June 24: Day -8

Today's entertainment provided by... Mickey Mouse!

I have to laugh. There is a really big day-at-a-glance calendar in our room. It says TODAY IS... then shows the number REALLY BIG. So I am looking at a giant TODAY IS 24, then under that reads Thursday. Under that reads June, 2010. Why am I describing this to you? When I first walked into the room, I thought, what good does that do Bella? She can't read! Now, just three short days into this journey, I realize, IT'S FOR ME!

Time is a paper construct that we all relate to like concrete.

Minutes of the hour, hours in the day, days of the week, they all just fizzle away on this side of the world. Yet, on the outside, I rush through traffic to catch every green light thinking, "Every second counts." I am the architect of my own anxiety. Aren't we all?

Today was a good day! Mommy and Ali went to the annual "Turtle Derby" outside in the plaza. This is a giant fundraiser the hospital does each year where they race... turtles. It's quite possible the funniest thing I've ever seen. Picture this: A blue tarp on the ground that spreads 12 feet long by 12 feet wide. On this tarp is painted a giant circle, like a wrestling ring about 10 feet in diameter. In the center, there is an inner ring maybe 3 feet in diameter. Now picture a 12" tall cylinder that sits atop the inner ring. The turtles are placed inside this holding pen, then, when the announcer starts "the race", the pen is lifted off and the turtles take off in all different directions at once. The first turtle to cross the outer ring in its entirety is the winner. All the departments and nursing units raise money to put a turtle in a heat representing them. It is pure comedy. Then, add dancing, clowns, kids, food, and you have a good time. They even televise the event so we could watch it up in our room.

Needless to say, what's the first thing I see when I turn on the TV? Ali dancing with a clown. Awesome.

Then, Ali went off on an all-day play date with my friends the Spectors. They are sooo great. Logan is my childhood friend from CT who became a researcher of childhood cancer here at U of M. He knows Dr.s Tolar and Wagner. Anyhow, they have just opened their family up to us so generously, we are so grateful. Ali went to the pool, then got to go to soccer practice with the Owen and Ellery! That made daddy very happy!

Ang and I did our afternoon dressing changes with Bella watching an endless loop of Mickey Mouse Clubhouse. The great thing about kids DVD's is that they feature a "Loop Play" or "Repeat Play" feature where it just starts over, and over, and over... and over. This is good for dressing changes because Bella doesn't care! She was sooo peaceful during bandages today. Not a peep. All without any pain meds as well. It is only day 2 of busulfan, so she is not experiencing any side effects from the chemotherapy yet. I tell you, when we do her bandages, there is a serenity that comes upon her. It often leaves as soon as we are done, too. She will either become more animated (or angry!), but it's usually after, not during. I tell you, it IS as if she knows this is all central to her plan. I had the experience today while doing her dressings of being totally and completely present in the moment. There was no world "out there." There was no "Thursday," no "June". Just me, Ang, and Bella, together. This is why I want to thank Erin, Logan's wife, again, because I knew Ali was happy and safe. It allowed me to just melt into the moment. Bandage changes used to be stressful. Now they are sublime moments of care, compassion, and tenderness. I only wish Ali was bigger and could participate in it more, but alas, it is all simply perfect as imperfect as it is.

Bella ordering dinner for daddy...

We headed off the night-time anxiety attack by giving Bella some happy meds (ativan) with her nighttime bottle. This kept her out long enough to slip into a deeeeeep sleep. We also did all her meds in the bottle, and did vitals before the bottle so once she fell asleep there would be no poking or prodding. We get better every day.

Before the meds...

... and after!

Now it is time for sleep. The moment by moment management of Bella's tentacles has left my brain quite tired. She has a lot of lines coming out of her body with pointy valves and connectors. Some of them really tore up her back and aggravated her belly during last night's fits, so great care is given to make sure she avoids unnecessary contact with them. Having Epidermolysis Bullosa and a belly full of sharp valves, lines, and tubes does not make for a good combination!

