In the Time-Never-Slows-Down category, Austin has an MRI of his abdomen and CT scan of his chest tomorrow to check for signs of cancer. These are his “end-of-treatment” scans which might be a serious misnomer. Or might not. We’re only officially scheduled for one more three-day round of chemo, which will bring us successfully (or not) to the end of the first eighteen weeks of treatment.  So we could be a mere three weeks from the end. Or not.

A lot hinges on tomorrow. Obviously, if there’s any cancer growing anywhere, we will continue with chemo. And if there’s cancer growing in his kidney, we would stop all the hemming and hawing and how-ever-can-we-save-this-little-organ? and just go ahead and remove it, dialysis be damned. If there are signs of cancer in his lungs, which is the spot Wilms tends to migrate to when it spreads, then we’d probably keep the kidney but start anew with some heavy duty chemo.

But if there’s nothing, no shadows or dark spots or lesions or masses, . . . well, then we have some options. We could decide to submit the kidney to more stress and do another twelve-week cycle of the chemo regimen we’re currently in the midst of. Not only might this damage the kidney, but it would surely take his bone marrow down another notch, since each period of “count recovery” leaves us a little lower than when we started. Picture a line graph with continually descending peaks: Each time we finish chemo, his blood counts dip. But after a few weeks, they rise back up (which allows us to start the next chemo), but each starting point is a little lower than the previous one. This cumulative effect can continue until eventually Austin’s “good” blood counts will be as low or lower than his original “bad” blood counts. When the bone marrow is depleted in such a way, treatment is often halted and then the patient becomes eligible for a bone marrow transplant which is no walk in the park. So, those are the two big risks of continuing chemo: depletion of bone marrow and destruction of the kidney. Plus, of course, that little fact that chemo can cause cancer, namely leukemia down the road.

Chemo, of course, also kills cancer which is (duh) the reason to continue.  In case there might be some teeny almost invisible cancer cells lurking around in there, waiting for us to cease our attack before they rear their ugly heads again. But what if the cancer’s already gone? What if we did enough with 1) the surgery, which removed almost all of it, 2) the radiation, which would have targeted any remaining cells in that area, and 3) chemo, which should have destroyed any cells hiding elsewhere in his body? So, maybe we’ve done it, maybe we’ve already beat that damn cancer. And in that case, doing more would only do harm.

Oh, decisions, decisions. Huh. First, let’s get to tomorrow. And hope for nothing new. After all, our hands are full enough already.

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