In-patient VTD-PACE, last night.

So here we are, last night (knock on wood) of the in-patient portion of VRD-PACE. Yeah I’m about ready to go stir crazy here so good timing.

Honestly, and kind of strangely, I’ve been in a really good mood all week. I’m walking a lot more than I usually do in the hospital (granted, I’ve been in 6-7 times in the last year for respiratory stuff and walking was not on MY top 5 list on those trips), cheerful.  Mostly bored, really.  I think the hardest part of this has been a combination of the steroids and the isolation — for all that I and others were worried about side effects, those apparently come next week. This week at Presbyterian St. Luke’s has mostly been about keeping occupied and not nauseous.

Although if you’re going to do inpatient chemo for 4 nights and 5 days, do it RIGHT.  Please note the following picture will offend and perhaps increase nausea in the Doomed who can’t look at any non-raw non-GMO non-vegan non-flavorful meal.  Or Darth Vader:

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The despecialized (un-re-edited) version of Star Wars and a 12″ from Fat Sully’s. Probably not the best anti-nausea fighter. Or the healthiest meal. Or the easiest to eat in a hospital bed, for that matter.

I care.

Awesome ‘za.

Hey when you live sort of in the sticks, being downtown with 3rd party delivery service is like a dream come true. Had a wicked bowl o’ ramen last night with some pork buns.

So yeah, not too bad really. The steroids have been the hardest medication to deal with so far. Forty milligrams a DAY of Dex has taken me beyond restless leg syndrome and into a Steve Martin comedy bit.

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Once I get to sleep I can stay there like a zombie, but being a night owl it’s soooo hard to actually get to sleep here for me. Trying an Ambien tonight … not a giant fan but I really cannot take another night of 40 laps around the onco-ward all tired but so jittery I can’t shut my brain off.

Also thanks to all those who swore to sneak me in some, erm, greener products. Appreciate and I love you but probably best if I don’t get booted out of the hospital, lulz.

Had some visitors today which was awesome (thanks!) and … I dunno what else, really.  This much time in a hospital all flows together until you aren’t sure what day it is and whether you’re coming or going, you know? I play games, watch movies off the home theater PC on the laptop and try not to puke.  I almost got caught today, that sudden salivation feeling you get, but the nurses responded so quick it was laughable.  They really have been great here: Julia, Tara, Campbell, Shasta, Rita, Kellie (note to self, check that list). I have to come in Sunday, Monday and Tuesday (FFS) for appointments so I’ll bring them something special.

You spend a lot of time thinking in the hospital, or at least I do. I’ve been wondering lately if cancer is just how we die now. In lieu of being eaten by saber-toothed tigers maybe this is the “new normal?” It’s hard to argue with some of the startling facts you find of incidence rates these days. Granted I would prefer, given the choice, of going in a slightly more pleasant way, but perhaps this is what we have to get used to. I can accept that, I think. In fact really the only cancer that truly gets me down, that I have no defense against, is childhood cancer. As mentioned before it’s just too goddamn much, too unfair.

I’m also having trouble not falling into the sheer hate aimed at the GOP lately. I try to see the best in folks, if I have time, but it’s been really tough for me lately.  I’ve always been a fiscal conservative and socially moderate agnostic, so I left the parties behind decades ago to force them to market better candidates to me.

Yeah, we see how well that plan worked out.

Seriously though — I’m reading an article today about some Washington Congresswoman and you just know, you KNOW, that if one of her three kiddos was diagnosed with our special sort of fun she’d be the first in line voting NO on this crap. Instead she’d be out sponsoring bills for medical marijuana, better healthcare, etc.

It’s just so fucking selfish, and as I come closer to the end — even if not a cancer-based one, who knows? — I find that flavor of selfishness so fucking disgusting that I just want to slap these people back to reality.  Why can’t they leave what’s in place there and just FIX it? That gets you re-elected. This scorched Earth policy is not. And as I reach further out from this little room on Twitter and Facebook and read story after heartbreaking story it becomes harder to control my disappointment and anger. Representative government, indeed.

If we don’t try to keep each other healthy, what’s the fucking point?  To die with the most toys like some Egyptian pharaoh?  For the love of the Almighty (whatever), c’mon already.

I don’t get it. And I apologize, for what it’s worth, for being a tiny bit political here — this week’s isolation has brought it out of me a bit on Twitter and I don’t like it.

