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Archive: May, 2011

POSTED: Tuesday, May 31, 2011, 11:29 AM

I’ve been back at CHOP for round eight of chemotherapy. This is a round that takes five days in the hospital, so it can get really boring.

When I first came in, nurse Jamie was on the job and got my intravenous port accessed on the first try (still batting 1000). Then Dr. Erlich and Dr. Balamuth from Oncology gave me the once over and checked out a rash that I got on my legs from my brace. They gave me some medication and a cream to put on it and it’s already getting better.

One of my biggest problems has been getting to a bathroom with my walker and this awkward leg brace. I was still using a wide wheel chair most of the time and a bed-side commode. But after I was admitted and was able to get into a bed in the Oncology Unit, things started going much more smoothly.

Rachel Kovach @ 11:29 AM  Permalink |
POSTED: Tuesday, May 24, 2011, 4:10 PM
(Kurt Kovachs)

Yesterday my parents took me to CHOP to meet with Dr. Dormans for a follow-up visit. It's been three weeks now since my surgery and Dr. Dormans  wanted to check on my incision, see how I’m getting around, and maybe take off a piece of this stupid brace.

Dr. Dormans was really happy to see me.  He said my incision is healing nicely and he was glad to hear that I’m not having any pain, and I haven’t needed any pain medication since before I left CHOP to go home 10 days ago.

He told me to start using crutches instead of a walker because I will be able to get around better and it will help to build strength in my right leg. He told me that I can put up to 50 pounds of pressure on my right foot now -- more than just a toe touch for balance. Another nice surprise was when Dr. Dormans said that the bottom part of my brace, the piece between my right knee and ankle, could come off. This will help me extend my right leg. The brace is heavy and the hinge is quite stiff. Without the bottom of the brace,  it will be easier to use crutches, and get in and out of the car.

Rachel Kovach @ 4:10 PM  Permalink |
POSTED: Tuesday, May 24, 2011, 3:37 PM
Rachel and her surgeon, John Dormans, have good reason to smile about her progress (Children's Hospital of Philadelphia)

Rachel returned to the orthopedic clinic for her first post-operative visit today. Her surgical wounds are healing well, and her x-rays confirmed excellent appearance and placement of the endoprosthesis. She is neurovascularly intact, and her legs are equal in length.

 The abduction brace that has kept her right hip immobilized has been modified with the removal of the lower portion today. As Rachel gets stronger, she will participate in physical therapy to allow her to go up and down stairs safely using crutches. Our ultimate goal is to help Rachel improve range of motion in her affected leg to allow her to function independently. Her uncomplicated recovery so far leads me to believe that she will continue to improve.

Best news: the margins of the removed tissue were free of tumor. Chemotherapy destroyed 90% of the tumor tissue prior to Rachel’s surgery.

Dr. John P. Dormans @ 3:37 PM  Permalink |
POSTED: Monday, May 23, 2011, 3:30 PM

My name is Naomi Balamuth and I am one of Rachel’s oncologists at CHOP. Rachel and her family asked me to update you on her treatment.

As you all know, Rachel had her surgery on May 3rd, 2011. We recently were able to review the pathology slides, and are very happy with the results. When we looked at Rachel’s tumor under the microscope, we saw that the large majority of her tumor was dead. This means her tumor responded very well to the chemotherapy. In addition, Dr. Dormans (Rachel’s surgeon) was able to achieve "negative margins" -- all the tumor was removed with a rim of healthy tissue around it. That's also great news because it means Rachel will not need radiation therapy. Radiation can have significant long-term side effects for our cancer survivors, so we were very happy to cross that off the list of treatments for Rachel!

Moving forward, she will continue to receive the same chemotherapy that she got prior to her surgery. She will be admitted to the hospital every 2 weeks. So far, she has tolerated the treatment beautifully. Her smile and positive attitude are remarkable! It is a true pleasure seeing her in clinic each week. We have every expectation that she will continue to do well, and we hope for a bright future, full of time with family, swim meets, and pillow fights!


Naomi Balamuth @ 3:30 PM  Permalink |
POSTED: Thursday, May 19, 2011, 5:31 PM

Today, we're tinkering with the usual blog format. Rachel's dad, Kurt, has great news to share. And Rachel has answered some questions from her readers. (Feel free to post more questions in the comment box for Rachel to answer in the future.)

Kurt Kovach here. We heard from Rachel’s doctors yesterday and today regarding the pathology analysis of the bone and tissue that was removed during her surgery.  The results are very encouraging. The edges of the removed tissue are "clear," meaning no cancer cells were found. And farther inside the tissue, the percentage of cancer cells that are "necrotic," meaning killed by the chemotherapy, is very high.  Her doctors are very pleased -- and we're thrilled.

Q & A with onco girl:

Rachel Kovach @ 5:31 PM  Permalink |
POSTED: Wednesday, May 18, 2011, 4:50 PM

Hello. My name is Dr. Lamia Barakat. I’m director of psychosocial services in oncology and a psychologist in the Children’s Cancer Center.