Thank you again for your comments. You give us so much strength; I hope my words of gratitude somehow capture a glimpse of how GOOD your comments make me feel when they hit my phone throughout the day. Ang and I call each other throughout the day and talk excitedly about all the different comments. We feel so... cared for. Thank you again, and good night.

Last Night Home...

... and when I say home, I mean the Ronald McDonald House. Tomorrow at 11:00 am, we admit Bella to the hospital, and she will begin her treatment immediately. I met today with our social worker, Janet, who is AWESOME, as well as a representative from a volunteer group called Care Partners. They assign a volunteer to the family for the entire journey who is kind of at our disposal. Laundry needs doing? They're on it. Groceries? No problem. Hang out with the girls while I play soccer? Easy. Support, baby support. It's all about having enough support to counteract the immense increase in stress on the family, both individually, and collectively.

Ali's craft work while I met with Janet

Last, but not least, I met with Dr. Wagner today. He's the head researcher on this trial and quite the guru in curing incurable diseases. He is great. No ego whatsoever. We spent an hour going over all the risks and benefits of the trial for one last time to make sure we are clear about what we are getting ourselves and Bella into, and realistically what can we expect to get out the other side.

How to keep a 4 year old preoccupied...

His tone was more measured than in January regarding promise for the protocol being a possible cure. Today, her referred to it repeatedly as "A first step." That really wasn't that cool to hear the night before we're admitting our daughter, but, 6 months have passed and a lot has happened since then. The hard truth is that out of the 10 transplants that precede us (number 11 gets transplanted in three days, and we are number 12), 2 died, and 1 experienced graft failure, but miraculously grew his/her own white blood cells back. That isn't supposed to happen, so that patient is really lucky to be alive. That leaves 7 other patients, and their results range quite a bit in terms of reduced acuity of the disease. So, when you are on the front lines of a new treatment, anything's possible. We accept this and are frankly grateful that Bella is only 12 months old and participating in this rather than 12 years old. We do know that for the majority of the 7, there has been improvement in their skin. How much ranges the entire gamut.

The master artist at work in her shop...

Let me try to break down succinctly if I can what is going to happen. Here's the deal: Bella is going to receive 8 days of intense chemotherapy to effectively clear out her own bone marrow, and completely eradicate her body of any immune system whatsoever. Then, she'll have a day off, and following that day off, the docs will pull bone marrow out of Ali's hip bones, and through a simple blood transfusion, give it to Bella. Now, the idea is that Ali's marrow will start producing stem cells that will turn into new blood cells, and a new healthy immune system. But more than this, the stem cells go to the skin, where the area of injury lies, and these stem cells start to generate new skin cells as well as blood cells. This is where this trial is the first of its kind. Normally, BMT is done for cancers of the blood, where the injury is in the blood and marrow. Not with Epidermolysis Bullosa. The stem cells somehow "know" that the skin is where they are needed so they home in on the wounds and generate healing previously never seen in the patients.

So, this means that all the areas of injury on Bella's body currently will potentially get an infusion of healthy new skin so that these areas no longer blister and wound as easily in the future. Here's where it gets interesting: What about the areas that have no wounds? Well, they aren't included in the equation. Somehow, the trauma sites send out a signal calling for back-up, so to speak, but the uninjured areas have no reason to send that signal (yet) so the stem cells don't go. However, once a site injures for the first time (anytime after transplant), the stem cells will then get in gear and head to that site to increase healing.

We brainstormed about several different subtleties about this disease, and during the conversation, what struck me was that Dr. Wagner is so far down in the trench... literally into the micoscope, with this particular protocol, that he hasn't yet delved into other more global questions about EB that surface when you theorize about what is next AFTER this. At one point, I suggested what I see as a future evolution in treatment, and he looked at me point blank and said, "I never thought of that!" That was fun. Brainstorming with Dr. John Wagner. Sweet.

How to make sure your kid doesn't take a header off the bed while you pee...