Anywho, going home tomorrow night — my 24-hour chemos end at 4-5ish pm and then I’ll … well, “bolt” is a bad word for being released into southbound 5 pm Friday traffic, but I’ll be bolting as much as I can =)  I miss my daughter and wife, the comfort of their hugs. How they smell.  That sheer “rightness” of being home with them where I am supposed to be. I wish Mischief was there to greet me too but that’s a story for another time.

Talk to you soon and thanks for the kind DM’s on Twitter, comments here and other stuff — it means more than, well, actually it means what most of you already know.  but it’s pretty new to me so thanks and hugs.

VTD-PACE, days 2-3.

Just a quick update. Other than some nausea and some 4 am hi-jinks with a separate IV things are going smoothly.  Not enjoying the Dex at ALL even though I am in a cheery mood, really.  Hoping the drug who’s name I’ve forgotten since Monday is helping with that.

The biggest issue, really, has been boredom. When I’m on high-dose painkillers, my usual regimen for being in the hospital (due to the flu or pneumonia), the little aches and pains don’t bother me.  I’ve found this time I can’t get super comfortable, so I’ve been sitting in a chair in my room on the laptop when I can. Sadly I have a brand new lap desk sitting at home but everyone I know outside of the hospital that would bring it down here is sick =/

Second would be the Dex … normally I would get 40 mg a week from what I’ve experienced with with it before.  With this chemo I’m getting 40 a DAY.  Let’s just say my restless legs have started their own band.  I’ve also put on over 15 pounds in 3 days!!! All water weight and being retained by the various chemicals, but now I’m on Lasix which helps you pee.

A LOT.

That’s a pill btw, not the eye surgery.  My nuts see just fine.

One risk I think I talked about before with this, and I keep forgetting the damned name of, is that the PACE works quickly and explodes the bad cells (and some good ones too I’m sure). So the nurses and doctors monitor various things like calcium and magnesium (think that’s right, I’m a lil’ fuzzy).  Anyways, my calcium is up so hopefully that means this is doing some work — that’s part of my good mood.  If you have to go through this it might as well work, right?

I know the really bad side effects are days 7-10 once I’m home, but keeping my spirits up.

THIS.  WILL.  FUCKING. WORK.

That’s my prediction.

The nurses here at PSL are great on the cancer ward (and presumably elsewhere here) and have made this a lot easier.  Quick responses, intelligent ideas, etc.  Today’s nurse, the awesome Tara, is usually a charge nurse AND she lives with a coordinator for my care so I know I’m in good hands.  Add to that Kellie and Rita (mostly adding these here so I don’t forget the names for a thank you, btw) and it’s been a pretty smooth ride.

Been doing a ton of walking every day as well.  Not sure what that accomplishes but it breaks up the boredom and seems to be appreciate by the nursing and doctor staff.

Man this is a Facebook update, not a richvsmm post.  Guess that’s alright sometimes.  If it helps you rest easy that I haven’t turned into a Hallmark card, though; I did send Congressman Ken Buck from Colorado a “Rich” Tweet yesterday:

If it helps, though, my 5 1/2 year old Facetimed me yesterday without her mom’s help … after she got bored she just started staring at the TV over the top of the iPhone though so we cut it short, heh.

My hips are a code violation.

Eventful week, and not really in a good way.

So Friday I went in for the weekly Dara appointment, but there were problems with my CBC (“complete blood count”) results.  Namely that my red blood cell count was in the danger zone.

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Sorry, Archer joke.  Here’s what the danger zone looks like, apparently, with my number and then the “OK” range in parenthesis and a description of what each one is (that I shamelessly copied/pasted from webmd.com):

  • Hematocrit 18.8% (40-54%).  This test measures the amount of space (volume) red blood cells take up in the blood.  The value is given as a percentage of red blood cells in a volume of blood.
  • Red Blood Cell 2.14 10 12/l (4.4-6.0 10 12/l).  RBC’s carry oxygen from the lungs to the rest of the body, and carry carbon dioxide back to the lungs.  If the count is low (anemia), the body may not be getting the oxygen it needs.
  • Hemoglobin 6 g/dl (14.2-18 g/dl).  the hemoglobin molecule fills up the red blood cells.  It carries oxygen and gives the blood cell its red color.  The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood’s ability to carry oxygen throughout the body.
  • Platelet Count 78 10 9/l (150-400 10 9l).  Platelets are the smallest type of blood cell.  They are important in blood clotting.  When bleeding occurs, the platelets swell, clump together, and form a sticky plug that helps stop the bleeding.  If there are too few platelets, uncontrolled bleeding may be a problem.

