After receiving immunotherapy at Angeles Oncology in Tijuana, I returned home for three months of after care. Tests were taken at that time which indicated that there was minor improvement in my liver but tumor growth in my right chest cavity, lungs and bones. Upon receiving the news, both my Mexican and local doctors agreed that chemotherapy was the next necessary step in order to get my tumor load down. The Mexican doctors still felt the immunotherapy had been helpful as evidenced by the fact that I was still alive and that there was some improvement in my liver where my tumor load was the highest. According to all my doctors, my tumor load was so high that statistics would have predicted my death long ago. Although the results of the immunotherapy were far less positive than I had hoped for, the Mexican doctors gave the immunotherapy credit for holding things at bay enough to keep me alive, but now a change in plan was in order. Immunotherapy works best when the tumor load is low. The new plan was to get my tumor load down through chemotherapy and then return to immunotherapy with the expectation that the immunotherapy would be able to be more effective when fighting a smaller tumor load.

Evaluating the Effectiveness of Immunotherapy

September 22, 2014

Subject: treatment – next step

Hi Dr. Palma [doctor at Angeles Oncology],

My second round of chemotherapy will be complete in a week. I have some very important questions that I need to ask you . . .

Dr. Palma, I hope you will not get defensive by these questions. They are not meant as an attack, and I am only asking these questions so I can make the most informed decisions possible. I am very grateful for my time and treatment in Mexico. I have no regrets. I do, however, need to better understand your perceptions of my body’s response to the treatment. I am NOT looking for links for info on immunotherapy. I want to understand why YOU think the immunotherapy was helpful and why YOU and the treatment team think I should do it again considering that the cancer progressed on multiple fronts during immunotherapy—though there was improvement in the liver.

As the cancer has progressed, time and quality of life have become more pressing issues. Each decision I make now is very important. I have chosen life under very difficult circumstances because I still have good days and because I have a mission that I am committed to completing. I need your assistance in my decision-making process. Please provide your feedback on the two issues detailed below:

1. The cancer progressed during the immunotherapy, again with some improvement in the liver. So please explain, simply if you can, why you think I should do immunotherapy again after I finish chemotherapy. I know that according to statistics I should have been dead long ago. In that sense, treatment sustained my life even though there was some progression of tumor load. If the chemo reduces the tumor load, however, I can’t help but wonder if we should have started with chemotherapy instead of letting the cancer grow further. I AM NOT CRITICIZING YOU OR MY PAST TREATMENT. I HAVE NO REGRETS. I AM JUST TRYING TO UNDERSTAND.

2. Please explain whether I need a break between chemotherapy and a trip back to Mexico for more immunotherapy. In one of your videos you said there needs to be a waiting period between chemotherapy and immunotherapy. Please clarify this for me.

Again, I am very grateful for the treatment I received in Mexico. I did what felt right in the moment. I followed where my spirit guided me, so how could I have regrets? But important decisions need to be made now and I just want to be sure I make the most informed decisions possible and the decisions that will support the highest quality of life for the longest period of time.

Thank you for your support and taking the time to address my questions.

most sincerely,


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