Delayed Intensification Phase

Here's the "road map" of Avery's treatments and all of the medicines she has to take on this phase. One day it may be a blurr to me and I may just forget. After all, we starting taking "roids" again and the doctor (and I) forgot to have her fill a prescription she's suppose to take with them. After getting back to Rachelle's I remembered and had to call them back. So here's what I "think" I know about this phase and her medicine Regimen. I always find out more along the way!

Phase 4 (Delayed Intensification) I've heard this is the worse one and it does look nasty!
56 days or 8 weeks long
Days 1-7 & 15-21:
*Dexamethasone pills (aka steroids) by mouth twice a day-4 in the morning & 3 1/2 at night (This is the first time we've tried pills and so it has been a process the last few days trying to teach her how to swallow pills especially since those pills are nasty tasting and although they're small there's lots of them.
*Prevacid taking every day with the steroids. (helps with heartburn)
Days 1, 8, and 15: Vincristine IV Chemo (push over a few minutes) and Doxorubicin Chemo (push over 15 minutes) Just love (ha-ha) to read fatal if given intrathecally or medication errors have occurred due to confusion between vinCRIStine and vinBLAStine. These are things I don't want to read about!
Day 1: Methotrexate (chemo) in her spine Because she was asleep for this procedure she also got a flu shot.
Day 4: Pegaspargase IV over 1 to 2 hours (We go back tomorrow for this one)
Days 29-32 and 36-39: Cytarabine (chemo) IV over 15-30 minutes
Days 29-42: Thioguanine (chemo) pill by mouth
Day 29: Cyclophosphamide IV over 30-60 minutes
Day 29: Again Methotrexate (chemo) in her spine.
Plus medicine for abdominal pain (Ranitidine), for nausea (Zofran), an antibiotic for pneumonia (Septra) given twice on Monday & Tuesday's, and medicine for additional pain.

Wow! I know I'll be glad when this phase is over and so will she! Poor thing! She must remember some from her steroids days during Induction. Evil me did video a few of the crazy "roids" moments, but never showed her . Anyway, yesterday she said, Mom, if I'm mean to my friends at school they won't send me to the principals office right because I'm on those steroids and they make me mean. My teacher knows right? Poor thing is worried about the roids too.
I remember a fellow cancer mom posted all the medicine regimen for the previous phases and I'm going to post them so I can remember all this fun! (Thanks Amy)

Phase one (Induction)
This phase is designed to put the leukemia in remission, which means no leukemia is detectable in the body.
She received a blood transfusion the night we got there and also platelets to get ready for surgery
29 days long
Days 1-28: dexamethasone liquid by mouth twice a day
Day 1: cytarabine in the spine and vincristine IV, surgically inserted power port for future IV's, bone marrow aspirate
Day 4: Pegaspargase IV (released from the hospital this day-after 6 nights there)
Day 8: methotrexate in the spine, vincristine IV (outpatient oncology clinic at PCMC)
Day 15: vincristine IV (outpatient oncology clinic at PCMC)
Day 22: vincristine IV (outpatient oncology clinic at PCMC)
Day 29: methotrexate in spine (outpatient oncology clinic at PCMC)
The main side effects she experienced during this phase were increased appetite (big time and didn't want anything sweet), woke up in the night to eat, irritated easily & moody, ignored everyone and didn't want to play. Avery had severe abdominal pain in her tummy and pain in her legs & heels. She had a really big tummy and round face from the steroids. Her feet and legs got so swollen she hardly walked. She lost a little hair toward the end of the month.
Phase 2 (Consolidation)
28 days long
Days 1-28: Mercaptopurine (6MP) pill by mouth once a day
Day 1: Methotrexate in spine, vincristine IV (outpatient oncology clinic at PCMC)
Day 8: Methotrexate in spine (outpatient oncology clinic at PCMC)
Day 15: Methotrexate in spine (outpatient oncology clinic at PCMC)
This phase I remember she was much happier and her appetite decreased. She wanted to play a lot more but was still a little swollen from weight gain (11 lbs). Her hair really fell out in chucks. She had very thin hair on top and a tiny pony-tail in the back. On July 4th, she finally broke down and buzzed it all off. Counts dropped big time after the 6MP chemo at home. It took us 4-5 weeks to start the next phase because her ANC count had to be back up at 750.
Phase 3 (Interim Maintenance I)
8 weeks long
Days 1, 11, 21, 31, and 41: methotrexate by IV and Vincristine by IV
Day 31: methotrexate in the spine too
This phase brought "some normalcy" as far as how Avery was feeling (well the new crazy normal) back into our lives. During this phase I was put on bed-rest, had baby Carson, Kelsi turned 2, Avery started Kindergarten and Carson was blessed at church.
Phase 4 (Delayed Intensification) This is the phase we just started so I wrote about this up above.
Phase 5 (Interim Maintenance II)
8 weeks long
Days 1, 11, 21, 31, 41: methotrexate IV and vincristine IV
Days 1 and 31: methotrexate in the spine
After this she starts maintenance phase and I don't have a lot of details about this one yet. On Friday at treatment I quizzed the nurse, Jason. Sounds like we'll go once a month and then every 3rd month she'll get lumbar puncture with Methotrexate in her spine plus take the 6mp chemo at home every day.