anna's blog

Our beautiful, gorgeous little girl, Anna, has leukaemia. She was diagnosed on Monday 5 December 2011.

Anna’s new wheelchair

20140413-110524.jpgAnna finally has her new wheelchair. We’ve tried several times over the last year to collect it but Anna had always had either an infection or a broken bone and we’ve been unable to travel.

We went down to Cambridge on last Sunday and spent all day at Dragonmobility on Monday doing final fittings and checks.

It’s bright pink, sparkly and absolutely gorgeous!!

Thank you Dan and Lou for such an amazing chair. And thank you again to every single person who helped raise the money for this chair. The difference it has made to Anna is almost indescribable. She has mobility, independence and freedom. X

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2 special certificates

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Anna was awarded the ‘pupil of the month’ certificate at school last week.

An achievement for any pupil, but in Anna’s case also marks the fact that she has actually completed her first full month at school.

Her second special certificate was for today’s trip to theatre at sick kids. We were here for 8am to have bloods checked, assessment by doctor/anaesthetist and then under general anaesthetic by 10am. She had a lumbar puncture and chemotherapy injected into her spine and brain fluid.

This one is so special because it’s her last one. She has now officially had her last chemotherapy dose. She’s still on daily anti fungals and weekly antivirals.

We are spending all day at sick kids because after her theatre trip, she’s having her 4 hour pomidronate infusion (to strengthen her bones). She currently has no fractures and seems really well.

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2 different but both very significant events. I might have a small celebration tonight!
Well done, Anna.

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Hospice and Hospitals

20140224-230603.jpgWe seemed to spend most of last week in one or other of the above – both planned and unplanned visits.

We are very lucky to be supported by Rachel house Hospice, in Kinross, part of CHAS (Children’s Hospice Association Scotland) and get to go there several times a year for a short break. As the children were on holiday Monday and Tuesday last week, I booked a couple of nights from Sunday onwards.

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When we are there, I feel like I can be Anna’s Mum again instead of her nurse/physiotherapist/occupational therapist/carer etc. as everything is done for her. I get to sleep for a whole night without being woken by Anna (I’m always so tired from interrupted sleep). I don’t need to use a hoist several times a day to take her the toilet or to give her a bath. I don’t need to give her medicines – the nursing staff will make sure she has them and keep an eye on her temperature. I don’t have even have to help her with her food – she has somebody with her the whole time to look after her. And Anna just gets to be like any other five-year-old girl – doing arts and crafts, chasing people up and down the corridors, watching TV and just generally having a fantastic time. When she is doing all that, Nathan gets to chill out with Xbox or PlayStation or just spend some time alone with me. I always take a book with me as its one of the few places I get a chance to read.

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A huge thank you to CHAS and all the team who work there. It makes such a difference just knowing we can have a few days there every now and again.

Once we got back on Tuesday, we headed straight down to St John’s Hospital in Livingston to collect her new leg splints and (for the very first time!) school shoes. Because Anna isn’t weight bearing at all ie standing on her feet, there is a very real risk that the muscles in her ankle will start to contract and she will lose the ability to move her foot. The splints keep her feet as close to a 90° angle as possible so that when she can (hopefully) start to weight bear again, her feet will still go into the right position. Her new pair are pink and covered in a butterfly design – all these little aesthetic touches make it a bit easier for her.

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However, the splints are so bulky that is almost impossible to fit normal shoes over them. The orthotist agreed to order some specialist shoes and Anna is now the proud owner of black shiny patent shoes. They have to be several sizes too big to fit over the splints but even so they look fantastic!

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Wednesday was Anna’s last official intrathecal (general anaesthetic for chemotherapy to be injected into brain and spinal fluid), along with her bone marrow sample for end of leukaemia treatment. It means an early start – we have to be a sick kids in Edinburgh before 8 o’clock in the morning – and we are usually there until mid afternoon. Although officially it’s the last one, we still have one to catch up next month as she missed several because she was so ill at times. We normally try to do her 4 hour pomidronate infusion (bone strengthening treatment) on the same day, to cut down hospital visits, but we are slightly out of sync so will have to go back in a couple of weeks It’s a logistical challenge every time – making sure Nathan has someone to look after him in the morning when I take Anna in, and making sure I will be back before he comes back from school.

