Thursday, July 30, 2009

Lab Rat

After 2 weeks of steroids the white and red cells seem to be holding. The stability may be illusory, but it keeps me from getting a shot or a transfusion, and may allow more therapy, such as thalidomide. Will know more on Monday. Received an email from Arkansas today saying Barlogie just received a letter from Rifkin and Dr. B doesn't agree with Dr. R. My short response to the nurse was to the effect of, "Have Dr. B call Dr. R and talk about this." Duh! Am I supposed to get in middle of this? Based on my knowledge of biology, hematology, oncology, pharmacology, and medicine, I shouldn't be in the same room with these docs. It seems I've gotten myself smack dab in the middle of the debate between blast it out of existence and manage the disease. That being said, I do know that I won't get in the line of fire of any treatment loaded with high dose chemo. After 4 1/2 years, "blast it" has not worked at all with my cells. (both unsuccesful transplants were preceded by high dose chemo regimes.) "This should prove to be very interesting," said the lab rat.


Monday, July 20, 2009

Inside Looking Out

I think I'll start from the beginning. That is, when I first considered going to Arkansas for treatment. Many of you were with me in those early postings last November and December. In brief, my maintenance treatment here was no longer working. Rifkin had not articulated a definitive treatment plan. And quite frankly, I was encouraged by my meetings with Barlogie that he might get me into remission (I was, after all, "low risk", according to his testing). Almost 4 years of treatment made us all want to believe this nightmare might be brought to an end. Well, 2 months delay in getting treatment (again, Barlogie thought it better for introduction of his protocol that I not be in the middle of a treatment regime), and my cancer levels jumped from a stable 10%--12% to 90%. Change of plans, hit me with everything in the cupboard. Spare no cell in my body from the assault.

And herein lies the great divide between the Arkansas treatment plan and that used by Rifkin, Mayo, and a number of other cancer centers. Blast it out of existence vs. manage it with a combination of drugs. Each has its risks. Neither is a "cure". Being in remission does not equal being cured. Managing the disease is not remission. No one has the answer. As you all know the "blast it out of existence" approach didn't work for me. Instead I now bear the scars of that unsuccessful approach, which is marginally functional bone marrow, completely numb feet, and skin that flakes off like dandruff. And those scars (primarily the injured bone marrow) now impede my ability to withstand even the mildest of treatments. I am not one to look back and live with regrets. I made my decision with as much info as I could ingest. I know that had I stayed in Denver for treatment that course may not have been successful either, and I might now be shuffling off to Little Rock for treatment. That being said, I must admit I am extremely frustrated that my Arkansas treatment regime has left me in a state where I can currently receive minimal treatment for a disease that is "angry", as both my doctors say. As a former trial lawyer, it feels like I've just gone through a "bet the company" piece of litigation, and haven't fared very well. I always counseled my clients against taking things to the brink--too risky and they needed to be able to afford losing it all. And I must say that I never appreciated that the super beam plus chemo along with the transplant was an "all-in" bet, that might leave me with no more chips to bet. I even specifically asked whether the super beam plus chemo would prevent me receiving a transplant in the future (whether from my own cells or my brothers'). The answer: absolutely not! hmmmmm. So, you ask, what's my point, other than venting? I'm not sure, except to say, sometimes learning the lesson, once again, that we can't see into the future can be very frustrating and difficult.

So, on to the current numbers and the plan. Plasma cells (which are the cancerous ones generated by myeloma) are at 75%. They were 50% when we left Arkansas. They were at 90% or higher before the transplant. The disease is still "angry" according to Rifkin. More info on things such as "flow", that I don't really understand, will be available next week. The plan? Rifkin told me there were 2 courses of action: blast it or go at it with more finesse. Blasting it, per Rifkin, would likely leave me with bone marrow that will never recover. He didn't recommend that course but said that is undoubtedly what would happen if I were in Arkansas. (My marrow is slowly recovering. This is the first time since I returned to Denver that I have not needed a blood transfusion within 2 weeks of my last one. The white count is now 2.0, having received a neupogyn shot last Monday. Slow progress---but progress) Back to Rifkin: I didn't even consider the "blast" given the difficulties I have had since receiving the high dose chemo in early April. He says he does not want to give me any mylosuppresants, i.e., drugs that might potentially suppress the myeloma, as those drugs would also adversely affect my white and red cell counts. So I'm starting a regime of prednisone, 50 mg., every other day. Roid rage anyone? If this holds the myeloma or brings the numbers down, then he will introduce another drug (perhaps thalidomide). If that works to some degree, and my white/red counts are stable, then perhaps another drug, and so on.

The watchword is patience. Whether it takes 6 months, a year, or two years, I am confident the cancer will begin to lose its anger (no one or no thing can stay mad forever--it is a law of nature), the counts will stabilize and new treatments will begin to surface. Susan and I have been through this before. We have tapped our inner resources like never before. We know that is the source of the strength to weather this storm. Susan has been the most unbelievable pillar of support for me and she continues to show that behind those tears that constantly flow is a block of granite so solid that no storm could crack it. Similarly, Catherine and Julia are worried but steadfast in their resolve to help us through this. Catherine told me she is very frustrated with that cancer and is going to have to have a stern talk with it. Go get 'em Cate!

