Thursday, September 2, 2010

Ongoing GI issues...

I am happy to be off meds for a couple of weeks right now.  Velcade interferes with the bone marrow biopsy process so I halt Velcade a week before my visits to Little Rock.  Revlimid requires aspirin to combat the potential side effect of deep-vein thrombosis, and aspirin thins the blood, and they don't want thin blood before any surgical procedure, bone marrow biopsies included.  And dex, I suppose, is a rounding error in this mess.  So I'm off VRD for two weeks -- the week before the tests and the week of the tests.  A time for my white cells and platelets to recover -- and maybe even a chance for some of my IgG to recover, which is odd considering I was so consumed with suppressing it and eliminating all the bad protein there.

In fact, it's been some time since I've been concerned about Myeloma, per se.  I really don't expect to see it again.  Of course I am waiting for the formerly active lesions in my bones to heal, and next weeks' MRI -- as dull as that process is -- will be interesting to see.  I do not think they will have knitted but some progress should be seen, I hope!  

I must confess I am getting extremely tired of the constant diarrhea.  Most recently I thought this was an impact of the Velcade and that I'd experience some relief when off it, but no such luck.  I looked to see what I'm still taking -- aaah, Magnesium.  The reliever of those awful leg cramps.  Turns out causes diarrhea.

So to recap:

Velcade - causes diarrhea AND constipation
Revlimid - causes diarrhea AND constipation, particularly in combination with Dex
Dexamethasone - causes diarrhea
Magnesium - causes diarrhea big-time
Acyclovir - causes diarrhea
Lipitor - causes diarrhea


Not sure what to do about all this, but I'll ask BB and team next week.  I'm not getting rid of the Magnesium -- those leg cramps are the worst.  So maybe I'll just add Immodium to the mix and hope for the best.  But I'm a little concerned that things may never be the same.  Particularly since, according to studies on long-term Rev-Dex use, the worst may be yet to come:

Update from recent studies: Increased diarrhea in patients taking Revlimid-dex for an extended period of time (>8 months)

  • In studies with more than 700 patients, patients taking Revlimid-dex for more than 8 months experienced significantly more diarrhea than patients taking dex alone (39% vs 28% with dex alone).
  • In the majority of patients, diarrhea started after taking Revlimid-dex for 19 months.

Not sure what to do about all this, but I'll ask BB and team next week.  I'm not getting rid of the Magnesium -- those leg cramps are the worst!  In the grand scheme of things, I suppose, if somebody had told me "we'll get rid of the Myeloma, but you'll have diarrhea the rest of your life" I'd still have signed up to get rid of the Myeloma.  This is a high class problem, albeit a low-class post!  :)


  1. Thanks for your 'moving' post, Nick! While misery supposedly loves company, I understand that I'm not alone fighting the dreaded 'D'. I also take magnesium (250mg daily) and was thinking that it is the culprit, too. And, like you, my cramps are much lessened while on Dex. Mag stays in the arsenal. I'd write more, but I have to run.....


  2. Oh! so H has that to look forward to - still perhaps that will be somewhat of a change for him, nothing ever 'moves'.

    Does quinine not help at all with the cramps or is it bad for you when taking all the other meds?. Or is a little tonic water before sleeping not likely to work/advised in keeping the leg cramps away.Just a thought.

  3. I love a good gin and tonic (yet another thing that plays into my Anglophioia!) but tonic water suppresses platelets so I am leaning against that.

    I am going to try to split the magnesium into morning and evening doses and may switch to a different version that some believe is easier to absorb. Meanwhile the leg cramps struck last night after failing to take a magnesium before bed..perhaps a subtle reminder that it is probably worth the GI discomfort!

  4. Maybe you've heard this a thousand times but have you ever tried taking acidophilus/bifidus
    supplements? It just helps out the good flora in your intestines and is benign stuff. Worth
    a shot but boy with all those meds affecting your gut, I'm surprised you ever get off the throne at all.
    Denise(who is dealing with a puppy who is a pooping machine too.)

  5. Hi Nick,
    I'd second what tim's wife said, a probiotic supplement would be a great idea. I'd also consider trying glutamine, can really help heal all the mucous membranes of the body, and is great at helping the body fight off treatment-related wastage as well. Other ideas include fish oil, if you're not taking it already, to reduce overall inflammation, including in the gut. Also, slippery elm is really great, but needs to be taken away from oral medications by a few hours. James my hubby is on all of the above and rarely gets diarrhea from his big cocktail of myeloma treatments. Good luck! Drop me a line at if you have any questions,
    cheers, Carlin