Saturday, January 27, 2007

Normalcy Continues

Oh, those dreaded IGG counts came in this week: IGG's are now at 1596, up from 1433. Still in the normal range, which tops out at about 1680. As I've said before, we certainly don't like the upward movement but it seems to be inevitable--at least according to Dr. Rifkin, who seems compelled at every visit to advise me, "you know it's going to come back". I continue to reject that in my mind, but it's hard to argue with as I watch the numbers going up. On a positive note, there are other indicators that Dr. Rifkin is watching which are improving. One in particular is the Kappa Lambda ratio of the light chains in the blood. Now, if anyone of you out there understands what that entails I would appreciate some enlightenment. I have tried to figure out what this ratio means but I just can't get it. Anyway, that ratio has been off since diagnosis and now is very close to normal. As with other visits, given that the IGGs are still normal, I know I have at least another month without treatment and probably two.

I also had my checkup with my urologist and everything continues to be fine on that front. PSA is 0.

My mediation practice is set to start this next month. I'll be working with a very experienced mediator here in town, Joe Epstein, and he is rapidly filling my calendar. As I only want to do 1 or 2 mediations a week, he has already filled my February calendar. I'm still struggling a bit with letting go of the identity of a trial lawyer, but am confident that once I fully extract myself from my law firm and start my new life as mediator it will be fine.

The family is doing well. Julia is applying to study abroad next year in South Africa, working with HIV/AIDS clinics there. South Africa certainly has its problems, not the least of which are crime, muggings, etc. But she is determined to work in a third world country and ultimately we left the decision to her. Catherine continues to love her job and is learning more and more about investing (but she still refuses to advise me about my retirement portfolio). Susan now has a job--working as my Chief Operating Officer in my mediation practice. In order to get the health insurance coverage I need, my business is required to employ 2 people. So she is in charge of the bookkeeping, billing, banking, scheduling, filing, etc. She seems happy to do it, but maybe that's only because she knows this business will get me out of the house and she is willing to do anything to see that happen!!

The two year anniversary of my MM diagnosis is just around the corner--March 24. It's hard to believe it's been two years and it's harder to remember what life was like before cancer. I remember when my sister was here in the fall of 2005 just after my transplant and she asked me if I ever had moments where I forgot about having cancer. Sadly, I responded no. I can now say I do have those moments, maybe even hours now where I am engaged in some activity and oblivious of the fact of my disease. I guess one could call that progress.

So, in closing, thanks to all of you who continue to hang in there for us, who silently check the blog, who call and write, and who pray. We know you're out there and we are thankful every day for the blessings that are our friends and family.


Sailor Hawkins said...

Dan, you always inspire me with your honest expression of feelings and humor. I know movement from a lawyer identity to that of meditator is a huge step for anyone. I can just imagine how wonderfully well you will function as a supporter of healing for others. I have a feeling that your new job will bring many new blessings. Blessings that are bigger than we dared to dream! Thank you for allowing us to pray, care about, and love you and your family. Knowing you are doing well makes my step a little lighter. I appreciate your up-date. Thank you.
Peace and action,

Molly said...

Dan (and anyone else who is interested),

Here is some information about the kappa lambda ratio.

look at this webpage (which has a picture of what i'm talking about):
while you read the post.

This(the picture on the webpage) is the basic structure of an antibody secreted by a B-cell. The pink portion is known as the light chain, while the blue portion is known as heavy chain. Both The heavy and light chains have regions that vary between antibodies (variable regions) and regions that are the same (called constant regions) in all antibodies.

The reason for having variable regions is so that cells can synthesize a vast amount of different antibodies to fight off any type of infection that may arise, since each antibody is specific to only one thing.

The constant regions of the heavy chain determine what “class” the antibody is: IgA, IgD, IgE, IgG or IgM. Certain classes are better at fighting certain kinds of infection than others and each has a slightly different function in the body.

In humans there are two types of light chain constant regions, called kappa or lambda. There is no functional difference between the two, they just differ in the sequence of DNA used to make them (and I have no idea why they are called kappa and lambda).

An individual antibody molecule always contains identical light chains and identical heavy chains: an IgG molecule, for example, may either have kappa or lambda light chains, but not one of each.

In normal B-cell populations the ratio of kappa and lambda expressing B-cells is 2:1 (as far as I know).

Cancer cells are essentially “clones” of a single parent cell. Therefore all of these cancerous cells are identical and have the same light and heavy chains. It looks as though the parent of your cancer cells was an IgG expressing cell, which is why they count the IgG numbers. If for example all of your cancer cells (since they are all identical) have kappa chain, it could have made the kappa lambda ratio 3:1 (out of normal range?).

Having IgGs could simply mean you have a lot of antibodies ready to fight infection. Perhaps your body rebounding a bit from the chemo? The fact that your kappa lambda ratio is good means that there are NOT a lot of IgG “clones” (cancer cells) floating around in your blood. Which is why that ratio is GREAT news!

Let me know if that makes any sort of sense or if you have any questions


scoopondan said...

I knew Molly would weigh on this scientific question. So, apparently my ratios have gone from a 3 to 1, to a 3 to 2, which would definitely be in the right direction and maybe even normal. After reading your explanation I now know why Rifkin was less concerned about the IGGs and more enthused about the Kappa Lambda ratio. thanks Molly.

Jaike and Shawn said...

We have a good friend here in Chapel Hill that went from a trial lawyer of 20 years into mediation. He seems to prefer it. I know you will do well with it.
We were thrown a career curve ball going on 12 years ago and what transpired from it has been far more prosperous than we could have imagined. Not to mention, it has taught us some very big lessons in life. Working with your spouse can be wonderful and at the same time torturous, but it is never dull!!
Love to you all.

brett said...

Since you need another employee let's think of the ways you could fit me in as one...associate chef in charge of Saturday breakfast so I can enjoy seeing how your family really functions, personal driver to see Beat poetry relics, fetcher of thick drinks with gummy bears in them that seem like "balls of snot," or my favorite, "Hanger-on friend who will come over to your house any day of the week, sometimes without invitation, to eat Susan's fabulous food and to drink your outstanding wine."