So, tomorrow begins the year-long walk down a very dark tunnel to emerge out the other side with a brighter future for Bella. I say year-long, because realistically that is how long it will take her immune system to be back on line firing on its own cylinders. Until then, we walk a dangerous road, hoping to avoid graft failure (Bella's blood attacks Ali's blood), Graft verus Host Disease (Ali's blood attacks Bella's), and infections as best we can.

This is where that time-honored struggle of control kicks in again. How to do everything possible, fight every battle, take every necessary step, and yet KNOW that it is totally OUT of our control while we weigh decisions that APPEAR to demonstrate that we ARE in control... what a conundrum. I like the phrase, "God is in the results business." We are in the process business. If we just do the best we know how, then turn it over to God, it's really the only way to manage any sanity throughout this. This is when I am grateful for my Faith. See, my faith is of my own volition. It is not anyone else's faith. Others may believe similar things I do, but at the end of the day, I CHOOSE to have faith. No one gives it to me, and no one can force it upon me. Consequently, no one can take it away from me either. It is literally my own creation, and since it is such, I create a faith that empowers me, strengthens me, inspires me, motivates me to get out of bed and face my terrifying fears head on. Without this asset, I wouldn't have the ability to get out of bed in the morning. The fear I am experiencing going into tomorrow is far beyond anything I have experienced in my life.

So, what do I have faith in? What do I believe?

I believe Ang's and my love for each other deepens every day we walk through this together.

I believe that Ali's character deepens every day she is Bella's big sister.

I believe that Bella knows exactly why she is here. She just smiles blissfully at us while we labor over her bandage changes as if to say, "ah, yes, this is why I chose YOU... because I KNEW you would do a good job with me."

I believe that I will be pushed past what I thought I was capable of and thus know myself as enhanced, increased, and upgraded from my previous image of my self.

I believe that Bella will inspire many, many more people, and that this was her plan all along.

I believe that God has the answers, and I believe that I ask him pretty good questions.

I believe that one day, Bella will look back on all this and say, "Yeah, I was born with this rare skin condition, but when they brought me home from the hospital, it went away."

What do you believe in?

We're Back Home!

Well, we are back home from snowy, cold Minneapolis. We had a BLAST! First off, after you've lived in extreme temperatures ( like Phoenix ), extreme cold isn't any different than extreme hot. You know as you are walking out the door that you are about to be slapped with a temperature your body won't like and can't tolerate for very long without being properly prepared. The nice thing about the cold is you can bundle up. In the desert, you can't "bundle down" to cool off, you just dehydrate and burn to a crisp. However, in the desert, you don't have to shovel heat, either.

okay, enough about the weather.

On to... the GOOD STUFF...

We met with the good Doctor John Wagner. Here is his title off his business card:

Director, Pediatric Hematology/Oncology/ Blood and Marrow Transplantation

Scientific Director of Clinical Research, Blood and

Marrow Transplantation and Stem Cell Institute

The University of Minnesota has been doing Bone Marrow Transplants (BMT) since the sixties. They are the leader in the field, and he's the head hancho. His Curriculum Vitae is quite impressive, yet, he doesn't have the ego that you would expect. He's a researcher, and a teacher. So, when he explained what he is accomplishing in this clinical trial, I could see the wheels spinning in his head. He has a child-like passion for what he does. What does he do? In his words, "I cure incurable diseases."

That rocks.

So, we spent 2 hours together where he presented his results up to date, then answered all our questions. I had two pages of questions for him, but admittedly, when it came time for Q&A, he had already answered most of my questions in his presentation.

We talked about so much, it's honestly hard to recall specifics. Also, I can't talk about the results of the research as it is currently being peer reviewed for possible publication. What I can say is that we feel extremely confident in him, and in the U of M staff. He has broken into uncharted territory with his research. Don't go around using the word "cure" as it would not be appropriate at all, but you can say that his results have never been done before with an EB patient.

