Chiara Petersen Fox: 21st August 2011 (Day 5 of Chemotherapy)

Sunday, 21 August 2011

21st August 2011 (Day 5 of Chemotherapy)

Well today was Chiara's 5th and final day of the first batch of Chemotherapy I(Fludarabine and Busulfan). Monday and Tuesday she will be given ATG which is the Chemotherapy we are not looking forward to as it can cause loads of side effects and we have been told this is the one that will most probably make her fall ill.

Anyway today I arrived at 8.30am to find Chiara still in her cot and only just awake. She had been up at 5am for a bottle of milk but had then went back to sleep.

Unfortunately her lying longer in bed meant I had to endure the 9 syringes of medication. She took the first couple as good as gold but as soon as I tried to give her the Cipro antibiotic she gagged and puked all over floor. I seriously think now that this has to be either changed to IV or something else.

No 10am Chemotherapy this morning YE HA. Examination with Doctor was good.  .

She ate well at lunchtime , beef casserole today.

She played normally and was lively today.

Her wee bottom has broke down though, it has been like this for some days now. Not as red as I suppose it could be but then that might have something to do with the fact that everytime I get near her for a nappy change I slap on layers of Orabase. (To me it just looks like really thick brown sugar ). I am now cleaning her with Hydromol, warm water and swabs.

She had what was probably her last bath in a proper big luxurious bath for a while. Jammied up and ready for bed. 6.30pm and I was pestering the nurse for all her 9 or 10 syringes. Tonight I was going to try the Cipro first and any other meds that were dissolved tablets. 7.15pm and I eventually got them, one down and another 8 or so to go. Cipro went in, gagged and the whole dinner, etc came hurling back up and all over the floor. Definitely no way I am giving her that again, she is coping so well with her Chemotherapy and eating so well all day and then one medication just makes her throw the days meals back up, just not worth it.   I gave her the rest of the syringes no problem followed by a big
bottle of milk.

Now came the part of trying to get her to sleep, not having any of it as after a huge vomit she is now hungry.   Anyway before long she fell over to sleep. She was being given her Steroid IV tonight which she requires to be commenced on before her ATG tomorrow.

1 comment:

Pamela Mitchell21 August 2011 at 22:10
Hi Michelle
Sorry to hear about Chiara being so sick after Cipro,hope they get it changed.
Sounds like a very trying day, your keeping so stong, you are a wonderful mum.
Hope Chiara tolerates the chemo as best she can over the next few days,one amazing little "Princess".
Take care, big hug
Pam and Ash xxxxx
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MPS1 (HURLERS)

Mucopolysaccharidoses are a group of metabolic disorders caused by the absence or malfunctioning of lysosomal enzymes needed to break down molecules called glycosaminoglycans - long chains of sugar carbohydrates in each of our cells that help build bone, cartilage, tendons, corneas, skin and connective tissue. Glycosaminoglycans (formerly called mucopolysaccharides) are also found in the fluid that lubricates our joints.

People with a mucopolysaccharidosis disease either do not produce enough of one of the 11 enzymes required to break down these sugar chains into simpler molecules, or they produce enzymes that do not work properly. Over time, these glycosaminoglycans collect in the cells, blood and connective tissues. The result is permanent, progressive cellular damage which affects appearance, physical abilities, organ and system functioning, and, in most cases, mental development.

The mucopolysaccharidoses are part of the lysosomal storage disease family, a group of more than 40 genetic disorders that result when a specific organelle in our body's cells – the lysosome – malfunctions. The lysosome is commonly referred to as the cell’s recycling center because it processes unwanted material into substances that the cell can utilize. Lysosomes break down this unwanted matter via enzymes, highly specialized proteins essential for survival. Lysosomal disorders like mucopolysaccharidosis are triggered when a particular enzyme exists in too small an amount or is missing altogether.

