the spinal tap. These results were our hope. They were supposed to give us answers and logic and help us save our daughter from the OMS terrors, suffering and pain. We waited all week after returning.

In the meantime, Abbigail had an other routine MRI (every 3 months). We continually check her abdomen and pelvis to ensure her cancer doesn’t return. She has had a half dozen already and they always come back NED! Best three letters any cancer patient could receive! Just so everyone knows what NED means…..NED means no evidence of disease. It means there’s no test or scan sophisticated enough to “pick up” disease. A child can still have disease in the body, but it’s just not seen.20130630-232231.jpg

So we did the scan on the Thursday after returning and the following day was her monthly antibody infusion treatment (IVIG). While I played with my precious baby girl and watched her giggle as she tickled her baby brother’s tummy, the oncologist walks in making our usual small talk to Abbigail. No doors shut this time, just a few words is all it took, much the same as those dreaded first days as a cancer mom. My heart began to race as I listened to her tell me they found a new growing mass in her liver. I want to know what this is and when can it be removed! Slow down I’m told. This mass required a biopsy. Without going into detail, a liver biopsy is dangerous and complicated and in Abbigails case, as most medical things seem to be with her, extra rare and difficult. They tried to get a biopsy last week, Abbigail endured more than you want to know, more than a parent can stomach, and the biopsy wasn’t successful. The urgency to discover what this still growing tumor is exactly, is increasing. We are off to camp trillium tomorrow and as we try to relax, we know the team of doctors, surgeons and radiologists are meeting to discus Abbigail’s case. Her lungs and kidney are obstructing access to the tumour making closed biopsy difficult and risk. There will be an other biopsy scheduled for next week, we will be called away from camp to bring Abbigail in for yet an other CHEO sleep over and days of torturous testing and more anaesthetic and sedation, needles and pain. This second attempt at a biopsy is being done because we still need to know if this is Neuroblastoma again and doing an open biopsy could be potentially life threatening.

There are so many feelings being felt here this week, so much being said and even more not being said. Matthew and I are paralyzed in fear that our daughter is possibly facing a fate we know all too well now. We aren’t naive anymore, we can’t be told it will be ok. We know too much. And so we wait, the agonizing wait for answers. We are paralyzed and unable to move for we fear those words…this time the words are louder and much much more painful.

Oh wait! Dr. Pranzatelli … He wanted to provide us with the hope we so desperately sought, but he was unable. Abbigail does have substantial brain swelling and our fears of OMS have been confirmed. The damage that was caused to her brain is permanent. She has suffered a number of relapses since diagnosis and he feels that they have each caused further permanent damage and that subsequent ones will continue to do so as well. So he laid out a plan for us to review. This plan however didn’t involve much in terms of changing what the OMS is doing to her. He wants to prevent relapses with oral chemotherapy at home weekly for a year. This will hopefully train her immune system to stop turning on the OMS and attacking her brain each time her immune system is activated (cold, virus, fever, extreme fatigue, sedation, etc). He feels that Abbigail may be as close now to being at a baseline, which means this may very well be as good as she gets meaning further treating her will do more harm than good. This kills me! She isn’t Abbigail! I don’t accept this and wont stop fighting!

Next week is huge for Abbigail. We will know if she has relapsed and if the cancer has returned. If it has, we will put one foot in front of the other and keep on fighting like a kid! If we dodged a big one, we return to her OMS treatments as scheduled, as for now we must stop them until this tumour is dealt with.

Abbigail’s Story from the Beginning…

I would like to start from the beginning for those new followers and anyone who doesn’t fancy Facebook and who may not be up to date on Abbigail’s prognosis and progress.

From the beginning of her journey & fight…

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Our Innocent Abbigail at 7 Days Old

One year ago surgeons successfully removed Abbigail’s cancerous tumor. Some might think that once the cancer was gone that she would return to the life of an average toddler, which was not the case. She endured 12 months of chemotherapies, transfusions, treatments, immune altering drugs and countless procedures that brought heavy tears and frightful moments to her not-so-average life of an oncology toddler. That moment when the surgeon walked down the long narrow hallway to take me to her, in our minds, she became cancer free. This did not mean that the battle was over, this had meant we dealt with the obvious and that the true fight begins. Abbigail endures regular scans to ensure that her cancer has not hidden itself and that she does not relapse. Neuroblastoma does have a relevant relapse rate, hence the numerous scans. We are however optimistic after her 1 year scan last week, which came back clean as a whistle, that she continues to be cancer-free and that she will continue to beat the odds.For those of you unfamiliar with much of Abbigail’s diagnosis, she is indeed a case for the books. She is 1 in ten million a year that are diagnosed with this rare diseased indirectly caused by her cancer. Opsoclonus Myoclonus Ataxia Syndrome (OMS) is life altering and can be very debilitating at times, especially for a toddler, and it currently has no cure. When Abbigail first was diagnosed, she couldn’t stand on her own, she couldn’t walk, nor barely crawl and even sitting up alone was a task. This is not close to the average for a 22 month old, given that she was running, climbing, self feeding, and keeping up quite fine with her 4 year old brother just weeks prior. Abbigail went from an above average 22 month old to barely being comparable to a 9 month old. She began quickly losing motor functions, both fine and gross, shaking tremulously, unable to keep eye focus (darting eyes), confusing prior learned sounds/words and being quite irritable and inconsolable at times.

