Of Transplants and Whirlwinds
Last week ended up being a whirlwind of doctor’s appointments and information. We received three very good future treatment options for Mike and took the weekend to think and pray about which would be best. Mom has some more tests to determine her treatment plan, so an update about her will be coming in a later post.
Visits at Duke
Our appointment with the Duke Urological Oncologist was quite informative. He offered solid background information as to why Mike only seems to have had a partial treatment response to his first-line chemotherapy. Mike has platinum refractory disease, which is: cancer that does not respond [favorably] to treatment with anticancer drugs that contain the metal platinum [at standard doses], such as cisplatin and carboplatin. Mike’s first-line treatment included the drug cisplatin. Since the standard protocol treatment was discovered and curated by Dr. Einhorn in the 70s, it has been widely understood that germ-cell tumors typically respond beautifully to platinum-based chemotherapy. However, 10-15% of germ-cell tumor cases are platinum-resistant (relapse in six months or less) or platinum refractory (initial good response, then resistant with growth in 4 weeks or less from the last treatment). Mike is, unfortunately, part of that 10-15%.
Based on this knowledge, Dr. Ramalingam (the Duke medical oncologist) made a couple of different recommendations but feels like the best option is high-dose chemo, followed by stem-cell translplant. Mike could try a second-line standard-dose therapy alone, but it would still include platinum-based drugs as a main agent, and therefore the success rate might not be as high in his case. Dr. Ramalingam recommended we meet with the transplant doctor and his team for an initial consultation to gather further information. The transplant doctor, Dr. Long, worked us into his schedule two days later because he felt Mike’s case was urgent enough to do so.
It’s hard to describe the surrealness one experiences when meeting with a transplant team if you’ve never been on this road. You don’t just meet with the doctor. You see their nurse coordinator, the social worker, the financial team, and you usually get some bloodwork. It takes several hours and there’s tons of information given to you at breakneck speed. Yet, somehow, the folks at Duke made all the information digestible and the atmosphere calm. For example, Mike was having severe back pain and some nausea the day we visited, so they ensured that he was as comfortable as possible with heat packs and warm blankets and they even got him some nausea meds from their pharmacy.
As an additional note, Dr. Einhorn called for Mike’s virtual appointment on Wednesday while we were on our way to the appointment with the transplant doctor at Duke. His recommendations were essentially the same as Duke’s with some slight institutional differences in protocol and practice.
The Timeline
We have no firm timelines yet. I know that will be everyone’s next question. We have a good idea of what each step will be, but we aren’t yet sure when those things will start. There’s a lot that needs to be done in the meantime to prepare. He needs to have another CT scan as a pre-treatment baseline. He needs to do some follow-ups with his local urologist to make sure everything is good to go there. He has to get work stuff in order at his job. He needs to go to the dentist to make sure there are no underlying issues that could cause infection in the next six months or so. These are all things that take some serious orchestration.
As you pray for us, please pray for peace. Pray for healing. Pray for rest. Pray for a long, healthy life to follow this very difficult season. We just keep facing bad news on top of bad news healthwise. The woes of living in a sin-tainted world are brutal and crushing us right now. I would love just one piece of good news that moves us in a positive direction. It seems it’s all negative at every turn. I’ve said to several friends that I’m feeling a lot like Job in the Bible these days. It seems that on the heels of one messenger of doom rests another one.
People keep asking me how I’m holding it all together. My only answer is God’s presence. I feel like I’m standing in the eye of a storm and chaos is swirling all around me, and I should be a basketcase, but I’m miraculously . . . not. There is no other explanation other than God with me, Emmanuel. Of course, there are meltdown moments, but my overall disposition is relatively calm. It doesn’t make any sense to be this calm in this season apart from the Holy Spirit within me. I am reminded constantly of God’s love and care for us through the support and encouragement of friends and family, a passage of Scripture that comes to mind, and just the quiet moments of joy we carve out in our family together. Only God can give that sort of calm assurance. It can’t be found anywhere else. If you’ve never met the one true God as described in the pages of the Bible, I’d love an opportunity to introduce you. Hit the contact button at the top of this page.
Once more, Thank You isn’t enough, but it will have to do. Thank you for praying. Thank you for adding us to your church prayer lists. I’ve lost count of how many lists we’ve been told we’re on. God is kind and gracious to us.