Anna was back at school on Thursday. I got a call mid morning asking me to come down as Anna had caught her arm under the table. For most children that wouldn’t be an issue – probably the worst that would have happened was a bit of bruising. But for Anna, who fractures without even touching things sometimes, it’s more serious. I checked her temperature before giving her some paracetamol and she insisted on finishing the day in school. Her arm continue to hurt overnight but she insisted on going to school Friday morning (golden time is so attractive!). However as it was still sore Friday afternoon, we headed into A&E at sick kids and went through the usual routine – assessment, x-ray, cast. They all know us very, very well by now. Anna has a lovely removable cast – it’s the first time we’ve seen this. It was fitted and then cut and Velcro put on so we can actually take it off for short periods if we need to. It does make a big difference. It’s on for a couple of weeks. She wasn’t keen on me taking a photo.

Mum and Mary came and took me out at the weekend and I also had a wonderful pampered chef night out on Saturday. All much needed!

Just a normal week.

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Back home

20131207-141405.jpgAnna is back home. The newest spot didn’t develop further, all the other ones have reduced so she’s been allowed home continuing with oral rather than IV antiviral medicines.

Fingers crossed that her shingles don’t come back.

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Shingles, fractures and steroids

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Anna is still in hospital. She’s now had a further two weeks of intensive anti-viral treatments, with the accompanying hyperhydration and anti-sickness drugs. Yet she still has shingles, with a new spot appearing even yesterday. IV acyclovir is generally the most effective treatments for shingles But for some reason it doesn’t seem to be working effectively for Anna. We are currently waiting on the results of blood tests to check how she is responding to the aciclovir.

She has her sixth fracture of the year – in her left ankle. Her bones are now so incredibly weak that the slightest trauma can break them. It’s the result both of being non-weight-bearing and also the steroid treatment. We are trying to use the hoist for any kind of moving and handling. It’s the safest way to do it.

Anna’s recurring infections (potentially life-threatening) and increasing incidence of fractures mean her consultant and medical team have finally come to decision that she will have no further steroid treatment. She would have been due a further five steroid doses before the end of the leukaemia treatment. I’ve found it a really difficult decision and I’m getting emotional again even when I write this. I just want to feel we’ve done absolutely everything to beat the leukaemia. There’s no point in having strong bones and no infections if she doesn’t survive the treatment. I trust the team and know that this is not been an easy decision and there has been a lot of thought and discussion. It’s still hard though…

Nathan is struggling. He’s missing me and he’s missing Anna. I’m so lucky to have good friends who will take him in the morning and after school (thank you Aileen, Louise and Courtnay…) but all he really wants is to be home in his usual routine. I’m making a point of trying to drive back from the hospital to pick him up from school and then bring him back to the hospital so at least he can see me and Anna. And granny, grandma and Clare are all helping out to allow me to do this.

Princess Anna, as she now wants to be known, is on really good form, despite all the difficulties. She is very clear about what she wants, makes people curtesy when they come into the room and and scores them and me for how
well we’ve hoisted her.

I really hope we see improvement tomorrow. It feels like this is never going to end but I know that it willl.

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More shingles and another fracture

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Anna’s shingles looked like they were beginning to clear up by the end of last week so she came off her aciclovir (anti-viral medication) and hyperhydration. Everything seemed okay but then over the weekend new spots appeared. So, on Monday she went back on the aciclovir. The anti-sickness medication continued and she’s back on hyperhydration (aciclovir can be quite toxic to the liver so they hyperhydrate to flush it through). It might be another five day course or longer – it depends on how quickly the rash starts to clear up.

