"Little kids get sick all the time!" thought Nyree George, as she gave her two-year-old daughter, Sandra, the antibiotics for her ear infection.
She thought the same thing as she gave Sandra another course of antibiotics for the urinary tract infection that soon followed. Sandra had been on a healthy holding pattern, but Ms. George decided to take Sandra in for a quick check-up. "My intuition was telling me to take her in, just to be on the safe side." Though she didn't know it at the time, her "mother's intuition" had just saved her daughter's life.
Sandra's pediatrician took blood samples and ran a complete blood count (CBC)-a common yet comprehensive blood test that is able to detect blood diseases and disorders such as anemia, infections, clotting problems, blood cancers, and immune system disorders. When the results came back, the George family's phone began ringing. Sandra's blood showed the presence of cells that were suspicious for acute lymphoblastic leukemia. "The doctor said to get to the New York Methodist Hospital emergency room immediately, and referred us to the care of Revathy Sundaram, M.D., chief of pediatric hematology/oncology."
"Lymphoblasts are immature lymphocytes, the type of white blood cell responsible for fighting certain infection," explains Dr. Sundaram. "Typically, lymphoblasts account for less than five percent of the bone marrow. When I first met Sandra, her lymphoblast count was
greater than eight percent, which points towards a cancer of the blood known as acute lymphoblastic leukemia (ALL).
"Lymphoblasts grow aggressively, taking over the marrow and suppressing the production of normal mature blood cells. In order to make a definitive diagnosis, however, we needed to perform a bone marrow aspiration-a type of biopsy. The results unfortunately confirmed our initial diagnosis-little Sandra had ALL."
"It was the worst day of our life, hearing the news. The rug was completely pulled out from under us," recalls Gilford George, Sandra's father.
"We didn't have a lot of time to sit with it, though. Due to the fast-moving nature of ALL, Sandra needed to begin treatment immediately. Hours after we learned of the diagnosis, Dr. Sundaram was walking us through the treatment process and what we should expect. Needless to say, our heads were spinning."
ALL is the most common type of cancer in children. The chances of remission are very good, but its treatment is rigorous. An intensive chemotherapy protocol was prescribed for Sandra, and it was essential that it be initiated immediately. "Chemotherapy for ALL usually consists
of several phases," explains Dr. Sundaram. "First is the intense induction phase, the goal being to kill as many cancer cells as possible over a four-week period of time. We try to essentially 'blast' the cancer into remission. The second phase, consolidation, continues to fight cancer cells in the marrow, but also acts on the central nervous system and kills any cancer cells that may have entered the spinal cord and/or the brain. This second phase lasts about six weeks, followed by the interim maintenance phase-a period of rest with lower doses of chemotherapy, and then by an intense phase of therapy called re-induction/consolidation.
"The final phase, maintenance, lasts for two to three years and essentially keeps the leukemia under control. Throughout all phases, the patient is monitored closely with physical examinations and blood tests to ensure that the leukemia has not recurred."
"I am not going to say that it wasn't tough to see her, for weeks on end, receiving chemo in the pediatric intensive care unit," says Ms. George, "but the staff on the floor made all the difference.
The nurses helped make a difficult situation as comfortable as possible, not only taking excellent care of Sandra, but of me and my husband as well. They brought care and light to some dark times.
"Sandra is able to receive her outpatient maintenance chemo at the Hospital's Ambulatory Infusion Center, which is so helpful in terms of logistics. All of her health records are accessible and Dr. Sundaram can seamlessly communicate with the Infusion Center staff. The staff works hard to make Sandra as comfortable and happy as possible when she is there. Going so often, Sandra has built really positive relationships with the staff, and they are truly lovely. As a parent, I so appreciate that.
"I am delighted to report that Sandra has been in remission for almost two years now. There have been some setbacks, but she has soldiered on.
She has gone from a two-year-old cancer patient to a four-year-old ball of energy with a crush on Justin Bieber. We still have a few months of maintenance ahead of us, but with kindergarten beginning, cancer is the last thing on Sandra's mind. Just the way it should be."
Read this story, other inspiring patient stories and more in the Annual Report to the Community 2012-2013.
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