The Quickening Descent
Austin’s GFR results were 34. Right … no typo there: 34. Almost as bad as the result last month that necessitated a retest. And not nearly the still-not-fabulous-but-definitely-acceptable 66.
Here’s what this means in the world of kidneys: He can still get this next chemo, which is scheduled to start on Thursday, but it needs to be further dose-modified. If his GFR dips below 30, which we assume it will next month, he either has to stop this particular drug or (maybe — this hasn’t been confirmed yet) get dialyzed after each dose. We’ve already explored the possibility of doing only two of the three drugs in his protocol but have been told that their effectiveness lies in the specific combination and leaving one out would render any of them much less useful. So it’s sort of an all-or-nothing thing: either we stop chemo altogether or we continue and add dialysis to the mix.
For someone who doesn’t have cancer but suffers from regular old kidney disease, a GFR of 30 makes them eligible to begin the transplant process. Austin, of course, won’t be eligible for transplant until two years after the end of treatment (not two years after March 30’s clear scans, as I had hoped). And a GFR of 15 means thrice-weekly dialysis.
The path ahead seems a bit inevitable right now. I suppose the descent could slow or stop and we could hover here with a GFR of 34 for weeks or months or years, but we’re not holding our breath for that one. There are many many discussions to be held with our doctors when we’re in-patient this week; many questions to ask and answer; many scenarios to play out.
But no matter what we end up with, no matter which thorny path emerges from the forest, we will walk it.
Krissy, please make sure to ask the docs how effective is the chemo if it gets dialyzed off right after the treatment. I’m guessing they won’t have a specific answer to this, but it’s probably worth asking, and thinking about. By the way, which is the chemo drug that they’re worried about, in terms of Austin’s kidney? I’m still looking at this as an “ascent” not a “descent” – an ascent to being cancer free, but I know what you mean.
Barbara
Thanks Barbara. Carboplatinum is the guilty party. He gets it with etoposide these three days and then cyclophosphomide with etoposide on his five day cycles. (First protocol was dactinomycin, doxorubicin, and vinciristine.)
Krissy, I just used your line, “… no matter which thorny path emerges from the forest, we will walk it” at a support group this evening for ovarian cancer patients. You are inspiring more people than you can imagine.
I came home to read your story about the connection with the other mother, and our program tonight had been some dramatizations about the strength of cancer patients and their husbands. You reinforce that too, bringing out front and center the strength of parents of cancer patients.
Your writing is inspiration to a wide world. Georgia