Office visit 2/23

02/23 15:15
ANC 4508

With Wednesday's bad news we knew Doc P would not want to jump into a new chemo regimen without sitting down to talk with us, so we rescheduled the morning appointment that would have administered a third cycle of the old plan to an afternoon appointment so he would have more time for a discussion.

At least this meant Alan was able to go to PPCD and the rest of the day at preschool. The teachers and little friends at preschool were especially glad to see him as he had not been able to attend most of the time since the tumor came back. They practically came running when we brought him to the class on the playground and Alan gave his special teacher Miss Kim an enthusiastic "Yes!" when she asked if he had missed her.

Doc P had several conversations with Doc H2 on Wednesday about the treatment Doc H2 recommended but by the time we had our appointment with Doc P that afternoon, he had taken some time to consider Doc H2's plan and was not satisfied with it. He considered it to be merely palliative and thought we could achieve a much better result with drugs that have proven effective on Alan's tumor in the past.

He proposed a a mix of old and new drugs - Vinorelbine (15 minutes by IV), Cytoxan (60 minutes by IV) and Topotecan (60 minutes by IV) on Day 1-5, off for the rest of the 28-day cycle, then Vinorelbine and Cytoxan again this time with Doxorubicin (2 day slow IV) starting Day 1 of the next 28 day cycle. The Topotecan is from the same family as the Irinotecan that used to be so effective against Alan's tumor. Over time the cancer cells have become resistant to the Irinotecan (think along the lines of antibiotic-resistant bacteria) so Doc P is hoping that switching to Topotecan will do the job. We had used Doxorubicin in the first year of Alan's treatment, again to good effect, but it was dropped because it can be very hard on his heart and we were coming up to the limits of what we could safely use. Now we need to think about killing the cancer and taking care of his heart later.

This is pretty much #2 on Doc H2's list of options for systemic control of the cancer - a custom cocktail of drugs. Doc P having so much more intimate knowledge of the in's and out's of Alan's treatment was able to come up with a plan that we think Doc H2 was, if not too timid, then too conservative to. And let's face it, Doc P has been in the trenches with us for the last three years - it's a little more personal for him that he fight this thing as aggressively as possible.

We tend to favour Doc P's plan, but being the type who like to dot all the i's and cross all the t's, we asked him to discuss his plan with Doc H2, so they would be on the same page. We will come back to the office Monday for chemo - what regimen will be determined then. Poor Aurora - as the chemo nurse, she needed to know what drugs to have ready, but Doc P had to have a chance to talk to Doc H2 first. Nothing like living on the edge!


Alan and Miss Kim