Sunday, April 26, 2009

"This is your captain speaking. We've reached our cruising altitude of 38,000 feet. Flight time today will be 3 hours, 15 minutes. Arrival in DFW at 5:00 pm local time. Speaking of which, er... anyone know how to land this thing?"

That's basically what this passenger was getting over his intercom during Wednesday's weekly meeting with his doc. When I reported that the Hamburg doc had recommended foregoing a transplant for now and waiting to see whether I belong to the lucky 30% of patients who gain mid-term (5-6 years) remission from (Led) Zevalin therapy alone, he replied, sure, we could do that, if that's the treatment course I wanted to take. (Apparently, somewhere, somehow, in the course of all the treatments, consultations, and my own gonzo research, I seem to have gained some clout in the realm of medical opinion, wherein my Miles&More card qualifies as a pilot's license.)

So I said that I didn't expect he'd just take my word for it, and I was kinda seeking his counsel. And he smiled and said there was a reason he referred me to the Hamburg doc, Germany's Zev expert. And that although he hadn't heard of the 30% bit, having heard of the latest revisions in the pre-transplant Zevalin conditioning protocol, he had planned anyway for us to wait a few months to let the nukes do their nukin' before my own stem-cell transplant. (My own googling confirmed what the Hamburg doc said: that Zev doesn't kick in until a month or two after administration, and that the "optimal effect" of stunting bad cell growth occurs after 2 years. So I got that going for me. And total consciousness, which is nice.)

At times, doctors seem all-knowing. Other times, they seem stumped as the grown-ups we as kids asked to sort disputes over rules to games we were making up as we went along. But to his and all doctors' credit, with all he types of cancer and therapies, no one doc can be an expert on everything. And as we learned in school, you don't gotta memorize everything; just know where you can look it up.

And we are kinda making it up as we go along, as he reminded me of something he's told me several times before: that, look, since we together agreed to deviate from the course that the other docs had recommended to treat this type of lymphoma, we've veered off of the standard flight path and into only newly charted air space. (Whereas after nearly a year since the relapse, with five rounds of chemo and continual changes of plan, it seems more like an eternal holding pattern.) As noted in a prior captain's log, late last year when all the top oncology docs in Frankfurt conferred on my case, all but one -- my doc, the chief doc for transplants -- agreed that the best course would be a donor transplant. My doc was "not convinced," and believed that we should hold that ace in our sleeve. That, yes, that's the right option for an acute leukaemia, but that I'm not now in desperate mode, so let's explore some other treatment options. So he did some research, made some calls, and laid out an "individual" treatment plan.

Anyway, when I asked if I could get my walking papers as we wait and watch, hoping I'm in Led Zevalin's lucky one-third fan base, he proposed waiting until my next scheduled PET CT, next Thursday, to see whereabouts the boat is size- and sighs-wise. And we can talk about who's walking where then. And so it's yet another week in the holding pattern, but perhaps a runway will soon clear for me, back down there in reality.

Happy landings