Day 170 - Calling an Audible

     For those unfamiliar with the phrase "calling an audible", it's a football term where the quarterback changes plays before snapping the ball once he's had a chance to evaluate the opponents defense.  In Oncology terms our primary physician has called an audible.

Santa display at CHoA.

     In the short time we've been in treatment Evan has experienced more than his fair share of infections and setbacks.  We were scheduled to begin our second half of Delayed Intensification before another bone infection manifested itself.  Cristy had a long talk with Evan's doctor and he shared the fact that he's had many sleepless nights trying to determine the best treatment options for Evan.  What he ultimately decided on is a plan that scraps DI (for now) in exchange for drugs that are easier on Evan's body.
     The new plan closely mirrors that of Consolidation.  He'll take daily Mercaptopurine and weekly Methotrexate for the next 28 days.  His blood counts will be monitored throughout to ensure that this adjusted plan has the desired long-term effect.  Our doctor came to this conclusion based on Evan's responses so far to these drugs and because of other genetic factors discovered during Evan's initial bone marrow aspiration.

Getting into the Christmas spirit at home.

     During their discussion our doctor also advised that we start working with an Immunologist.  In the past when Evan's blood counts have recovered his body should have been able to defend itself, but something still seemed amiss.  The doctor thinks that Evan's immune system could benefit from a closer look.  Cristy had a similar conversation with one of the Oncology doctors in the past that echoed a similar sentiment, but she suggested waiting until after chemo had completed due to the fact it could paint a misleading picture.
     Evan met with the physical therapist a couple of days this week and she noticed more mobility in his ankle than prior to surgery.  She felt that the infection might have been limiting his movement.  As I've mentioned in earlier posts Evan seems more willing to walk now, although we're trying to temper his enthusiasm.  We're in wait-and-see mode until the infection has cleared.  Once the ID team gives their approval we can crank our PT up to 11.

When is Santa coming?

     The drugs he's on now will have a slower impact giving his antibiotics time to heal his leg, but will eventually decrease his counts.  We're still a bit unclear on what the next phase entails.  Could DI be re-introduced?  Will we move to Interim Maintenance?  We're not sure, but the doctor has some time to consider his options.