Not as simple as an oil change

As you may recall, the eager-beaver docs at my current practice had me rigged with a porta-cath while I was under for one of my biopsies. This was done partly for efficiency, since I was under the knife anyway, and partly on the assumption that I'd be starting treatment soon enough.

Well here we are four months later, and its looking more and more like any treatment will be a ways off in the future. This is a good thing, but unfortunately the porta-cath is not a "set-it-and-forget-it" kinda thing, it needs maintenance. To whit, every 6 weeks or so, it needs to be flushed with heparin, an anticoagulant, to keep it from clotting up.

While this is actually a simple proceedure (I've had it done twice now, and it only takes a few minutes) it turns out that getting it done is not as simple as taking your car into the garage for an oil change. I found this out when I asked Dr. G. if he could have it done while I was seeing him for my consult. And he wouldn't touch the thing with a 10 foot pole, because I was not his patient.

So either I need to get this thing ripped out, or I'll be seeing a doctor at least once every six weeks, for a while.

Still here.

Hey y’all. S’up?

Oh, this thing? Yeah, it’s still our cancer blog.

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The week before Christmas, Dan and I went to get the so-called second opinion with another oncologist. Unfortunately, it turns out that Dan still has stage 1 follicular non-Hodgkins lymphoma. (Hey, it never hurts to hope that absolute incompetence on the part of four oncologists, two surgeons, five radiologists, at least three labs, and one hospital led to a misdiagnosis.)

Dan selected Dr. G based on the recommendation of a co-worker who’s had Hodgkins lymphoma for many years. After the requisite waiting period (this time with cookies, though, since the office had apparently had their holiday party that day), Dr. G reviewed Dan’s records, then gave him a physical exam – including prostate, something that hadn’t been done up til then. Lymphoma has been known to get ambitious and try to set up residence there. Everything was in its place, though a few groinular lymph nodes seems to be bobbing to the surface again. A normal occurrence in light of their cancerous state.

We explained to Dr. G that our primary reason for see him was we were hoping for some help unraveling the myriad of treatment options. He recapped said options thusly.

Primary Options
1. Do nothing: more on this later.

2. Rituxan antibody mono-therapy: as previously discussed, Rituxan is the critics’ darling right now. Practically no side effects, a non-toxic nature, and a minimalist infusion schedule. Rituxin is still new, expensive, and hasn’t done a lot of solo-piloting.

3. Rituxan + Fludarabine combination chemotherapy: Apparently, Fludarabine isn’t the only contestant in the beauty pageant, but it’s a popular choice. I kind of zoned out on the others, because basically, it’s back to the whole chemo scenario. Though it’s better chemo option than most.

Secondary Options
4. CHOP combination chemotherapy: four chemo drugs in one infused cocktail – cyclophosphamide, doxorubicin (Adriamycin), vincristine (Oncovin), and prednisone (a type of corticosteroid). Odds are they’d sprinkle a little Rituxan in, too. This is closer to traditional chemo, with multiple drugs, each doing one specific thing. It requires more infusions and has more side effects.

5. Targeted radiation treatment: real Star Trek stuff. Injected/ingested isotopes that attach to the cancer cells and deliver radiation right to their doorsteps. We’d originally heard that Dan’s cancer was too widespread for radiation treatment.

Dr. G also directed us to the best online resource I’ve found regarding cancer – People Living With Cancer, www.plwc.org. Developed by cancer docs, independent of pharmaceutical companies and ribbon-wielding advocacy groups, it has science-based information in clear language. Check it out.

We’ve had a couple of weeks to mull over the options, and we’ve made some decisions. But this post is too long already. We’ll be back soon.