April 29, 2010


The first visit to MD Anderson showed a doctor (let's call him Dr. Andy for MD Anderson) who was willing to take my brother but was not pushing it.  He kept stressing that it was a long way from Dallas, it's a big headache to drive down, the same treatments are available up there, yada yada yada.  He even went so far as to say that the treatment prescribed by the Dallas oncologist was a respectable one.  Really?  Then why did he go further with cisplatin, docetaxel and zometa?

Fast forward a bit.  At the last visit before his second round of chemo, I mentioned that my brother's white blood cell counts had rebounded quite a bit from the counts a week and a half ago.  Dr. Andy's expression changed immediately.  You see, he hadn't bled at MD Anderson.  He had been bled up in Dallas.  "Why are you getting bled."  It was really a statement of disapproval rather than a question.  The Dallas oncologist had bled him for a couple of different reasons and we explained that this was all part of him maintaining a relationship with a doctor up there in case of acute needs like an infection, incidently which was all urged at the behest of Dr. Andy.  It was clear he wasn't happy about the bleed.  "Look, you're going to be a pin cushion by the end of this and I don't want you getting bled needlessly."

I couldn't have been more pleased at that point.  Dr. Andy had taken ownership of my brother's care and was no longer offering up these nonsensical platitudes that care is care no matter where one goes.  He had skin in the game and didn't want things messed up by another doctor.  I can relate.  As a scientist, I hated it when people tried to derail my experiments by piling on pointless measurements.  I'm sure I won't be that different as a doctor.


Steve Parker, M.D. said...

I'm confused. Does "getting bled" refer to therapeutic phebotomy?

I can understand the initial comment about getting chemotherapy close to home. Chemotherapy patients fairly frequently have acute complications that need urgent hospitalization: anemia, sepsis or neutropenic fever, vomiting and/or diarrhea with electrolyte abnormalalities, etc.

But there are many other considerations as you are well aware.

When I lived in Austin years ago, I accompanied someone to MD Anderson for a consultation on treatment of leukemia. The oncologist in Houston convinced us that the Austin doctors could do just as good a job.

It was not a rare malignancy.


Isaac said...

Sorry, "a bleed" is a holdover from my research days which is what we called it for animal studies when we sampled sera/plasma at various timepoints. The doc was looking at electrolytes (my brother was complaining of muscle weakness, cramps, spasms and the chemo is known to deplete potassium and magnesium) and decided to get a cbc while he was at it.

Regarding the where, you're right. It absolutely depends on the disease. My brother's is stage IV lung cancer in a young, healthy non-smoker with no family history. Anything but usual. The Dallas doctor offered up carboplatin and taxol. Pretty standard. They didn't handle the first biopsy terribly well in my opinion, though. There was some other things about the way it was handled that didn't sit with me. MD Anderson offered up cisplatin and docetaxel in addition to zometa for the bone mets. They also offered up a Plan B, a Plan C, and a Plan D with respect to clinical trials. From my limited understanding, cis and docetaxel was more aggressive and had some demonstrable superiority in earlier stage disease. After looking into zometa, the addition of a newer bisphosphonate sealed the deal for me. It should be at least considered in patients with bone mets and emerging data suggests that it may have anti-tumor effects in the bone. We'll have to wait and see for the larger studies to finish, but for a young, otherwise healthy patient like my brother, I thought the more aggressive therapy was absolutely warranted. He's not a 70 y/o diabetic with a history of hypertension who would have difficulty handling such an aggressive therapy. He's a 38 y/o healthy male with no other comorbidities. So it ended up not just being a decision between locales but a decision between treatments. As I hinted, it wasn't an easy decision