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MORE WHIPLASH & THE NEW CHEMO PLAN

MORE WHIPLASH & THE NEW CHEMO PLAN

Remember that time I wrote a blog post about how well Tiffani was doing on chemo and how encouraged we were by the intense improvements we could see? Well, karma decided we were in a really good place. Somebody told somebody else it was time for more learning. If you find those people, kindly tell them I would like to have a word in private…in an alley just over here…yeah, right there.

All coping mechanisms aside, we learned Tiff’s tumor has not responded to the chemo as well as we thought it would. We initially expected her tumor to have almost completely receded by this time. The PET scan was supposed to show a massive decrease in activity in the areas where her tumor had been. What we saw, instead, was a still active tumor which has shrunk to 1/3 its original size.

The Tumor

These images show a side-by-side comparison of the original PET scan and its week-old counterpart. According to the official report, her tumor was given a Deauville score of 4 and a partial response (PR).

A Deauville score identifies the metabolic activity of a lymphatic tumor with 1 being the best and 5 being the worst. The designation “partial response” indicates the activity level of the tumor has decreased from the baseline imagery and identifies no structural progression.

Side-by-side PET scan results of Tiff's tumor

So, now what? New Chemo.

Tiffani’s Oncologist has prescribed a radically different treatment plan. In case you’re curious, here is a link to the previous list of medications, known as ABVD. The new plan is known as Escalated BEACOPP. In either case, the assortment of capital letters each represents a unique medication. We are abandoning two of the ABVD medications and adding six new medications.

Previously, Tiffani had been receiving four chemotherapy medications—by infusion—in one session, one time every two weeks. The new, more aggressive, plan consists of two, three-week cycles. Here is the schedule beginning Thursday, June 14th. (The grey boxes represent a built-in recovery period)

New Chemo Schedule

There are two main goals of this treatment plan.

  1. Kill the cancer: This seems obvious, but we need to consider that active cancer has the potential to evolve and invade more areas of the body. If you’ll remember your anatomy, the tumor’s current location is far less than ideal.
  2. Another Diagnosis: Because we have been operating under the impression that Tiffani has Stage 2, Hodgkin’s Lymphoma, it is possible we were blind to the fact that another type of cancer was growing simultaneously. The original biopsy samples came from her neck, not her upper chest. That being said, Hodgkin’s presents itself in precisely the way Tiff’s biopsy and PET scan showed in the beginning.

Tiffani will have another PET scan following this next six-week chemo barrage. If under these aggressive measures, the tumor has not receded, there will be an additional biopsy and an accompanying diagnosis.

Thoughts

We have tried our best to stay ahead of our emotions. That hasn’t been easy. After lots of crying, excellent conversations, and much prayer, we have decided to move forward with faith.

This development simply must be part of God’s plan. I can’t speak for Tiffani, but I refuse to acknowledge any interpretation that does not involve a good reason for this and I know God loves my little family.

Also, I feel great about Tiffani’s entire medical team. From her primary care physician to her Oncologist to her infusion nurses, we have been impressed and we have felt loved. Tiff’s Oncologist said she had contacted her mentor for guidance who told her she was doing everything perfectly and that the escalated regimen was precisely the next step. That’s not to say we don’t trust her doctor, but I’m not going to lie, having a built-in second opinion was reassuring.

Finally, we have the most amazing group of friends and family. Our support is layered in a unique and nuanced way. Our ward family, here in Greenville, is jam-packed with the most kind-hearted and compassionate people we have ever met. Even with babysitting, we have been covered on a literally daily basis. Some of our dearest friends live only two hours away in Georgia. Phone calls, text messages, Marco Polo videos (yeah, send us a Polo!), emails, Facebook messages, packages and handwritten letters have been pouring in from all over the place. We are never without an ear to listen, a shoulder to cry on, or a friend to help distract us for a precious hour or two.

We have even had friends and family take time out of their busy schedules to travel across the country to visit us from Day 1, literally.  

Our friends, they Eyre’s, planned to stay with us the week of Spring Break. The plan had been in place for nearly two months when we first learned about Tiff’s cancer. Her PCP referred us to oncology for an assessment and Tiff was scheduled for a biopsy in a matter of about 10 days. In the flurry of activity, I completely forgot about our friends’ scheduled visit.

Jordan sent me a text message to confirm the plans. He said they were so excited they were considering how to pack up the car to begin their trek from Oklahoma to South Carolina. They were set to arrive sometime on Sunday evening on March 18th. Tiffani’s biopsy was scheduled for March 19th at 7:00 a.m. I called Jordan and explained the situation.

First, he asked whether their arrival and stay would be too stressful? I told him it would likely be a welcome and pleasant distraction. Then, I asked whether our new situation would be a burden on them during their week-long vacation? He assured me it would not. I asked if they would babysit on the first morning of their vacation since we had to leave by 6:30 a.m. and Olivia would not normally wake up for another hour.

“Of course,” he said. “We would love to. However we can help, you just tell us what you need.”

Orchestrated? You tell me. Support from Day 1, literally.

I don’t have to like the plan. I hate this part of the plan. For a little while, after the foggy numbness lifted, I was pretty angry. But I’m not angry anymore. I’m sad. I’m scared. I’m hopeful. And I have faith that all will be as it ought to, and should be. At the end of the day, I still have the most amazing wife. She is resolute in the decisions she has made to battle cancer her way. We have everything we could possibly need and a few things we want. What more could you ask for?



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