Anyhow, the doctors decided to keep the Dara appointment but prescribed two bags of blood.  Thankfully I ran my errands the day before, since that added four hours to my day.  Easter weekend itself wasn’t horrible although I was exhausted all weekend even with good sleep.  Saturday my daughter Ariana had belt testing at her TKD gym and did great, then Amy’s parents came up to celebrate Easter since my mother-in-law had to fly out Easter Sunday.  They set up an egg hunt outside which she loved.  Sunday we met my parents in Cherry Creek briefly after lunch at one of our favorite seafood restaurants, Blue Island Oyster Bar.

So Monday comes around and it’s IViG time.  The CBC from Monday looked about the same as Friday’s, just minor improvements.  Due to my numbers last week my doctors asked for a bone marrow biopsy, my fourth now, to give the doctors a better picture of what’s going on with my disease.  Not wanting to inconvenience anyone I opted for no anesthesia and just did it with a local — really didn’t hurt much at all and was vastly quicker than doing it with the fun drugs in the hospital.

Do those holes grow back, by the way?  I need to ask my doctors that.  Feel like my hips must look like Swiss cheese now.  Seeing as how my hips are, as far as I know, load-bearing, I’m pretty sure I’m not up to code anymore.

Had trouble sleeping last night, although I was in a great mood last night.  Oddly I think the non-Dex steroids might be IMPROVING my mood.  Lord knows I had enough between Friday and Monday, Jesus.  Even a good mood couldn’t keep the pain away though — spent most of the night uncomfortably sitting at my home office desk and fighting off what seems like a minor cold and a minor temperature (99, at 101 I’m supposed to call the doctor).  Came to work today since I missed Monday and will miss Thursday (Dara day this week) but popped an Oxy when I sat down and I’m just trying to relax and not move my hips.

Sorry for the inelegance of the first part of this entry — just sort of core dumping the last 4 days and I can’t think 100% clearly today thanks to the body aches and pains.  I wanted to jot some notes down about just that, however.  I’m wondering, as I’m sure a lot of the doomed do, if it’s possible to separate out what is causing what pain-wise.  While driving to work this morning I was thinking about this — whether the bone pain I am feeling is the Myeloma and not just side effects from something else.  Hard to know — I’ll ask the doctor but I’m guessing that there’s no way of knowing.

I’ll be honest, I’m a lil’ freaked out.  Just a little, mind you, but there’s something truly un-nerving about watching parts of your body and its systems fail.  The irony that what’s beating me up so bad (presuming this is chemo drug-related) is actually working so far hasn’t escaped me either.  It would be nice to catch a little break here — I have yet to really have phenomenal results from any of the five or six treatments I’ve done so far, which really is a bit scary.

So is the NOT knowing.  Which drug’s working on me?  Revlimid or Dara?  That’s the problem with so many variables.  I was demo’ing a new app on my iPhone last night to help me track dosages for hospital and doctor visits since I can’t remember all of this stuff, and the sheer number of things I take always makes me wonder how you really know which one’s putting in the real work.

Anyways it will be interesting to see what they do Thursday with my Dara treatment.

Deja vu — ouch!

You know when you are at your desk Monday morning chasing Percocets with a soy latte that it was either a really good, or really bad, weekend.

Friday my white blood cell and other counts were bad enough that Dr. Matous and his nurse practitioner agreed that if we’re starting a new Revlimid cycle there’s going to be a problem at my numbers and the current dosage.  As a result they decided to change my Revlimid to 15mg every other day (from 15mg daily) and got me approval for a shot of Amgen’s Neulasta, a $7,000 drug that stimulates the body into making more white blood cells.  The last time I had this, or something similar, was when they were harvesting my stem cells for transplant 3 years ago, although I think then I had Neupogen.  As I recall, the primary difference as I understand it is Neulasta lastas longer.

When a typo becomes a bad joke on the next Geraldo.

Minor problem arises … the insurance companies apparently won’t approve a Neulasta shot within 24 hours of chemotherapy.  Solution?  Either drive back to CBCI on Saturday or wear an injector that, 27 hours later, will automatically give me the shot.  Not wanting to drive all the way downtown AGAIN I opted for the injector being stuck to the back of my arm.  They look, and are about the size of, a container of dental floss:

onpro-device

When they put the injector on you it pokes through the skin and then starts blinking green.  27ish hours later it beeps and then injects you.  Pretty wild stuff.  Kind of nerve-wracking too, though … I mean it’s $7,000 of medicine just taped to you on the hope it works right.  What do you do if it screws up, call the insurance company on Monday for another one?  Felt kind of anxious walking around with it, as well as anxious that it’d start and I’d watch $7,000 of Neulasta run down my arm instead of into it because I had bumped it once or twice.

