Game Plan

We saw the lymphoma specialist late this afternoon, and we got somewhat of a game plan for moving forward. The doctor wants to do a few more outpatient tests and procedures that will help stage the cancer and give him all the information needed to decide what chemotherapy drugs will best fight this cancer. Some of these tests will help assess Parrish's basic functions (kidneys, liver, etc) to determine the right dosage--one that will attack the cancer but not put too great a strain on his organs. Other tests will help determine the stage of the cancer, so that the doctor can determine the best chemo cocktail for this particular Hodgkin's.

So, today, they drew more blood to test, among other things, Parrish's creatinine--above all else, they need Parrish's kidneys functioning more normally before starting chemotherapy. We should have the results from those labs tomorrow. In addition, they will do a urine study on Thursday/Friday. Don't worry--those of you that really know me know that I have a slight (or some would say, significant) water obsession. I have Parrish on my water intake regimen to ensure optimum kidney function. Between my prayer warriors and 150 ounces of water a day, surely that creatinine will be back to normal!

On Friday afternoon, Parrish will have a PET scan. This will be a full body scan that will show any other lymphoma inflammation, and also be able to indicate whether that inflammation has cancer activity or not. This scan will also assist in determining exactly what stage the cancer is. In addition, if his kidneys are okay, they will do another CAT scan (which requires dye, which is tough on kidneys) in order to see the tumor more closely now that the pleural fluid is gone.

Tomorrow, we should also get the bone marrow biopsy back--this too will help with staging. In addition, it will help the doctors analyze post-chemotherapy treatments that can help with more long term cures.

On Monday of next week, Parrish will have an outpatient procedure done where they will place a mediport in his chest--this will be where he receives chemotherapy. We will meet with the lymphoma specialist, and then, chemotherapy should begin on Tuesday. All of his chemotherapy will be in-patient--meaning he will have to go into the hospital overnight. The drugs that they will be using are "continuous infusion" so he will be in the hospital 2-3 days, receiving chemo continuously through the mediport. The treatment will be once a month for 4 to 6 months. They will not be using any of the same chemo drugs that Parrish received when he was 17. This is for two reasons. One, Parrish has already received these drugs in high doses and there is a concern that he has developed a resistance (think how a child becomes resistant to certain antibiotics when they are continuously used). Two, chemo drugs are poison. They kill cancer--but are toxic to the body. Using the same chemo drugs poses toxicity concerns. Thankfully, they now have other, even better, chemotherapy options to use.

At the end of the chemotherapy treatment, and once Parrish is cancer free, they anticipate doing a bone marrow (or stem cell) transplant using Parrish's own stem cells. This is referred to as an autologous stem cell transplant, if you are googling it. This type of transplant is commonly used in lymphoma patients and has incredibly successful long-term cure results. This procedure is obviously down the road, and rather involved, but provides lots of hope for a complete cure.

There is no plan for radiation. Again, Parrish received high doses of radiation while at St. Jude. There is concern that additional radiation will cause other problems--organ function, radiation-induced cancers, etc. St. Jude has been communicating with all of the UAB doctors, and they too have voiced concern over any additional radiation.

So, while we had hoped to get the chemo show on the road this week, we understand and support the decision to wait until next week when we have a more complete picture. At every step, we have learned that this is a hurry up and wait sort of thing. Patience is a virtue that I am working on!

Again, thank you for all of the thoughts and prayers...we feel so loved and so supported by friends and family. I can't tell you how that has carried us through the last week and a half. We feel so blessed to have all of you on Team Taylor!

Much love,
Molly