Once diagnosed and a treatment plan was researched and decided on, we put one foot in front of the other and pushed through the next day. Abbigail began a year of more than I ever expected. I did my research, I read more studies than I did books in my 30 years, I may have gone through more literature in the last 52 weeks than our oncologist has when it comes to OMS. I was prepared…so I thought. We went into her first day of treatment with the understanding that in 12 months she would be back to health with perhaps a few minor setbacks that would easily be overcome and some mild side effects from her treatments. Watching the other sweet kids walk in and out of the oncology playroom with numerous cancer treatments hanging from their IV poles, hearing the other moms talk about how this was their 15th trip to the ward this year and seeing the size of some of the children’s charts on the shelf, we had it easy we thought. Now, 52 weeks later, 3 treatment plans unsuccessful, we too have had to push a heavy IV pole with three pumps attached to it, and I laid awake in my daughter’s hospital crib crouched at 9 months pregnant just to hold her while she endured yet an other sleepless night attached to too many wires and her charts too are so large they require numerous binders on the shelf.

In March 2012 Abbigail started her first treatment protocol, which consisted of high dose steroids orally at home on a daily basis, in addition to the other oral medication to control the treatment side effects and she received intravenous chemotherapy and intravenous immunoglobulin (IVIg) transfusions every 28 days. If that wasn’t enough for her little body to endure, she underwent weekly blood tests and office visits with her oncologists at CHEO. Abbigail’s acute symptoms, the obvious physical ones of walking and standing improved significantly, however never returned to anything near that of a 12 month old just yet. Then throughout the summer months we began to see her symptoms return and she began once again to deteriorate. She began shaking again regularly, her eyes would dart numerous times in a day and her awkward and uncoordinated balance became more and more obvious as the weeks went by.

It was decided by her team of oncologists that this first treatment plan didn’t succeed, and that we would begin the search for a new treatment plan, which came recommended by a doctor in the United States. This next plan consisted of much of the same however rather than daily immunosuppressive steroids we went to a higher dose pulse therapy in addition to the IVIg and side effect medications. Come November 2012, although we saw her walking more and shaking less, her gross motor skills took a back seat to her now cognitive symptoms. We experienced some of the darkest and toughest days yet. We were losing that bright bubbly baby girl to such frightening and dark symptoms. It was and is so hard to watch our once joyful little girl slowly slip away and viciously lose her sparkle.

Now, pushing the lump in my throat further down, as we run through an other treatment plan, we again, in part with our oncology team, consulted with the same doctor from the United States who is as experienced as you can be with OMS, and we came up with an other plan and it started immediately. This plan consisted of an unapproved course of treatment for her diagnosis however one that proved promising in the little research there is out in the world for OMS. Hope was restored and although the battle was nowhere near over, we had a plan again. Abbigail endured four more weekly rounds of a different targeted chemotherapy, throughout the month of December; her last treatment was January 3rd! She received her treatment of IVIg transfusion on January 18th and February 15th as she had been for the last 12 months as well as continued to receive steroid treatment at home.

That brings us to the present.

Abbigail saw a number of weeks in December and January where her physical symptoms and motor skills appeared near average for a 2 year old (she is almost 3) and her rage, behavior, mood and overall irritability had improved enough for us to breath again. Her sleep disturbances continued however we felt that was bearable. Come February, we noticed that each day Abbigail got increasingly worse. She now requires a supplement to sleep, otherwise I am up with her a lot, sometimes up to 8 times a night, which is only exacerbating her OMS symptoms. She spends many hours a day screaming or fighting herself in a fit of rage, sometimes inflicting pain on herself or her siblings and us. Her walking is still leaps of improvement as we look back on one year ago, however she tends to be uncoordinated more and more and her ataxia (shakiness) has gotten more evident over the last month; more often when she is tired, which feels like all the time now.  I know these symptoms all too well and I recognize them, their patterns and how her body and immune system tend to react to them on a daily basis and that is why I have no doubt in my mind, my heart and my gut when I say that she has yet to induce a neurological remission.  This is why we decided to start an other course of treatment.  Her oncologist agrees, that she has not reached her “potential” yet and that we can not take any chances of letting her immune system go on the attack again, risking further brain damage and life long sequelae.  So for the month of March, Abbigail will endure yet an other course of chemotherapy, every Friday until Easter.

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2013 March 08 {Day 380}

Abbigail may exhibit symptoms that would make most strangers sneer or stare and she might not be up cognitively with her soon to be classmates, but she is still our little girl, she still loves playing dollies and dressup, and she adores her big brother.  I could go on and on about how she is, how I wished she was and how she steals my heart each and every smile regardless, but I will save some fun for an other day and many more posts.

I realize this was long, but now that you are all up to date on her prognosis and progress with this brave journey, I invite you to continue to follow her journey through my eyes here and to like her Facebook page http://www.facebook.com/KissesForAbbigail for fun photos, quick updates and interactions.

Thank you for reading and sharing.