'His life changed that day'

MERCEDES - It started out as a fever.

Four-year-old Alejandro Valdez woke up one morning six months ago with a temperature above 105 degrees.

His mother, exhausting all other options to cool her son down that May morning, finally drove Valdez to the emergency room at a McAllen hospital. Doctors took Alejandro's blood work and spent five hours drawing his temperature down before sending him and his mother to a nearby clinic.

It was there, at the Vannie E. Cook Jr. Children's Cancer and Hematology Clinic, that Amalia Rivas learned her son had an aggressive form of cancer.

Hospital doctors decided almost immediately after seeing Alejandro's blood work that he had acute lymphoblastic leukemia, a fast-growing cancer of the white blood cells that is most common in young children.

Alejandro spent the following 18 days at the clinic as the medical staff battled the infection that attacked his weakened immune system and caused the fever.

He has had so many trips to Cook clinic since then that he barely cries out when the nurses stick the hollow needle into the fluid surrounding his spinal cord at least once a month.

But the trip his mother remembers most vividly was when the hospital staff dismissed Alejandro and sent him to the clinic with the grim news that he had "something stronger" than a fever.

It was May 26.

"His life changed that day," Rivas said one afternoon as Alejandro rested on her knee at the kitchen table in their sparse two-bedroom apartment. "My whole family's life did."

EVERYDAY LIFE

The four boys sleep together at night, two to an oversized bunk, in a small room to the side of the house.

Rivas sleeps in a queen-sized bed in the other bedroom with her 11-year-old daughter, Annahisa, and 1-year-old son, Aberando, to her side.

It's cold in the morning, but there is no heat. Rivas does not trust the heater; she worries it will catch fire.

It's like any other day in Alejandro's life.

Alejandro, his mother, his four brothers and his sister are the sixth family featured in the 11th annual 12 Days of Christmas. The series, sponsored by the United Way and The Monitor, highlights local families in need and asks Rio Grande Valley residents to make their holidays a little brighter.

Rivas loads her children into her small car in the mornings and drops the four oldest off at Mercedes schools. She then makes the 30-minute drive from Mercedes to the Vannie Cook clinic in McAllen with Alejandro, who was held out of school because of his illness, and the toddler.

With Alejandro diagnosed with an aggressive form of acute lymphoblastic leukemia, his doctors decided to put him on one of their strongest chemotherapy treatments.

The stronger treatments, especially in the critical first six months, has meant that Rivas often has to drive her son to the clinic about four times a week.

The illness has been an extra burden on Rivas, who is trying to raise her six children alone on limited income after the father left the family last year.

Medicaid covers Alejandro's medical costs and Rivas receives about $800 each month through Temporary Assistance for Needy Families. About $250 goes to rent, a couple hundred goes toward the bills and some is budgeted to buy gasoline for the frequent trips to the clinic.

The medical staff at the clinic knows to finish Alejandro's routine treatment up by early afternoon. Rivas likes to pick her kids up from school.

Sometimes, the treatment can't be completed quickly, and her four children are left at home alone.

Annahisa, whom Rivas describes as a second mother, takes charge at that point. She pulls the food prepared in advance by her mother from the refrigerator and carries it next door, where a neighbor loans the use of a microwave.

Rivas arrives home later with Alejandro reeling from the effects of the chemo, and she makes sure her other children behaved and did their homework.

Then they're sent to bed, always by 9 p.m., to make sure they don't disturb Alejandro's rest.

Rivas goes to bed with them but hardly sleeps. She goes over and over the doctor's instructions in her head, running down tomorrow's schedule, trying to memorize dosages for constantly changing prescriptions and worrying she might get something wrong.

"I lie in bed thinking about the next day," Rivas said, her nephew, Tony Valdez, translating for her. "At first it was really hard to do. Now it's like it's nothing at all."

GROWING PAINS

Some days Alejandro doesn't want to get up.

Those are the worst days, the ones where he lies there for hours, begs his mom to block out all the light and easily gets angry at his brothers and sister.

Rivas said she knows those days will happen far less often as Alejandro advances through the three-year treatment.

The first six months of treatment are the worst, even for patients who don't have Alejandro's aggressive form of the disease.

The intent is to aggressively attack the cancer at the beginning of chemotherapy to reduce the risk of relapse before settling into less frequent treatments, said Ruth Anne Herring, the pediatric nurse practitioner at Vannie E. Cook.

The chemo makes Alejandro nauseous, causes him to lose his hair and makes him sensitive to light.

The standardized treatment also means Rivas must stick to a detailed schedule. She carries a bag containing all of his medicine and adrenaline shots for emergencies, gives him chemo treatments in his leg at scheduled times of the day and ensures he naps often and eats plenty - combined with the chemo, it's the best way to increase his chance of survival.

The overall cure rate of acute lymphoblastic leukemia is nearing 90 percent, and even stronger cases like Alejandro's are almost always beaten in three years.

Still, doctors do what they can to make the treatment as easy on the patient as possible.

They give small gifts to the kids before treatments and find ways to help them relax during painful procedures like spinal taps, Herring said. The attention of active parents like Rivas - she always sits in on Alejandro's procedures and Herring half-jokes that she could teach the class for new parents - makes it easier on the child.

Even with her son's illness that takes up much of her time, Herring and school administrators said Rivas pours herself into her other children.

Sylvia Carlin, the student services director at Mercedes school district and the one who recommended Rivas for this series, said she has developed a reputation by teachers for staying active in parent-related activities.

Her children are well-behaved in class and make good grades, Carlin said, and they participate in extracurricular activities.

Rivas missed an appointment with a teacher earlier this year when Alejandro's treatment ran late, and she tearfully explained her situation with Alejandro and the other children.

It was the first the teacher - or anyone else at the school - had heard about Alejandro's cancer.

‘A GOOD DAY'

Some days are better.

There are afternoons like ones earlier this month where five of her children - her oldest, Heriberto, 14, is at school for a math competition - are gathered around her at the table in her cramped kitchen and Alejandro is as playful as ever.

There are no major treatments at the clinic for him early this month as his doctors let him rest in preparation of a Dec. 14 spinal tap with 16 weeks of heavy chemo to follow.

Alejandro tries to dig around in the refrigerator against his mother's wishes, and he playfully smacks his cousin, Tony, with a stuffed animal in the face.

Rivas said she has no idea what she'll be able to do for her children's Christmas.

The three oldest boys said they want bicycles and Annahisa would like a computer.

They have mentioned they want a Christmas tree.

Addalberto, 5, says he just wants Christmas vacation to come sooner.

The house could use more furniture like another bunk bed for the boys' room. Alejandro, who likes to watch Shrek, could use a television for the days he feels sick other than the ancient 10-inch that only picks up one channel.

Rivas said she's happiest on the days when Alejandro has energy, when he bounds about like a typical 4-year-old, rather than the days he refuses to leave the bed.

The mother watches Alejandro push a toy truck, a gift from his doctors, along the kitchen table.

"Every day is something else,'' Rivas said. "Today is a good day."

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Jared Janes covers Hidalgo County government and general assignments for The Monitor. He can be reached at (956) 683-4424.

The United Way is accepting donations - including, but not limited to, clothing, food, furniture, toys and money - for the families of this series. To donate, call (956) 279-9047, (956) 279-9048 or (956) 279-9049 or mail to United Way, P.O. Box 187, McAllen Tx. 78505. You can also make an online donation on the United Way of South Texas website at www.unitedwayofsotx.org. The United Way of South Texas is located at 1200 E. Hackberry, Suite F in McAllen. The Monitor is not accepting donations.