An agile approach to treatment

I’m a software developer – been doing it for almost 15 years. There are a few different ways to approach software development – some more effective than others. One approach is to make a plan and stick to it – no matter what. And typically, when you get to the end (if you even make it that far), you miss the mark, even though you stuck to your plan. Another approach is something called Agile. It’s more of a way of thinking then a method or framework. The concept is to constantly re-evaluate what you are doing to see if it is working and what your user (or customer) wants. If not – change course. I’m amazed at how effective this is.

There are a bunch of different ways to do Agile development, one of which being Scrum. One of the benefits of Scrum, is it has a very strict schedule, despite being flexible and agile. In Scrum, work is broken into Sprints – which is a designated period of time – typically 2 weeks. So every two weeks, the team does the following:

  • Day 1 – planning. The team agrees what work will be done over the next two weeks
  • Day 2-Day 13 – working. The team does the agreed upon work, meeting every day to give a brief status.
  • Day 14 – review and retrospective. The team demonstrates the work done and then evaluates how they did and what to change in the next Sprint
  • Day 15 = Day 1 of next Sprint

It works really well, especially when deciding what to do next, based on lessons learned.

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Today I was thinking about it and decided, Josie and I are in our own Scrum team – with 1 month Sprints with Oncology. Today was her one month checkup, where we discussed how she’s done over the last month and what needs to change. It was like a review, retrospective and planning all in one quick 30 minute appointment.

So how’d that checkup go? Pretty good. Her weight has dropped from 47 to 44 lbs since the last visit, but I made sure to point out that it had already dropped during the first couple weeks, and appears to have stabilized at 44 lbs. Also, she did this the last time she was on Prednisone. It’s an interesting effect – she is starving and eats more, but looses weight. Typically, that means muscle loss – something to be concerned about long term.

Other than that, everything checked out good. She still looks good. She has good air flow out of both sides of her nose. I even shared the story about freaking strangers out with her random nosebleeds. I think the oncologist was as entertained as I was by it. Overall, a positive checkup. Granted, I’m still waiting on the bloodwork results, but I’m sure they’ll be looking good too.

We did make some changes. First, a not so obvious change – we changed the Palladia dose. And not for any reason that I find promising – apparently the 10 mg and 15 mg tablets are on backorder. They only had 50 mg tablets in stock. So, regardless of how Josie was doing, we had to drop the dosage due to this. The positive side is she lost weight, so she’ll be less effected by the drop in dosage. In fact, the mg/lb ratio is still about the same. The negative side is – what happens next month?

The second change was a direct result of the weight loss. We dropped the Prednisone dosage. The oncologist did say Josie still looked good, and her muscles still looked good, but there is a huge concern long term what will happen. So as a preventative measure, dropping it makes sense. I’m hoping the fact her weight stabilized means she won’t drop any more weight – but I am watching it. However, it will be interesting to see if her nosebleeds get worse on the lower dose.

So, Josie and I are now in “Sprint 2” of metronomic therapy. Here’s hoping it goes as well as the first one.

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