Life and Procedures

Routine...sort of Noah has gone through his second round of chemotherapy and is now on the "bounce back". Unlike the first round, where Noah was in hospital and when his diagnosis was very fresh, things seem to be going a bit more routinely (as much as that is possible) and we are starting to learn about the flow of this part of his treatment. Over the five days on which Noah actually receives his chemo drugs he heads out to McMaster early in the morning and first visits the finger poke lab to have his blood samples taken. Next, he goes up to the out patient clinic to have his chemo drugs administered and then, every day but Friday, he pretty much comes straight home. And then...he lays around in front of the TV like a cancer patient all day? One might think! Actually, no. Then Noah plays with his sisters, goes outside for a walk, heads over to the old quarry near our house to get pushed around on the ice, comes home for dinner, plays basketball with his mini hoop, rolls around on the floor, plays horsey, begs not to go "night" and then, eventually, he heads up to bed. The biggest affect the chemo seems to have on Noah concerns appetite, which slowly depletes as the treatments go on. He also needs a big sleep at night but not much more than any other active three-year-old. He really does embrace the time he has with his family and he is content to carry on as usually. Fridays, however, are not the best days. On those days, Noah goes to clinic and has his dressings changed, something he - and, judging by the screaming in the clinic, all other little ones - absolutely loathes. They peel old stickers and bandages off of his catheter and feeding tube, swab them down and then replace them with new ones. This, of course, is all meant to help prevent Noah from getting infections which he becomes increasingly susceptible to as his blood counts plummet post chemo. Still, he hates it. Last Friday was a particular doozy as dressing change coincided with an absolute bottoming out of blood counts. On top of the regular rigmarole, he had to receive platelets and a blood transfusion, both of which really extend the unfun experience beyond Noah's regular patience. The good news, though, is that - as of Monday's blood work - Noah is officially on the bounce back. His counts are rising again and he is recovering from the last round. His appetite is returning along with a bit of his sassiness, which is somewhat softened when he is under the weather. We were especially happy that, in spite of concerns from nurses on Friday, Noah did not end up with a fever this weekend. This would have sent him back to the Emergency Room and to the ward. Fortunately, however, Noah continues to be amazing and, instead of checking into the oncology ward Saturday, he was able deliver a very special paper bag full of dried kidney beans (Noah's choice) to his Opa and to follow up this delivery with a nice, socially distanced visit which Oma also joined.

Scans and extractions But of course, there is more to treatment than just these initial rounds of chemo and this week of recovery will, unfortunately, not be quietly spent at home awaiting the next round. Yesterday, Noah had to go back to McMaster for another scan, one which is meant to more clearly indicate the location of the cancer within Noah's body. A similar scan had been done a few weeks ago but, as can happen in a small percentage of cases, the imagery did not effectively show what the oncologist needed to see and so another scan was ordered up. This different scan required sedation and additional preparation and took longer to complete. The scan (and not an MRI as Noah's "official" certificate indicates) left our little guy pretty bagged and grumpy for most of the afternoon though he did eat heartily once he got the opportunity to stuff himself. And there is no rest for the weary. Today, he left early in the morning to be checked into Sick Kids hospital in Toronto. This is anticipation of a later phase of his treatment. Here I should clarify. I had written earlier that Noah would be receiving a bone marrow transplant of his own harvested bone marrow and this was incorrect. I blame my lack of proper medical training for the error and I've committed to watching more Doogie Howser, M.D. so as to fill in any further knowledge gaps. What is actually happening in the next few days is the extraction of some of Noah's stem cells. While on the bounce back from chemo, Noah's body produces (with the aid of some injections) increased numbers of stem cells which help regenerate the bone marrow and blood that is wrecked by the chemotherapy. Today, Noah will be sedated for the second time in two days and he will have a temporary "port" placed into a vein in his leg. This port is more robust than the Hickman catheter that is currently installed in his chest. Tomorrow and/or the day after and/or the day after that, Noah will be hooked up to a machine which will harvest his stem cells. Similar to hemodialysis, blood will be drawn out of Noah's body, put through a machine, and then sent back into Noah's body. How long this procedure takes and how many times he has to undergo this procedure will depend on how many stem cells they are able to harvest during each session. Once they get the amount they need, the new "port" will be taken out and Noah will go home. The stem cells will then be frozen and taken home, scratch that, kept someplace secure until they are needed later on in Noah's treatment. And this is where the bone marrow piece comes in. After these initial five rounds of chemo at McMaster and after the surgery to remove his largest tumor, Noah will go back to Sick Kids for two very, very powerful rounds of treatment. These rounds will make Noah both incredibly sick and incredibly vulnerable. After each of these rounds Noah will be given a transfusion of his own harvested stem cells to help his bone marrow and blood recover. This will, we pray, help him get through the rounds of chemo and prepare his body for subsequent assaults. Our prayer Aside from healing and renewal, one prayer and ask we continue to have is for God to show us our role here. How do we help Noah go through all of this? One thing that has become clearer over the last few weeks is that we are increasingly unable to protect Noah from all of the bad things - which range from inconvenient to downright awful - that are happening to him and which will continue to happen to him as this treatment moves forward.

This does not feel good or natural. But we do what it is we can do. We love him. We play with him, we stay with him, we hold him. We spoil him and we discipline him. Mostly, though, we are there for him. We make sure that he is living life. We try our best to continue walking down this road with him, hoping and trusting that he will make it through this treacherous journey safely, and that God will hold us also.