Thursday, October 8, 2009

Apologies to Henry Mancini, and other news this was me on Tuesday.

Slightly different dialogue, though. In the film, Chevy Chase ends by asking the doctor if he's done time, and then adds "are you gonna use the whole FIST there doc?"

My dialogue was more like this.

Me (casually) "I'd like to add a PSA test to my bloodwork since the chemo left me with a slightly enlarged prostate."

Doctor (looking like he's just found an unopened present under the tree) "Let's check that out."

Me: "I don't think that's necessary, we already know it's enlarged."

Doctor (snapping the glove on his hand) "Well *I* don't know that it's enlarged. Turn around, elbows on the table."

Me: "But I've seen the PET scan."

Doctor "You don't need a PET scan to tell you that you have an enlarged prostate, and I don't know how big it is."

Me: "Sure you do, it's 4.5cm. My best friend is a doctor and he tells me the digital exam is 98% uselesssssWOWWWWW!"

Ahem. Enough of that.

Doc says the prostate has no hardening or extra nodules and doesn't seem all that enlarged. That's good news. However it doesn't really put me any more at ease than getting the PSA and free PSA test back will. We shall see. I suppose if the PSA is high (I have long-since given up the assumption that my numbers from any given test will be in the "normal" range) we can use the digital exam to help triangulate whether or not we think there is a real problem.

They accessed my interior port (note: while this could be another euphemism for the prostate exam, I am now referring to the portacath closer to my neck) and I was prepared for the worst since it was still sensitive to the touch. However, I was relieved (shocked, actually) that it didn't hurt at all. I used a lidocaine based numbing solution called Emla cream at their instruction (and with their prescription) and on top of this they sprayed a freezing solution to numb the area, and it was pretty easy after that.

My detailed bloodwork won't be back until today or tomorrow (and there won't be an M-spike run this time...I'm sure it is zero). I probably won't bother to obtain the results (essentially blood chemistry, liver numbers, cholesterol and PSA) until Tuesday when I'm back in for my next Velcade push. Preliminary results from the bloodwork, however, are mostly encouraging.

* White blood count is normal at 5.3 and I have a large percentage of young white blood cells (granulacytes) which means the system is working and new cells are being made and so the counts should continue to stabilize.

*Hemoglobin is at 14.6, which is the highest since diagnosis! Now if my darling two year old son would stop waking up at 3AM every night and completely robbing us of sleep, I might actually have some energy.

* RDW, the measure of the variability in width of the red blood cells which is a marker for anemia and thus myeloma, is down to 13.1 which is squarely in the normal range and again the lowest it has been since diagnosis (apart from one or two strange days in the middle of high dose therapy when things were bouncing around)

* Platelets have fallen to 135, which is either barely normal or a bit low depending on which reference range is used. This is to be expected by virtue of Revlimid, which is known to cause all these types of counts to be suppressed. Frankly I'm lucky to be getting away with mild thrombocytopenia (low platelets).

On the plus side, I'd been told wayyyy back when by Dr. KA at Dana Farber that Revlimid also lowers blood pressure, and mine was 119 over 84 at the time of testing (compared to 140 over 90 at City of Hope a week earlier before I started Revlimid). So this is one side effect that I am happy for.

As to other side effects, Revlimid takes the starch outta the old collar, to use a vague euphemism. I may be getting testosterone injections to "give me back my mojo" in the words of Austin Powers. However evidently that can cause prostate problems itself (testosterone injections, not mojo) and so we want to see the PSA tests before doing that. Meanwhile, the only other impact I notice from Revlimid at this point is sleepiness, so I take it at night. Usually this side effect is temporary, lasting from around 11:30PM to the time Carson wakes up screaming.

I've received two IV administrations of Velcade -- 154 to go, or thereabouts! So far, so good. I have tolerated Velcade well in the past, so hopefully that will continue to be a non-issue.

I received an IV infusion of Zometa, a bone strengthening agent, for the first time this past Tuesday. The idea here is that bone destruction and creation is constantly happening in our bodies, and the pace in a normal healthy person keeps that person in stasis. With the myeloma, the speed of destruction outpaced the speed of repair, hence the lesions. Now those lesions have stopped worsening, and I'm back in stasis -- so I need a boost of the bone building activity in order to make up the difference.

This all sounds good and fine. Zometa, according to my nurse, has a half-life of TEN YEARS, though, which is a little unnerving. The biggest potential issue is bone necrosis in the jaw, and so I'm to have no dental work done for the next few months -- at least not without checking. I also need to find out how many times I need this stuff -- I had thought perhaps only once, but there appears to be some confusion as one of the orders appears to call for it 3X, and the nurse told me she usually does it for longer.

I need to speak with the clinic people today about both that, and the maintenance schedule since the orders on Revlimid were convoluted -- I think the oral dictation got a little screwed up. It seems to me I should be on 15mg daily for days 1-21 of a 28 day cycle, but the orders seemed to suggest 20 days of this followed by 4 days of 5mg (which isn't even an available capsule size unless I'm mistaken).

Dex remains the biggest side effect issue. I don't get the steroid rage thing, which is good (for more people than just me). But I have esophageal issues (heartburn and a raspy voice) for about 36 hours, and I feel pain in my legs from muscle atrophy, and my vision gets blurry. I have started physical therapy to rebuild muscle, so hopefully that will help somewhat. But I wrestle with the idea of asking for dose reduction. I remind myself that I have an undesirable "subtype" of Myeloma within the low-risk group, and dose reducing a drug that is effective in cancer therapy probably isn't a great idea if I can avoid it. As much as I hate the medicine, I may just have to accept it. We shall see.

So that about brings us up to date. I want to thank all of you for your support re: the last little post drama and we'll put that whole issue to rest.

Speaking of which, I've now killed the time from 3:30 to 6:15AM and can try to get about 20 minutes of sleep in before both kids wake up again, so that's where I'm headed. And then I have physical therapy in a couple of hours...that's gonna be rough on about six hours of sleep in the past two days. But I need to go...I've been deadlocked at 13 stone 3 for a couple of weeks now.


  1. Hey there brutha Nick,

    Great read as usual. Sounds like things are pretty "normal" considering the regimen you are on. The physical therapy will help the muscles for sure. As much as any self-induced pain can anyway. :D

    Keep fighting like the warrior you are,


  2. guess yer doc is finger happy, psa's were fine.