Specifics on Pablo's Treats OR The Chemo Barista, The White Blood Cell Drop and The Seven Nation Army

Left: The Chemo Barista.
Right: White Blood Cells, by The White Stripes. Read on to unlock the mystery.

Hi everyone. Another post from Jo Ann (with a little sprinkle of Jeff), covering the background on Wilm's Tumors, and the spec on Pablo's treats-ment.

Pablo's treatment and schedule: After we had our CT scan to see if there was any cancer anywhere else and it came back clean, we decided–with or oncologist, Dr. Leo Mascarenhas and a nod from Dr. Michael Jensen, the head of pediatric oncology at City of Hope (who is parent at Grady's school)–to start Pablo on chemotherapy treatment right away. Everyone agreed a biopsy was pointless. It would prolong the start of chemo. And the docs knew what he had, so there was no need to put his little body through an invasive surgery and recovery at that stage.

This is what I know about Wilm's Tumor: there are two kinds: a good one and a bad one. The good one is the most common. Wilm's Tumor can be found on only one kidney, or it can be bilateral - both kidneys.

Bilateral is rare, and THAT IS WHAT OUR PABLO HAS. Of all the bilateral Wilm's Tumors out there, it is extremely rare for bilateral tumors to be the bad ones. The docs kept stressing they didn't want to talk about Pablo as if he were a number (ie, getting into statistic talk). But some of the stats are welcome and helpful. One of the key metrics in the Wilm's game is that almost all of the bilateral tumors take to chemo like a champ. This is a simple goal post to hang onto when thinking about Pablo's condition. SO - we are moving forward as if his tumors are the good ones.

This is our best case scenario and we are asking everyone to hold that in their daily prayers, meditations and thoughts.

Our treatment plan:

• Chemo for six weeks. This Tuesday will be week two.

• CT scan on June 26 to see that the tumors are responding to the chemo.

• If that checks out, we will head into surgery to remove BOTH tumors and save as much of BOTH kidneys as possible.

• Then, we follow up with 12 more weeks of chemo.

The actual chemo cocktail: is a combination of Vincristine and Dactinomycin (Actinomycin-D).

Vincristine = V
Dactinomycin = A

EVERY WEEK: Pablo takes V
EVERY THIRD WEEK: Pablo takes V and A

This is the national (and possibly international?) protocol for treating Wilm's Tumors. Not a lot of trial-and-error or theorizing going on with this cocktail. As we have written before, Wilm's is one of the most heavily researched and most successfully treated forms of cancer around. Dr. Mascarenhas is confident in his cocktail. He is pullin shots like a mad-skilled barista, and we are confident he's got our order right. Also, compared to the drugs given for other kinds of cancer and to adults, this protocol is pretty tame. It is regarded as minimally invasive. It will not render any long-term effect on Pablo's physical body or his organs.

During the treatment cycle, the A drug will be very tough on Pablo's body. He will need to become a seven nation army to fend off its gnarly effect. A will wear down his white blood cells the way Jack White wears down his fingertips riffing and rawking. There's a chance we'll have to wear masks around the house, and visitors will be off limits. Our hearts are hoping that this won't be too hard on Pablo. On the logistical and mental front, we're prepared for all this simply by knowing it's a possibility.

Where will Pablo receive his treats? He will receive chemo as an outpatient at the CHLA Oncology Clinic EVERY Tuesday. So, we are planning for very quiet Tuesdays and Wednesdays over here in Silverlake!