In Rachel’s posts, she’s introduced you to some of the members of our team (Brittany, her child life specialist, and Jamie, her hospital school teacher). I thought I’d chime in to give you more information about who we are and what we do to support children with cancer and their families.

The psychosocial team has social workers, child life specialists, and child activity coordinators, art and music therapists, hospital school teachers, and psychologists. We work with the medical team to help children and their families adapt to cancer and its treatment. Our job is to provide direct services, educational materials, and special programs. We support families in better understanding what to expect during cancer treatment, learning ways to use their resources, using positive coping, accessing their social supports, and keeping ‘normal’ routines and activities a person their age would usually keep (like playing and going to school).

Rachel Kovach @ 4:50 PM  Permalink |
POSTED: Monday, May 16, 2011, 6:38 PM
Rachel with some of her favorites, a pork roll egg and cheese sandwich, and Coco by her side at home.

I’m finally home! But getting here and getting set up was a lot harder than I thought it was going to be.

On Friday at CHOP, we had to get a lot done before I could go home. My parents, nurses, physical therapist and I had already spent a lot of time figuring how we were going to get me into our car. My dad brought a big SUV, but I have this giant, heavy, metal and plastic brace on my leg – from my waist to my right foot -- that only bends a tiny bit at the hip and knee. If I couldn’t get into the car, we would have had to go back and forth to CHOP -- a two-hour drive -- in an ambulance until I got my brace off! Needless to say, my parents and I really wanted to find a way to get me in the car.

We finally figured out that the front passenger seat was a fit. From my wheel chair right next to the car, I had to stand on my left leg and, using my walker, pivot so my back was up against the front seat. Then with the front seat all the way back, I hoisted myself using my left leg on the running board and the handle next to the door. Once up on the seat, I had to scooch around a bit until I got into a position where my legs fit and I could close the door. I just fit! Then, my dad had to figure out how to pack all of my luggage, books, blankets, stuffed animals, plus balloons and gifts I had received, and the wheelchair, in the back of the SUV. (Hey, I’m a girl and my dad tells me I don’t travel light).

Rachel Kovach @ 6:38 PM  Permalink |
POSTED: Thursday, May 12, 2011, 7:02 PM

Mom here. I thought I had a few years to go before worrying about Rachel's first prom, but this year has been full of surprises -- and the fact that Rachel is going to the prom tonight at CHOP is no exception!

The hospital has a great program. As I understand it, the event started mainly for kids of traditional prom age who would otherwise miss the proms at their schools due to a hospitalization. Now, the event is opened to all the patients. The hospital has been abuzz today with everyone from the patients to the staff and a host of volunteers getting ready for the big night.

Rachel is very excited about it. She spent the afternoon "shopping" for a prom dress from a room full of donated apparel. After trying a half-dozen dresses, she finally settled on the perfect yellow gown. Then she had her make-up and nails done by a professional volunteer. And then off to select the perfect jewelry to complement her outfit. Rachel looks gorgeous! You should have seen her face light up as she looked into the mirror and saw her reflection. Ready to go for her first prom!



Rachel Kovach @ 7:02 PM  Permalink |
About this blog
Rachel Kovach, 12, is a seventh-grader at Mother Theresa Regional School in Atlantic Highlands, N.J. She lives in Highlands, N.J., near the Sandy Hook national seashore, with her parents, Mari and Kurt Kovach.

Since first grade, Rachel has been swimming with the Monmouth Barracudas, a year-round competitive United States Swimming Club program. She hopes to continue competitive swimming after her cancer treatment; if not, she envisions coaching someday or maybe a career in medicine. Figure skating and jazz dancing have been big parts of her life. One of the things she hates about being in the hospital is missing her dog Cocoa and her many friends.

Rachel's doctors

These are the key physicians overseeing Rachel’s care at Children’s Hospital of Philadelphia:

Naomi BalamuthNaomi Balamuth, pediatric oncologist, specializes in treating pediatric sarcomas, a subset of solid tumors.

 

 

Richard B. WomerRichard B. Womer, pediatric oncologist, led studies of the latest chemotherapy treatment protocol for Ewing’s sarcoma.

 

 

John P. DormansJohn P. Dormans, M.D., chief of orthopaedic surgery, is an international expert in the surgical treatment of musculoskeletal tumors.

 

Timeline of Rachel Kovach’s Treatment

Dec. 3, 2010: Pain in Rachel's right knee is initially diagnosed as tendinitis.

Jan. 20: An MRI reveals a tumor in right leg.

Jan 24: Rachel sees John Dormans, chief of orthopedic surgery at Children's Hospital of Philadelphia.

Jan. 27: A biopsy confirms Ewing's sarcoma.

February to mid-April: Regimens of chemotherapy alternate every other week. The three-drug regimen is given over two days; the two-drug regimen is given over five days.

May 3: Surgery replaces most of the right femur with a prosthesis.

May 5: A Children's Hospital team will help Rachel get out of bed.

May 10 to September: Alternating regimens of chemotherapy are to resume.

Around May 10: Physical therapy will begin in the hospital and continue for at least several months after Rachel goes home.

Onco Girl
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