Her gripper site (where the gripper needle plugs into the port-a-cath under her skin to give her medicines and fluids intravenously) has shingles around it and was inflamed, bleeding and oozing fluid. Her gripper was taken out for a short period to see if it could recover. If not, she would have needed a cannula in her hand. Neither reinserting the gripper into a sore and open wound or having a cannula put in were attractive options. However, she needed one of them done as otherwise she wouldn’t be able to have anything intravenously. so she was very brave and had the gripper put back in. I think it was very, very sore

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Anna’s bones are so thin and weak that slight pressure exerted in the wrong place can cause a fracture. She woke up on Friday morning with a sore knee. The doctor examined it and she was sent to x-ray. Although initially there was no sign of a fracture, closer inspection revealed a small undisplaced fracture just above her knee in the growth plate. So although the cast on her arm was taken off on Friday, she was only cast free for about an hour. After a lot of discussion with the nursing team we now have a very detailed care plan in place specifying exactly how she is to be moved for toileting or going into her wheelchair, specifying how many people are involved and when the hoist is to be used.

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The daily weekday routine includes a visit from the hospital and outreach teacher, a session with the physiotherapist, discussion with others such as the dietician/dentist, a visit from various doctors (oncology, orthopaedic, general registrar) as well as regular medication (she is currently on metoclopramide for sickness, Oramorph on request for pain, cholecalciferol – vitamin d, posaconazole – antifungal, aciclovir – anti-viral, potassium – blood levels are low) and observations. She is also still having an overnight feed through her NG tube as her appetite has not picked up.

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Her red blood count is still low so she has had 2 blood transfusions in the last week. Her platelets are extremely low so she has had a platelet transfusion. She is neutropenic (her neutrophil count lower than one so she is unable to effectively fight infection). Her liver function has not been good but has not deteriorated further.

Despite all of the above, she is mostly smiling, laughing and singing. She’s in bed tonight with everything she needs – her new doll Emily (thank you Jim), piggy, sick bowl, NG tube with feed, IV tube with fluids and Disney princess blanket.

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Some smiles

Anna has been much, much better today.

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She is allowed out of isolation so we’ve been to the shop and chosen a magazine and even been out of the hospital to get a chocolate muffin from the deli.

Tuesday’s X-ray suggests her fracture is healing well.

There has been no vomiting, plenty poos and lots of eating and drinking.

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All the swabs, infection screenings, blood tests and urine/bowel samples have revealed no infection. There is still no real idea of what has been wrong – most likely an unidentified bug – but there is an underlying concern about the similarity of her symptoms to previous significant episodes (that seems to be the medical term for terrifying, life threatening incidents, of which we’ve had a few), in particular the low blood sugar level. So Anna will be referred to the metabolic team. I think she has already been discussed within the endocrinology team. I don’t think there can be many teams at edinburgh royal hospital for sick children who haven’t seen or discussed Anna. Certainly she is known to neurology, oncology, orthopaedics, respiratory, endocrinology and metabolics.

Tonight, she has had a lovely bubble bath and is sleeping soundly.

Despite trying hard not to, she smiled several times today.

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…and back into hospital…

Since being discharged on Monday, Anna has continued to feel really sick.

Although her temp is fine she is clearly not right. Her fracture is still sore, as is her tummy. Her skin is itching and she constantly says she can’t get comfy. She feels nauseous from the moment she gets up right through to going to bed. We’ve tried going to nursery and tried staying at home. She feels sick wherever she is. And going out any distance in the car almost guarantees vomiting. The general feeling is that there is impacted poo in her bowels which is building up higher and higher.

She is taking anti sickness medication ondansetron and metaclopromide, laxatives lactulose and movicol alongside her usual daily cocktail of drugs, but often struggles to keep them down. I’ve been in regular contact through the week with ward 2, keeping them updated, and they’ve been happy for us to manage it at home as she was still taking enough fluids and food. However on Friday, she was sick every time she had anything to eat or drink so we headed back into sick kids.

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She’s now on IV fluids, and additional, stronger laxatives and anti sickness are to be given. We are about to go down for an ultrasound. The doctors know that Anna has a high pain threshold (she lived with an undiagnosed fractured femur for 2 weeks) and also can become seriously ill very quickly. So they are being ‘extremely cautious’.

Anna is keeping herself as still as she possibly can, presumably to limit her nausea. Like many children, she instinctively knows what to do when she feels ill.