In the midst of all of this going on, however, I forgot how painful this drug can be.

It’s hard to describe what these drugs can make you feel like.  I had severe bone pain in my back, especially lower back, hips and legs, as well as a shooting pain in my skull.  I’m assuming this is somewhat similar to what the bone pain of Myeloma is like when it gets to that point?  Either way it SUUUUUUUUUUCKS.  I don’t even have a comparison I can make to help you understand this, but it’s easily the worst pain I’ve ever had in those locations.  When I had the Neupogen during my stem cell harvest I was just laying there and for all I know they even gave me painkillers.  Walking around in your normal life though?  Yeesh.

They tell you that for whatever reason Claritin helps with that pain, but if it did I didn’t notice.   I slept about 11 hours Saturday night and then the pain started.  By Sunday night I was in rough shape and started raiding the household stash o’ Percocets (which worked really well, btw).

So here we are, low on sleep and high on opioids.

Which incidentally is a great country music song title.

Nothing really pithy to get into today.  Days of pain generally force a recognition of my  situation that, as I’ve talked about before here, I mentally deal with normally by  distracting myself.  I was so goddamn tired all weekend, however, that I didn’t even have the strength to do that.  My wife, however, was blown away by how helpful I was to her on Saturday, so that’s a good thing — she had a gall stone attack Friday night and was in the ER from about 1 am to 12 pm Saturday and in bad shape pain-wise.  My continuing efforts to make up for the last several years of DexRich are in fact working (at least until the next major fail), which makes me happy, and having had my gall bladder already removed for exactly what happened to her this weekend I was able to offer some solid advice and doctor referrals.

Ahh, that was one thing I wanted to get into today.  So Fridayish I did something I rarely do, which is interact on Twitter with some of the more well-known names in Myeloma. I appreciate that it’s useful but I seriously hate Twitter.  As a writer, even a hack, it’s depressing how much Twitter just eats the beauty of language and the art of phrasing things and turns adults into people who substitute “u” for “you” like a 16-year-old texting someone just to make a character limit.  Regardless, I was, respectfully, calling out someone over some information on Dex on a slide from some Myeloma-y conference.  In seeing the slide I realized that it was just the usual boilerplate stuff I see and once again showed no real understanding of what patients go through, at least to me.  Having had my life and who I actually am pretty much rewritten by Dex it’s a sore subject with me.

Again, zero disrespect intended towards anyone involved but look at the pic link in the tweet I’m replying to and read the columns on that Powerpoint slide.  Now read this, a quote from drugs.com (my 5 seconds of Google research):

The most commonly occurring side effects have included alteration in glucose tolerance, behavioral and mood changes, increased appetite, and weight gain; the incidence generally correlates with dosage, timing of administration, and duration of treatment … A wide range of psychiatric reactions including affective disorders (e.g., irritable, euphoric, depressed, labile mood, and suicidal ideation) psychotic reactions (e.g., mania, delusions, hallucinations, aggravation of schizophrenia), behavioral disturbances, irritability, anxiety, sleep disturbances and cognitive dysfunction (e.g., confusion, amnesia) have been reported. These reactions have been reported in adults and children. In adults, the occurrence of severe reactions has been estimated to be about 5% to 6%.[Ref]

Frequency not reported: Depression, affective disorders, anxiety, emotional instability, euphoria, insomnia, mood swings, personality changes, psychic disorders, confusional states, anxiety, abnormal behavior, irritability, aggravated schizophrenia …

So to preface what I’m about to say, I know NOTHING compared to whoever @IMFnurseMyeloma is.  She’s a Mayo Clinic nurse who deals with MM all the time, I’m just a member of the MM doomed tribe.  That being said, the “Managing Steroid Side Effects” of her slide is side-effect management for the stuff to solve side effects from pretty much every drug I’ve ever taken — take with food, take some stomach stuff if you have “discomfort.”

I’d also note that in the drugs.com article they list a lot of what I went through, and others I’ve talked to, as only happening in 5% of patients.  Since they’ve happened in 100% of the people I’ve talked to I’d argue that statistic.

