Saturday, March 9, 2019

Team Meetings


           Monday - The oncologist's office called to see what we had decided about the Cetuximab, an immunological drug that is used in conjunction with radiation to augment the effectiveness; Cindy has decided to have this treatment.  There will be three or four doses which take about an hour each to infuse.  It has its own set of side effects but seems a good choice.

            Cindy had an appointment with Anneke, an oncology social worker basically concerned with the patient's physical, social and psychic support during the treatment.  She seemed satisfied that, for the moment, Cindy was not stressed by the upcoming treatment nor lacking in support.  As befits a social worker, she was chatty and we talked about her Dutch first name and Boer Dutch last name, results of her birth during her parent's assignment in the Netherlands and her husband's South African heritage.  Her kids have not been similarly blessed.

            We were asked to stop down to the radiation shop after the appointment with Anneke to see Elaine, who seems to be the patient support nurse there.  She wanted to talk about nutrition and eating problems, and referred Cindy to Swati, a nutritionist.

            Thursday - When we called Swati, she seemed slightly puzzled about what she could do for Cindy now but gamely made an appointment.  We were again confused in finding our way about the three sections of the Reston Hospital, but managed to find Registration.  Unlike the appointments with such weighty and ominous groups like radiation and oncology, registering for a nutrition session took a 15 minute paperwork drill complete with creating the ID wristlet (which Cindy declined wearing).

            Anyway, we talked with Swati about nutrition matters and she gave Cindy a couple of high protein drink sample bottles (she had a surplus anyway).  She seemed impressed with Cindy's recent healthful meals (your humble correspondent was appropriately modest).  She encouraged Cindy to return if she had trouble eating.

            Friday - The caller (Cindy/Cynthia) said she was a "case manager" and wanted to talk with Lucinda.  One worried about a scam,  carefully answered and waited for the request for the SSN and bank account number.  She was from Blue Cross and wanted to help (suspicion not abated).  However, she seemed genuine and had been prompted by the oncologist's request for approval of Cetuximab.  She was knowledgeable and went through her list of questions,including whether there were plans for a "GT" (gastrostomy tube) to feed Cindy.  We hoped not.  She's sending some material on coping with radiation treatment, gave us her direct line and asked that we call if we had any concerns.  We were stunned that Blue Cross was so proactive and are uneasy with implications of all these separate health entities contacting Cindy with concerns about the side effects of the treatment.

            The theme this week is that everyone involved is concerned that someone like Cindy, borderline underweight, will be challenged to maintain her health and psyche when suffering with the effects of this treatment.  We're hoping that this is an assumption about age-related decrepitude rather than the norm for this treatment, but it certainly focuses one's attention on getting food into the patient.