Part 2 in a series about survivors of pediatric cancer.

Cara Palumbo was at her brother’s football game the first time she felt ill.

“I said to my grandmother that I had a headache, and all that cheering wasn’t helping it,” said Cara, the daughter of Rob and Kerry Palumbo of Lehighton, recalling that September day five years ago.

When she got home, she took some ibuprofen and went to bed. She woke in the middle of the night with another, horrible headache.

“I woke up my mom,” said Cara, who was 11 years old at the time. “This was really intense. I don’t even know how to describe it. It was really bad, and it wasn’t going away.”

Her mother gave her something for the headache. Cara lay down on the couch to watch TV, but soon vomited. Although she felt a little better later, she stayed home from school. The headache abated, and she went to school the following day.

The next night, the headache returned with the same excruciating pain.

She woke her mother, hiccup sobbing with how bad the pain was. Her mother alternated giving her Advil and Tylenol, but nothing helped.

Cara kept vomiting. Kerry thought Cara might be getting a stomach flu. To try to relieve the symptoms of the headache, Kerry treated it like a migraine, keeping Cara in a dark room and giving her cold compresses. When there was no improvement, Kerry decided to take her to the hospital.

It took three hours to try to get Cara ready for the five-minute ride. Every time she sat up, she would vomit. They eventually went to the ER in their pajamas.

At the emergency room, the doctor did an eye check and ordered a CT scan. After seeing the results of the CT scan, the doctor at Lehighton recommended Cara be sent to Lehigh Valley Hospital. The neurologist there, however, was at a conference, so Lehigh Valley suggested she be sent immediately to Children’s Hospital of Pennsylvania in Philadelphia.

An ambulance ride later, Cara was admitted to the ICU at CHOP, and by 3 p.m., just three days after she first complained of a headache, she was diagnosed with a brain tumor. She was scheduled for an MRI first thing Monday morning to determine positioning, and for a craniotomy Monday afternoon.

“It was a whirlwind,” said her mother.

A frightening diagnosis

Although she admits she was scared, on the outside, Cara remained calm when she was told about the surgery, and asked the questions that were most important to her, like when she would be able to go back to school, and if she’d be able to go skiing. She also wanted to know if they were going to shave her head.

“I was happy it would be over with once they got it out of my brain,” Cara recalled. “I was relieved about that. And I was hungry, because I couldn’t keep food down.”

Her mother remembers Cara’s biggest worry was that her brother would videotape her coming out of anesthesia and her saying something stupid. She was afraid he’d upload such a video to YouTube. In fact, Kerry said, Cara’s first words after coming out of anesthesia were, “Did Dominic videotape me?”

Seventy-two hours after surgery, Cara was diagnosed with medulloblastoma, a malignant brain tumor.

Although Cara was only 11, she was already far too familiar with cancer for the average preteen.

In the recent past, she’d lost two great-uncles, one from a highly malignant and aggressive brain tumor and the other from prostate cancer; her mother had undergone treatment for cervical cancer; and her grandmother was recovering from breast cancer.

Her parents knew they had to tell her she had cancer and how it would be treated.

“Cara’s smart. She’s always been smart. I was afraid if we lied to her or tried to hide it, she would resent it and be more afraid,” said Kerry. “We tried very hard not to show her our fears.”

Cara’s surgery went well, but she developed a condition called posterior fossa syndrome, which is similar to having a stroke. Her brain stopped communicating with the right side of her body, and she leaned to the left. The neurosurgeon told her family it may never go away.

Once Cara’s tumor was confirmed as cancer and she was moved to the oncology ward, her head was tattooed and she was fitted for a radiation mask. Treatment included having to go under anesthesia every day for 30 days of radiation, 17 of which had her being intubated for the proton beam radiation, a more focused form of radiation, centered directly on the affected area.

Radiation and chemo

Cara said one of the worst things during her time in the hospital, which lasted almost three months, was that she was always hungry, yet she couldn’t eat.

“I had to be NPO -- nothing by mouth -- from 12 a.m. until 3 p.m.,” she said of her 30 days of radiation.

That time period would stretch even longer some days because the radiation machine would be down, and they would need to wait until it was back up and running. That would often leave only a short window for her mother to try to get as many calories into Cara as possible before midnight.

She went from 95 pounds down to 72 pounds.

Making it worse was that Cara also had to undergo chemotherapy.

“I was nauseous with chemo, but the doctors were on top of that. I would wear a scopalomine patch and take Kytril.”

Since she knew she would lose her hair, Cara took matters into her own hands.

“I wasn’t losing my hair yet, but I knew it would happen soon. I put it in a ponytail and my mom cut it off.”

Cara still has the 6-inch ponytail.

“Two weeks after we cut it, I started chemo, and within three days it started falling out.”

Having no hair didn’t really bother her too much while she was in the hospital, but it was more traumatizing when she went back to school.

“I had no hair, so I wore a hat.”

Although she missed three months of school, Cara kept up with her homework while she was in the hospital. She returned to school in January, happy to be back, despite some of her physical limitations.

Because of her balance issues and being weak and tired from the chemo, Cara needed to use a wheelchair while at school for two years. And while her balance still affects her to an extent, she’s gone from using a wheelchair to the golf team at Lehighton Area High School.

The Palumbos had been told that radiation could result in Cara losing up to 50 points from her IQ, yet she has consistently remained on the honor roll and principal’s list, takes honors classes, and recently began her first college class — intro to psychology — even though she just started her junior year.

Because of the weakness on her right side, Cara is now a leftie.

“It was almost foreshadowing,” she said. “I was trying to teach myself to write with my left hand before I got sick. I wanted to be ambidextrous. Now I had to relearn everything.”

What’s next?

Cara is 16 now and doing well. For the past couple of years, she has had an MRI every six months to watch for any evidence of disease. So far there has been nothing. In January, she’ll graduate to an MRI only once a year. It’s an important milestone.

Cara’s not sure what’s lies up ahead for her, but that has nothing to do with having had cancer.

College is a definite.

“I don’t know which calling or what I will do. Science really interests me, but I don’t know what I’ll specialize in,” she said.

Does she worry about the future?

“Yes, I do, but I tend not to dwell on it. It doesn’t keep me up at night.”

What does keep her up?

“Grades. What I have to do the next morning. Boyfriend. I don’t think about the long-term too much,” she said.

“I need to focus on one thing at a time.”