More on Cause and Effect

Last week we received the first of what will be a series of newsletters from the Northern California Childhood Leukemia Study at UC Berkeley. It reports what they are learning about the causes of childhood leukemia. In hopes that some of you will find it helpful, here is a quick summary of the findings.

The results I am going to report are based on comparisons of 1092 leukemia patients and their yolked partners, who are children born the same day in the same hospital who do not have leukemia. The families were studied over a 10 year period.

Women who ate more vegetables, fruits, and foods containing protein (specifically, beef and beans) in the year before pregnancy had a lower risk of having a child who develops leukemia. In the fruit and vegetable food groups, carrots, string beans, and cantaloupes show strong links to lowering the risk.

Kids who ate more hot dogs and cured meats were no more likely to get leukemia than kids who ate less. Fruits and fruit juices that contain vitamin C and or potassium (oranges, bananas) reduced the risk of leukemia, especially if consumed in first 2 years of life.

Both short term and long term breastfeeding lowered the risk of leukemia.

Children who spent more hours attending daycare had a lower risk of developing childhood leukemia. The earlier a child started, the longer a child attended, and the more children in the class, the lower the risk.

Use of indoor pesticides either before or after birth increased the risk of developing childhood leukemia.

Fathers who smoked in the months before pregnancy increased the risk, apparently by damaging sperm. Mothers smoking before pregnancy, during pregnancy, and during breastfeeding, did not have any effect (sorry, in my recent delerium I reported this finding incorrectly to some of you). But a substantially elevated risk was observed when both the father smoked before pregnancy and the mother smoked shortly after the child was born.

There were no childhood leukemia clusters in Northern California, meaning that region or neighborhood did not seem to have any association.

The researchers estimated that all of these factors -- diet, pesticides, and parental smoking combined -- could increase a child's risk of developing leukemia by 20% - 50%. This increase could account for about 1 to 2 cases per 100,000 children per year. Note however that known causes of childhood leukemia only acccount for 5% of the variance.

The study in which we are participants is looking specifically at the effects of magnetic fields and chemicals in the water.

On Saturday, when I received this newsletter, my reaction was to cart the the kids off to McDonalds for dinner. Cheeseburgers and fries, all around!! I even bought myself a Diet Coke and let the girls taste it (in their own little ketchup cups, of course, I am not that cynical about the germ connection in all of this). The girls could hardly contain their shock, and their delight. This was maybe Dayssi's third trip to McDonalds, in her 3 years of life. India, in contrast, has been there more often, as this was a favorite meeting place for the nannies and their charges for a while, before I pulled the plug on that party because -- I thought -- it was too unhealthy. But, India is ok. And Diet Coke was not even on the epidemiology survey. And most of the food at McDonalds hasn't been close enough to nature to have touched local water supplies, or even seen a pesticide.

Why so twisted? Because I feel like I am a flipping poster child for clean living, having done all of the "good" things (except for early day care) and none of the "bad" things, and for what?

On Sunday I straightened myself out and wrote "CANTALOUPE" on the grocery list.

In other news, Dayssi was especially adventurous today. This morning, unprompted, she said "I want to try the finger poke today." We've had the option of a finger poke, instead of a port access, on days when only blood was being drawn (no medications), but Dayssi has wanted to stick with what she konws. Today, she walked, no, ran in to the new lab (in new sneakers), smiled at the new technician, climbed up into the chair, stuck out her finger, and did not even flinch when she got pricked. The first finger didn't bleed enough so they had to prick again, and she happily volunteered another finger. Incredible. And it was actually a lot easier that the port thing, which takes all kinds of sterile prep beforehand.

Then, Dayssi had her first swimming lesson. She loved it. She grinned goofily throughout the whole thing, wearing goggles and little fins, ducking in and out of the water with teacher Louise close at and. She is not at all competent yet but she is totally relaxed in the water, ready for anything. And it was amazing to see India afterward, during her lesson, diving and swimming all around, and to remember that only two years ago she was where Dayssi is now, unable to keep herself afloat.

India asked to ride her bike to school today, and we did. She was fantastic, walked up the big hill without a single complaint, and smiled with the breeze in her hair the whole way down.

Dayssi's counts are decent today, 1400 (up from 680 last week). So that means we can go to a birthday party on Saturday and have some fun before starting delayed intensification. We start next Tuesday with a spinal procedure and intrathecal chemo. Friday she'll get a shot of PEG asparaginase, which is supposed to be a very effective drug but one that sometimes causes very severe allergic reactions. Afterward our weekly visits will include lots of new drugs. One big day --September 18 -- Dayssi will have two new drugs administered in clinic. It is the same day that Jim and I start teaching. So we'll run over to the hospital with her in between classes. Luckily there is a four-hour break.