Yesterday proved to be one of the longest days we have had in the clinic in a long time. We arrived shortly after 8:00 and we didn't leave until 5:00. That is certainly a full day.
The checkup went well...mostly. The oncologist has decided to hold off on any chemotherapy for now. He wants to wait until some kind of symptom presents. That is not an unusual way to approach the kind of cancer Nick has. Right now, the cancer is acting as an immunological deficiency. The doctor is wanting to wait until the cancer is acting like a cancer.
How will we know? The doctor is watching several different things for signs of a change. He is keeping a check on the size of Nick's spleen, different blood counts that would indicate anemia, pain levels in the back and abdomen, unexplained nausea or fevers. The onset of any one of these will be closely watched in order to establish a pattern. Once a pattern develops, the decision to begin chemotherapy will be made.
A couple of things that the doctor noted during the checkup yesterday: two of the blood test results were a little bit lower than last month, and Nick's spleen seemed a little larger during the physical exam. The differences were not significant to indicate that a pattern is being established. It is, at this point in time, something the oncologist will be watching. He feels that overall Nick looks good and everything is okay.
Nick's IGG level was low...again. Last month's mega dose of IVIG (750 ml-regular dose is 350 ml), did help some. Nick's IGG level yesterday was in the 400s instead of in the 200s. That is good, but since the low end of normal is about 750, Nick still has a long way to go. The IVIG dose Nick received yesterday was 550 ml. We didn't go with another mega dose yesterday because Nick had a rough night after the dose last time. The doctor decided to split the difference and see how Nick did with it.
Nick did very well during the infusion and during the night last night. One thing that might have helped is that the IVIG was run very slowly yesterday. I don't think it was intentional since there was a nurses meeting that our infusion nurse was attending. We had a couple of nurses that were watching over Nick and the rates didn't get increased at the normal pace.
Honestly, I was not happy about it yesterday because we were there all day long and I was tired. Seeing how well Nick felt and how good his night was, I'm counting it as an unexpected blessing.
We will go back in 4 weeks for another checkup, blood work, and IVIG. The decision on chemotherapy will be reevaluated with each checkup. The doctor has decided that when chemotherapy becomes necessary, he will begin with the mild chemo. He was very attentive to Nick's concerns about taking the aggressive therapy. Follow-up CT and PET scans will likely be sometime around December. The doctor doesn't want to wait too long and miss something.
Please pray as God leads you.
In His Grip,