We told him we were going to Columbia U. to discuss their "reduced intensity" BMT clinical trial as well. He gave us a few questions to ask and shared his honest thoughts about their multi-site trial that has just gotten rolling. Columbia will get their moment in court to "sell" us on why their trial is better, but Dr. Wagner is really the guy they are trying to imitate. He knows more about BMT for EB than anyone on the planet, so they have their work cut out for them to convince us to go to NYC instead of MN. Having said that, we're adamant about going and doing our due diligence. Leave no stone unturned.

Metaphorically, I wish there was another way to rebuild the engine without having to strip it down so far. However, when Dr. Wagner explained that they have successfully done BMT on FETUSES IN THE WOMB because you can be BORN with cancer, I realized that it's simply a point on a line... a line of treatment where researchers are looking for new, less invasive ways to treat these diseases, but have yet to make the breakthrough that will ultimately leave this treatment in the history books. So many other breakthroughs HAVE occurred in so many areas, it is simply a matter of time. However, here we are NOW, and not 5, 10, or 20 years from now. Lucky for us we ARE here now, not 5, 10, 20 years ago, when there was NO chance for an RDEB kid to have a shot at living a "normal" life.

The trip was especially fun because we got to have dinner with one of my childhood friends, Logan Spector, who is a pediatric epidemiologist at U of M. He's been there for almost 10 years now and knows and works with Dr. Wagner. He invited us to his home and we met his wonderful wife and two children. We also met Lonni Mooreland, who is the mom of patient #2 of the trial. Unfortunately, little Sara passed away due to complications from a weak heart; a condition she had since shortly after birth. She and her husband, Jay, are the ones who have started PUCK, a charity to raise money for Dr. Wagner. www.puckfund.org. Check it out. We will be partnering with PUCK with the release of Bella's book in the very near future. Anyhow, It was nice to connect Lonni and Logan since they both work with Dr. Wagner. Also, Lonni and Jay have moved to MN recently, so it's always nice to know someone new in town. The most tender moment of the night was when Lonni was leaving.

She said, "Thank you for inviting me, Tim. I was surprised you even wanted to meet me."

It dawned on me that she felt that we wouldn't want to meet her since her daughter died in the same study we are considering our daughter for. Somehow, it might scare us or remind us of the danger of the study. What I am reminded of is the sad fact that ANOTHER EB child passed away last week, bringing the total to 4 since December 1st. This disease claims its patients in far more ways than through experiments to find a cure.

I couldn't believe what Lonni said; that's the last thing I would think. Thanks to working on the Grief and Loss Retreat with my colleague Mauro and my Mom, I was able to quickly share with her how tough the grieving process is in our "afraid-of-death" culture. I was able to validate her experience and reinforce that the insane feelings she is having are in fact normal. It is our "feel-good-all-the-time-at-all-costs" culture that is totally insane. We are so completely cut off from the experience of death that we don't have a clue how to handle it.

She just looked at me, a little incredulously, as if to say, "You actually GET IT." Then, she said, "Thank you, I feel like I had some therapy tonight!"

By the way, U of M mascot is called "The Gopher." Wanna know why? Because just about the entire campus is connected by above ground skyways and underground tunnels. The farthest we walked outside the whole time was from the car to Logan's front door. No lie. Applebee's delivered breakfast to our door each morning. Starbucks was located in the lobby, and the hotel was connected to the medical center. Add Valet parking, and we hardly felt the sting of the cold. I did leave my Starbucks in the car Wednesday night by accident and here's what it looked like the next morning...

Ice coffee, anyone?

Anyhow. We feel great about U of M. If this is our path, it will probably happen this spring/summer. We don't want to wait. EB is too dangerous. Also, the younger the patient, the better the chances. This is our year! We know there will be much in store for us, but we genuinely had a good feeling up there in Minneapolis; a feeling that said, "We can do this."

Thanks for being there with us. We felt you.

Thanks to Grandma and Grandpa for watching Ali and Lucy as well as for donating their miles for plane tickets.

Thank you to Aunt Marie and Uncle Tom for their INCREDIBLE contribution.

Thanks to our friends at Harbor Christian Church for their generous contributions as well.