As we walked out of the cancer center I looked at Suz and she at me. We could see the love we have for one another in each other's eyes. We're more in love than ever. Funny how life's most difficult moments also bring blessings. And though we have to walk this difficult path, it is a long road but we're gonna make it.

Much love to all of you.

Wednesday, July 15, 2009

Digging for Bone Marrow

Monday was the day for the bone marrow biopsy, to be conducted by none other than Dr. Rifkin himself. It's usually done by a medical technician. I'm not sure why I got such special attention. Having been through a biopsy without anesthesia, of course I requested it (IV fentanyl and verced). Then, I forgot that I wasn't supposed to eat for 6 hours before the procedure. Not wanting to vomit all over the examining room, I confessed my sin and was promptly told that there would be no sedation given. All I would get would be an ativan to relax me. Ativan is not a pain killer. So be it. I could've rescheduled, but I want to know what's going on in my bone marrow and I knew the pain would be temporary. Rifkin was quite good at the procedure, i.e., it didn't hurt that much, even though he had great difficulty getting a core of the hip bone as it is too soft from all the treatment I've received. My ability to withstand the procedure without anesthesia is either due to the 12 bone marrows that I had down in Arkansas that prepped me for this experience, Dr. Rifkin's good steady hands, or the fact that my nerves are shot and I can't feel anything anymore. We'll get the results next Monday.

Otherwise not much has changed in my blood work. I can't seem to generate either white cells or red cells on a consistent basis. I'm hoping the bone marrow biopsy will shed some light on the cause of this problem, but I'm not sure it will. It may just be a matter of time.

Otherwise things are pretty slow around here. I spend too much time at doctor's offices. I am noticing a return of some energy which is encouraging. You all know the drill: slam me to the floor with chemo, watch me struggle to get upright, regain some weight and muscle and start feeling better, then slam me with more chemo. I certainly prefer to be in the strength gathering and weight gaining phase, which is where I am now. I try not to think about what's coming. One can actually paste together a life while riding this roller coaster, albeit not too active, but nonetheless a life, as long as one keeps his eyes looking upward. Speaking of which, I must emphasize again how much I am enjoying being back in Colorado. The summer weather here is so temperate and beautiful. And the skies are always a deep blue with a few scattered clouds (except for the afternoon shower). Every day I am thankful to be back home. Why, I hardly think about Arkansas anymore (and that's a very good thing).

My best to all.

Tuesday, July 07, 2009

Wishing For Some Control

One of the difficult aspects of this, and many diseases, is the feeling of powerlessness. What can I do to improve my situation, short of following doctor's orders? The western medical approach is: not much, try some exercise and eat balanced meals. I find myself searching for more avenues that might aid me in my body's efforts to heal. More on that later. First, the status report: IGGs back up to 4020 and M spike at 3.3. Given all the bouncing around, this is considered stable. White count is at 2.0, after getting neupogyn a week ago, and hematocrit is 23.5, hemoglobin 8.2. Those last 2 numbers require another transfusion--2 weeks after the last transfusion, which I'm headed for in about 30 minutes. So, Rifkin says my bone marrow seems stuck and we'll need to take a look at the bone marrow--bone marrow biopsy next Monday. This stuck bone marrow is of most concern as any significant treatment will likely require some level of functioning by my bone marrow in order to allow me some ability to recover from the treatments.

I started some acupuncture about 3 weeks ago to try to get some relief for my peripheral neuropathies in my feet--shooting pains and numbness. Not much success on that front. I saw a Chinese herbalist this morning for my thrush. He seems to have the greatest knowledge of where my imbalances lie and what I can do diet wise to try to restore balance. I had a very interesting discussion with him about my body's energy, the imbalances that are making it difficult for the bone marrow to recover and what can be done about it. This is also at the core of the thrush or coating on my tongue. As he said, it is but a symptom of the imbalance in the body. Now, I have been taking some concentrated vegetable soup from a Dr. in the UK, upon recommendation of a close friend who has had some success with this guy's product. He requires, as part of his regime, that I abstain from eating any meat or fish.

The Chinese doctor, on the other hand, counseled against a strict vegetarian diet because of my low red cell count. He said the best source of nutrients to aid in the production of red cells is red meat. Makes sense right? He provided a number of dietary recommendations along with some herbal tea to address the imbalances. He also counseled against acupuncture at this time because of my low white cell count--don't want to risk an infection. I had actually been reading about that risk, along with some other literature that said acupuncture may not be beneficial if you have a low white count. Rifkin knows of my trying acupuncture but had no opinions. Trying to exercise some control requires the balancing of conflicting opinions. And maybe it is all for naught. But I have to feel like I am trying to help myself so I proceed and try to do what makes most sense. Could it be that no one knows? It often seems that east and west will never meet and they go their very separate and disparate ways in efforts to treat disease. And the patient is caught in the middle.

And with that I will close. I am always thankful for everyone's support and continue to see this as a journey, no matter how difficult it may seem at any one point.
With much love and continued hope,