I don’t think she has smiled all week.

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Still sick

Anna is still in sick kids and feeling thoroughly miserable. After being admitted through A&E on fri night, she was put on ward 4 (not the oncology ward) as the hospital was so busy. Peter stayed that night and then I took over yesterday. She was moved to ward 2, where we always feel much more comfortable as they know Anna so well (although we are spending so much time on other wards other staff are getting to know Anna!).

Her temp has been below 38 degrees for 24 hours. The pain from her fractured femur is being effectively managed by morphine and she seems more comfortable but she is still being sick. She is having intravenous fluids through her portacath, and continuing to have her daily chemotherapy dose of mercaptopurine, as well as voriconazole for the previous fungal infection. Her stomach is very bloated and has been for a while now. It could be constipation from the variety of drugs so she is having laxatives. She has started vitamin d supplement and will also now have omeprozole to counter any stomach acid problems.

All Anna can think about is her next meal. She has been asking what will be for tea since 10am.

Nathan had a lovely afternoon at Neil and Courtnay’s fundraising talent show (thanks everyone for a superb effort!!!) and was then picked up by Peter when he returned from the hospital. Nathan knows the routine when Anna is in hospital. He enjoys getting to choose a sandwich and drink from M&S and eat it in the Anna’s cubicle during handovers.

Weekends in the hospital are much easier to manage than weekdays, when Nathan has to be got to and from school as well as someone being in the hospital with Anna during the day. Hopefully this won’t be a long stay…

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41.2 degrees

Anna is still in hospital and will be for at least another week, unless there is a dramatic improvement. Peter and I alternate staying nights and weekend days, and I cover most of the week days. It is a constant challenge to look after Anna in hospital and Nathan at home, managed with a huge amount of help from lots of you…

Anna’s temperature continues to be extremely high, as you can see below in her temperature and heart rate charts for the past few days. The temperature is the top chart in the pictures and heart rate is the bottom one. Normal body temperature is around 37 degrees (you can see a black line for this on the chart) and anything above 38 degrees is fever or pyrexial. The black dot in the vertical axis of the temperature chart is 38.5 degrees.

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You can see the dips on the chart when she is given paracetamol. Her temperature dips for several hours until it wears off, then goes straight back up again. A lot of her temperatures are recorded at 40.4 because that is the highest that the tempa dot strips go up to. It is probably higher than that. Her last temperature was 40.4 on the strips but 41.2 on the tempanic (ear) thermometer.

Her blood counts are very, very low. Haemoglobin is still around 70 so she has had another blood transfusion. Her platelets and neutrophils are almost zero, and white blood counts around 20.

The medical team are still working to find the cause of the infection but have also considered that the fever and accompanying shakes could be a side effect of one of her (many) drugs. The anti fungal drug she was taking, ambisome, can cause fever and shakes so that has been replaced by another antifungal. She is on several intravenous antibiotics, some specifically for respiratory infections and some more broad spectrum. She is also on drugs to maintain her potassium levels, which had been low, multi vitamin/minerals, and a range of others on demand to address either pain (codeine) or any side effects from the others (eg ondansetron for anti sickness).

She is still quite unwell but not causing the same kind of concern as last weekend. However, it is clearly not good for anyone to have such a high temperature for such a long time, especially a 4yr old girl.

As well as continuing to search for the source of infection, the medical team are now also trying to identify the anticipated progress of the infection. If there is no change, she will have another general anaesthetic on Wednesday and a bone marrow biopsy. The biopsy should show if her blood levels are due to improve or not. Of course, they will add in any other procedures while she is under a GA such as taking a sample of the fluid from the still unidentified lump in her neck and fitting her splints.

The splints are to avoid contracture in her feet. Because she is using her feet and legs so little, there is a very real danger that her ankle muscles will shorten and become resistant to any stretching. So she may regain strength sometime in the future but her feet wouldnt work. She has had splints cast, which she did not enjoy, and it would be easier just to put them on her while asleep.

Anna didn’t want any photos taken for the blog today (she really is feeling rubbish) so I’ve put some in from before her leukaemia diagnosis.

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