Thank you, God, for delivering us to and from MN right in between nasty storms. Thank you for Dr. Wagner, and thank you in advance for Betty Ann, the financial counselor at U of M, who will be getting full inpatient and outpatient approval for us from our new insurance provider (we pray!)

Friends, Family, Faith.

Always remember the Three F's. We are so blessed to be lifted up by all three simultaneously. That is not always the case in life. You are blessed to remember to lean on any one at a time, but three, we are very blessed, indeed!

God Bless You All,

Good night.

We're On Our Way To Minneapolis!

Daddy and Bella at Uncle Steve and Aunt Dina's

Pack your parka, baby! Oh - wait - we don't own parkas living in Southern California!

We are packed and hanging out at grandma's house, ready to hop on a plane first thing in the morning. We head off to Minneapolis by way of Chicago for a consultation with Dr. Wagner at the University of Minnesota Bone Marrow Transplant Center. Check out this Providence Story of the day...

We had been planning on staying at the Ronald MacDonald House in Minneapolis, but the way the RMH works is you get your name on a list, then call the day before to see if there is room. Well, I called today and they informed me there was no room at the inn. So, I remembered that in one particular email from U of M, there was a link for accommodations. I called the phone number, and a kindly gentlemen gave me the info on two hotels that give a discount for patients and their families. One is the Radisson University Hotel. Turns out the Radisson is closer to the building we will be going in on campus than RMH. RMH is a 6 block walk, while the Radisson is diagonally across the intersection from the building we'll be in! Then, while on the phone with my childhood friend Logan (who works at the medical center), he explained that there is a tunnel that connects the two buildings! We don't have to even go outside to go to the Doctor appointment now that there is no room at RMH!!! Grandma and grandpa informed us today that the temperature in Minneapolis today was -9 degrees. 6 blocks in -9? NO THANK YOU!!!! Boy I am GRATEFUL there was no room at Ronald MacDonald!

For a review, we are going to consult with Dr. Wagner regarding a clinical trial at U of M for kids with RDEB. They are using stem cells via bone marrow transplant to grow healthy skin on the patient. The trial involves a 100 day stay up there. 7 children have undergone the procedure, 5 made it all the way through. The other two passed away. Bone Marrow Transplant (BMT) is an incredibly intense procedure with a 40% chance of lethality. Most people who are considering a BMT are cancer patients for whom the main 3 treatments aren't working i.e. radiation, chemo, and or surgery, and it is usually a last resort. 3 EB kids have passed away since Christmas Eve alone, and since there currently is no cure for EB, BMT ultimately comes into the equation.

There are pros and cons to going through this procedure. The obvious pro is that if it works, Bella would grow Ali's healthy skin on her body, thereby reducing the chance of her succumbing to this bizarre condition. The big con is that Bella could die from the procedure itself. Also, the research team is tinkering with their research model with each patient. So, you can't look at any of the prior patients as a baseline for what to expect. Every patient is essentially n=1 because to my knowledge, no two patients have undergone the exact same procedure. Combine this with the uniqueness of each case of EB, and you have a pickle for anyone who wants to do good, rigorous research.

We knew that Columbia University has just started a reduced intensity BMT for RDEB patients, but word came out recently that a handful of other facilities are beginning clinical trials for reduced intensity BMT as well. We are planning on going to Columbia to meet with their team, and we'll see about the others. Because Bella's severity has been called "mild" by two within the EB treatment world, the full intensity of a BMT may not be worth the risk associated. We'll see. Anyhow, we're planning on going to NYC in February to shop for the best fit for Bella.

We want to hear from you! We miss the interaction. We're almost done with edits on Bella's book, and one of the great parts of it are alllllll the amazing comments you left us in the first few months. Let us know how you are and that you're still here with us. You are 2/3 of our support (Friends, Family, and Faith), and we are grateful to have you. You'll be with us as we travel to find the best care for Anabella that's available.

May 2010 bring you all of your dreams and wishes!

Blessings, and good night.