Wednesday, July 29, 2009

Pictures of M-spikes and matchstick men...and some random thoughts on a few other things...

Another fairly sleepless night. I attribute this to (1) excitement over my final surgical procedure this AM, removing my central line and replacing it with a portacath, (2) excitement over my primary treatment coming to a close, and (3) excitement over declining M-spike and approaching complete remission.

Labs yesterday were good. White count up to the mid 5s, so my immune system is back in place. Hemoglobin inching up. Platelet recovery, now that it is no longer inhibited by the growth factor, is happening as well -- they went from 26 to 50 overnight. They need to be 75 this AM in order to proceed with the procedure, so I received an infusion of platelets yesterday late afternoon just to be safe.

I will go in at 7AM this morning for what should be my final trip to the infusion center other than the seven followup visits I will have over the coming three years. I'm going to try to take a bunch of pictures today to give some life to the stories I've been telling on this blog over the past six months. Then at 8AM I will go to the outpatient center to have the line removel and portacath placement done under conscious sedation. One more victory -- it took a little less complaining this time, too!

We have become accustomed to basically daily monitoring of virtually every aspect of my blood. It will take some adjustment to not having the comfort of seeing that data with frequency. I am sure that during maintenance I will be getting information a couple of times a month, but this seems like an extraordinary delay in between readings. We shall have to get used to it. It will be easier to do so if I am in complete remission and we don't anticipate anything coming back.

Which brings me to another reason for my inability to sleep. We got the labs back from Monday, and the M-spike data hasn't been interpreted yet. But they do have a visual of all the protein in my blood passed through electrophoresis, which means a current is run through the blood and that current causes the different proteins to separate for quantification.

Here's what one of these looks like, from way back on February 27th. The X-axis (going from left to right across the bottom) are all the different types of proteins in my blood. The Y-axis (going from bottom to top on the left hand side) is the volume (how much) of that type of protein is present.

You will note a couple of things here. There is a large spike on the left. This spike is normal and everybody has it in their blood. I'm not sure exactly what it is (I suspect it is Albumin), but it's not the problem. Nor are the little bumps near the bottom. The problem is the GIANT spike on the right. This is the evil M-spike, in all its full-raging cancerous glory. This is the visual representation of all the little monoclonal proteins -- ones that serve no purpose on the blood since they are defective -- produced by cancerous plasma cells. The reading here is 5.5 g/dl of blood -- that is, the M-spike is 5.5

Now, here's what the graph looked like as of July 16th, about 10 days ago, when we first got the reading of "trace" levels. You will note, the spike on the right has declined tremendously.

The other proteins in the blood fluctuate but don't change too wildly. You can compare the size of the spike on the right to the other spike on the left -- the normal spike -- to see how much it has changed in five months of therapy. The bad protein spike has gone from more than twice the size of the normal spike to about 1/7th the size of it.

Here's where things get tantalizingly interesting and what is keeping me up tonight with anticipation. We're still waiting on the actual can see in both the photo below and the first one above that some of the results are noted as "in lab" on the sheet, whereas the actual results are shown in the second photo of the series (TR, meaning trace, with the explanation below). The chart below is from the analysis of my blood on July 27th.

Now I dunno if this is zero, or trace still, but the size of that hump is less than the size of it just 10 days ago. So regardless of what the quantitative reading is when it comes back, it's moving down! This despite the fact that my active therapy ended several days before the draw. So that's excellent.

I was told by SF that he would be shocked if my maintenance therapy didn't wipe out what little was left pretty soon. I had joked with BB that whatever cancer cells were left were like the two Japanese soldiers left on a tiny island who never received word that WW2 was over. Sooner or later they will get with the program. Strictly speaking, that begins the 72-month count. Recall that per BB's data, six years of sustained complete remission equals a cure. Few low risk patients (less than 20%) lose CR once it is achieved.

Okay, now that I've gotten a few more pictures from my iPhone to this blog, I did move two more over for comic effect.

First, a celebrity sighting...of sorts. :) Any of you see The Curious Case of Benjamin Button, based on the F. Scott Fitzgerald short story about the man born elderly who grows younger as he ages? Here's a well-known stlll from the film.

Yesterday, at the sushi restaurant we like here, I'm pretty sure we saw this guy.

Okay...okay!!! (your humble narrator is now ducking tomatoes and boos and hisses). Sorry! But c'mon it IS pretty funny, right? :)

I will leave you with the type of dessert menu only found in this part of the country. Please note that a "Moonpie" was the primary source of food for the hero in the videogame "Redneck Rampage."

We passed on everything -- particularly the Moonpie and the Bacon Ice Cream. Barf.


  1. Nick:

    Good luck with your CVL to Portacath switch. I'll be following your lead after one more, hopefully uneventful Consolidation period.

    It's fun watching the M-spike come crashing down, isn't it? John Williams ought to score the event with one of his bigger-than-life masterpieces.

    We'll be leaving lovely Little Rock for a few days to go home and see the kids and then I'll be hopping back here for my much anticipated Kyphoplasty on August 8. It'll be nice to get those few inches back and see what I've been missing.

    Was it at least 'turkey' bacon ice cream?

    Travel safely back to the left coast and Be Well! Sean

  2. Wow, what a week you have had. I am so happy for you. I know today will go just fine and can't wait to see pictures that you'll take. You must have mixed emotions about leaving. Obviously you are elated to get back home to the kids, friends and life but Little Rock is the place that saved your life. I'm sure a piece of you will miss it too. Not that you won't be back several times of course. =) Anyway, just awesome news. Enjoy the moment. It'll keep getting better as I say.

    Also, when I started to read the chocolate... pig... thing above, my smile of all that chocolate turned to a big ol' frown. WHO MESSES WITH CHOCOLATE LIKE THAT??? Yes, agreed: BARF

  3. Congrats, Nick! Also, I don't think that's the guy from "Benjamin Button." I'm pretty sure it's Dustin Hoffman from "Little Big Man."

    And bacon ice cream sounds pretty damn good to this nice Jewish boy...