MPS I is divided into three subtypes based on severity of symptoms. All three types result from an absence of, or insufficient levels of, the enzyme alpha-L-iduronidase. Children born to an MPS I parent carry the defective gene.
MPS I H (also called Hurler syndrome or α-L-iduronidase deficiency), is the most severe of the MPS I subtypes. Developmental delay is evident by the end of the first year, and patients usually stop developing between ages 2 and 4. This is followed by progressive mental decline and loss of physical skills. Language may be limited due to hearing loss and an enlarged tongue. In time, the clear layers of the cornea become clouded and retinas may begin to degenerate. Carpal tunnel syndrome (or similar compression of nerves elsewhere in the body) and restricted joint movement are common.
Affected children may be quite large at birth and appear normal but may have inguinal (in the groin) or umbilical (where the umbilical cord passes through the abdomen) hernias. Growth in height may be faster than normal but begins to slow before the end of the first year and often ends around age 3. Many children develop a short body trunk and a maximum stature of less than 4 feet. Distinct facial features (including flat face, depressed nasal bridge, and bulging forehead) become more evident in the second year. By age 2, the ribs have widened and are oar-shaped. The liver, spleen, and heart are often enlarged. Children may experience noisy breathing and recurring upper respiratory tract and ear infections. Feeding may be difficult for some children, and many experience periodic bowel problems. Children with Hurler syndrome often die before age 10 from obstructive airway disease, respiratory infections, and cardiac complications.
MPS I S, Scheie syndrome, is the mildest form of MPS I. Symptoms generally begin to appear after age 5, with diagnosis most commonly made after age 10. Children with Scheie syndrome have normal intelligence or may have mild learning disabilities; some may have psychiatric problems. Glaucoma, retinal degeneration, and clouded corneas may significantly impair vision. Other problems include carpal tunnel syndrome or other nerve compression, stiff joints, claw hands and deformed feet, a short neck, and aortic valve disease. Some affected individuals also have obstructive airway disease and sleep apnea. Persons with Scheie syndrome can live into adulthood.
MPS I H-S, Hurler-Scheie syndrome, is less severe than Hurler syndrome alone. Symptoms generally begin between ages 3 and 8. Children may have moderate mental retardation and learning difficulties. Skeletal and systemic irregularities include short stature, marked smallness in the jaws, progressive joint stiffness, compressed spinal cord, clouded corneas, hearing loss, heart disease, coarse facial features, and umbilical hernia. Respiratory problems, sleep apnea, and heart disease may develop in adolescence. Some persons with MPS I H-S need continuous positive airway pressure during sleep to ease breathing. Life expectancy is generally into the late teens or early twenties.
Although no studies have been done to determine the frequency of MPS I in the United States, studies in British Columbia estimate that 1 in 100,000 babies born has Hurler syndrome. The estimate for Scheie syndrome is one in 500,000 births and for Hurler-Scheie syndrome it is one in 115,000 births.

ERT (ENZYME REPLACEMENT THERAPY)

TREATMENT FOR HURLERS

Currently there is no cure for these disorders. Medical care is directed at treating systemic conditions and improving the person's quality of life. Physical therapy and daily exercise may delay joint problems and improve the ability to move.

Changes to the diet will not prevent disease progression, but limiting milk, sugar, and dairy products has helped some individuals experiencing excessive mucus.

Surgery to remove tonsils and adenoids may improve breathing among affected individuals with obstructive airway disorders and sleep apnea. Sleep studies can assess airway status and the possible need for nighttime oxygen. Some patients may require surgical insertion of an endotrachial tube to aid breathing. Surgery can also correct hernias, help drain excessive cerebrospinal fluid from the brain, and free nerves and nerve roots compressed by skeletal and other abnormalities. Corneal transplants may improve vision among patients with significant corneal clouding.

Enzyme replacement therapy (ERT) are currently in use or are being tested. Enzyme replacement therapy has proven useful in reducing non-neurological symptoms and pain. Currently BioMarin Pharmaceutical produces enzyme replacement therapies for MPS type I and VI. In July 2006, the United States Food and Drug Administration approved a synthetic version of I2S produced by Shire Pharmaceuticals Group, called Elaprase, as a treatment for MPS type II (Hunter syndrome).

Bone marrow transplantation (BMT) and umbilical cord blood transplantation (UCBT) have had limited success in treating the mucopolysaccharidoses. Abnormal physical characteristics, except for those affecting the skeleton and eyes, may be improved, but neurologic outcomes have varied. BMT and UCBT are high-risk procedures and are usually performed only after family members receive extensive evaluation and counseling.

Chiara Petersen Fox

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Sunday, 21 August 2011

21st August 2011 (Day 5 of Chemotherapy)

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