We are involved in a kind of race between the different elements of Isita’s treatment. If nothing else changes, on Monday 8 January, Marta and I will start training to administer the paraenteral nutrition (TPN) at home. Officially, this is a fortnight course 10am to 4pm daily. It is not hard but there is no room for error. Once we have learned, we can take Isita home and treatment continues from there.
One of the things that could change this picture is that Isita’s platelets could increase to the level that makes surgery possible. They need to be above 100. Having stuck stubbornly at just over 50 for the past while, they went up to 92 in the most recent blood test, the results of which arrived yesterday. If she is clear for surgery, we don’t think the doctors will delay.
The other thing that could change the picture is that Isita’s small intestine could start to function better. In the past few days we have roughly tripled the amount of feed she can take in a day from what was, admittedly, a low base. Yesterday she had 170ml, and only vomited once, quite early in the morning. It is impossible to guess how much feed she might be able to take 10 days from now, let alone in 24 days time when our TPN training would finish. Will it be necessary by then? The plan is , eventually, to swap the NJ tube for a ‘peg’, a tube directly into her abdomen, which will make it easier to administer the feed.
The final element of Isita’s treatment that will be affected by these various scenarios is immunotherapy. It would be better if she had surgery before rather than afterwards. But that has not been on the agenda until the recent news about the platelets. Immunotherapy and TPN training are also incompatible as Isita must be free of all IV treatments while the training goes on.
The senior oncologists want to push on as quickly as possible with whatever they can, and have been encouraging us to increase the rate of feeding in the hope of weaning Isita off TPN. The only option not on the table is radiotherapy as Isita’s gut is way too fragile to risk the collateral damage. But apart from that, we have to be ready for anything.