What I won’t argue is a simple bullet point addition to that list — TALK TO SOMEONE ABOUT THESE SIDE EFFECTS THE MINUTE YOU ARE PRESCRIBED THIS DRUG.  You may never experience the emotional and psychiatric side-effects but I, and others, have been broken by them.  Be informed, OK?  Suicidal thoughts, total lack of sleep, personality changes, irritability, emotional instability, even weight gain and the psychiatric damage that can cause — those are serious things, folks.  Those are what I call “suck-starting the shotgun in the basement” side effects. That’s real, and I’ve experienced it and not even realized at the time that some of these bizarre thoughts and reactions were being caused by one of the drugs I was taking and not my situation (which is hard to separate).  And since a lot of times you don’t see the onset of these (i.e., gradual changes), you may not even realize it.

For those without this experience, try to imagine you are diagnosed with cancer.  While survival rates, thankfully, seem to be up across the board for most types of cancer, that’s still probably the most serious, and depressing, news you’ll ever get.  In a 2012 study I found online, the risk of suicide spikes in the weeks immediately following a cancer diagnosis by 13 times in the first week and 5 times twelve weeks later.  It’s still three times as likely a year later.  Also thanks to the deplorable state of insurance and healthcare combined with drug pricing issues, add all of the financial issues that cancer victims have to deal with.  Then to ice this cake, add a drug to it that’s going to make you retain water so your weight goes up (another giant source of depression and one that can become a brutal circle).  You are experiencing the entire spectrum of negative thinking due to your diagnosis and how serious life just became, and now you’re thrown onto the rollercoaster of Dex.

And that’s not a focus, much less even a discussion point on the bullet list?

Err, eeek.

I can say for myself that the entire reason I began therapy was due to having suicidal thoughts over my diagnosis.  Which a lot of us do, honestly — who wants to live in pain / fear for their life?  I spent a decent amount of time pondering whether, since children have a tendency to “reset” their memories around age five, if it would be better to step out of the picture and let my life insurance take over as daddy.  Ultimately she’s the reason I didn’t pursue this line of reasoning and instead sought out professional help.

My point is simply that a little talking to your provider about how to spot and deal with the mental component is important — a lot more than “take with food,” which while I’m certainly not a doctor I can say with a lot of confidence will not save your marriage when you have become such a bitter, irritable jackass that it and every other relationship you are having is falling apart.  Again, no disrespect to whoever created this slide, it just reads like everything else I see in cancer, which is medical personnel downplaying the serious aspects of what we’re dealing with.

 

Also, given that half of my Twitter feed is articles about the importance of patient-provider communication and patients’ input on treatment, I wonder sometimes if it’s stuff like this that helps cause that divide.  Why isn’t talking with a mental health professional part of the initial diagnosis process?  Maybe it is in places, but personally I think it should be across the board — the absence makes you feel like that part is ignored or not a “real” problem … but I’m here to tell you it’s as real as it gets.

And to cop lines from the UFC advertising, apparently.

Also if you are a provider, think about the impact having someone ready to talk to on diagnosis would have.  Here’s a patient about to get the worst news of their life (or close to it), and, “um, see ya’ and best of luck with that!  We’ll start up poisoning you on Thursday.”  Now imagine how much more comforting if someone was there as part of an active team (not just if you find out they exist) ready to explain how the diagnosis, and some of the medications, may affect you and what to look out for and to check in at set intervals or as needed.

To me that’s just a smart choice that costs nothing.  How many times has an on-staff social worker / therapist / etc. been sitting in their office doing nothing while 2 doors away someone got the “you have cancer” spiel?

Seeking mental and emotional healthcare, especially prophylactically, is not a sign of weakness, emasculating, something to be embarrassed by, etc.  It’s not an admission of being crazy or even that you have a problem — it’s just smart planning.  Please don’t ignore this aspect of treatment.  Every oncology office I’ve been to has some sort of help along these lines, usually free (your mileage may vary of course), specifically to deal with this stuff, although they don’t always let you know about it.

Use it.

Anywho, enough of me playing Surgeon General today.  Not even sure who ours is right now, come to think of it.

With Trump in office it’s probably Doc McStuffins.

Dara week 4-5 thoughts.

In psychology there’s a concept called the “ironic process theory,” or alternatively the “white bear problem,” where an attempt to NOT think about something makes thinking about it more likely.  For whatever reason, unless put directly to the test (i.e., “Rich, DO NOT think about cheesecakey goodness”) I’ve somehow managed to turn the ability to not think about things into the coping mechanism I rely on most of the time.  Perhaps too much, as it generally involves focusing intensely on something else like a video game, etc. But I’ve been doing it for so long I don’t remember a time when I couldn’t just automatically tune out my parents going off on each other as a child, whatever anxiety I’ve had through the years, and certainly all of the fun thoughts brought on by the BIG C in the last four years.

I had some trouble lately doing it last week, unfortunately.  Thoughts snuck in, unbidden, and once present became harder than usual to dispel.  While trying to get my mental state back under control I couldn’t write.  Just as I NEED to write at times, sometimes I just need to NOT write at times, or even think about anything serious — it really can turn into a Pandora’s Box without warning.  Does that make sense?

Little unpredictable things crack the Box open sometimes when I don’t realize the emotional walls are in place and shored up.  I remember, as the dusty twitch in my nose confirms as I glance to my right, that one trigger was just staring last week at a picture framed on a bookcase in my office.  It’s my favorite picture in 46+ years, of Ariana’s hand resting on my finger the day she was born.  She’s my Achilles Heel with this Myeloma thing, if you weren’t aware.

My cancer numbers are another source of anxiety, building towards next week when I’ll find out the results of the first 4 weeks of Dara (get tested Friday before my infusion, and should have #’s by the middle of next week for the Myeloma labs since they take longer than your standard CBC workup).  Hell even my current CBC numbers are a cause for concern — although they did my infusion Friday, presumably because the IViG I take covers the gap, my white blood cell count (WBC) and neutrophil count are WAY low.  As in normally I don’t think they’d do an infusion low.

On the bright side where that’s concerned, this is my off week for Revlimid, one of the 3 drugs I take with this current regimen, so I’m looking forward to that.  It’s a 28-day cycle with the last week free of the Revlimid pills.  Hopefully the numbers rebound a bit since walking around without a working immune system is about as fun as it sounds.

Death is the last part that I’ve had trouble erasing from my conscience lately.  Thinking about Ariana always wends it’s inevitable path towards this, to not being around for my daughter.  Far and away the hardest thought to dispel, it’s just been on my mind lately with all of the death surrounding me.  A diving friend.  A really nice guy I knew from back in the foosball days — RIP Bear and no that’s not a typo, I actually played ranked “tour” foosball for years albeit at a pretty low level and ran a local tourney for quite a while.  And non-death cancer stories too — a friend’s mother, an old friend from my Live Journal days, a close friend with Myeloma in a bad way and facing some nasty non-cancer issues, a text from my mother-in-law asking for a recommendation for a friend’s 28-year-old daughter who was just diagnosed last week with Hodgkin’s Lymphoma.

Regularly this wouldn’t affect me as deeply but all at once has been difficult.

Not that I want any of those notifications or conversations to stop oddly enough — I don’t see those things as a burden but instead I’m pointing them out to note two things.  One, there’s a difference between hearing something like those issues when you do and don’t have cancer.  The folks who go through this stuff with us don’t get this part, or a lot of this really.  They try, most of them, but they’ll never GET IT.  And that’s OK — I think all of us doomed folk would kill to go back to that naivete, wouldn’t we?  I know I certainly miss NOT knowing what was behind that particular door.  But that also means they just can’t provide the same comfort, at least to me.

I lived this with two different therapists (I think you’d call them both “therapists,” my bad if that’s incorrect).  Both were amazing, but one was actually working in a blood cancer clinic.  In one session with her I got more than I did from months of dealing with the other for what should be obvious reasons — it’s all she dealt with.  Even though she didn’t have blood cancer herself, we’re all she talked to professionally.  She’d heard it countless times to the point where she was an honorary member, if you will.

Anyhow the point is I feel like there’s a bond among cancer patients that you just have to experience to truly get — it’s in the same ceiling tiles counted.  Choking back tears in a car in your oncologist’s parking lot.  In nurses having to take a second shot at veins too abused to handle another poke, and a laundry list of side effects and their cures.  It’s wondering if the next time you go into the hospital if you’re coming back out.  It’s the mantras some of us (maybe all of us, who knows) use to get through the hard spots when the thoughts threaten to overwhelm.  It’s laughing in disbelief at the number of medications they want you to take, or in pondering death, not in the abstract sort of way we all ponder it, but in a very real “holy fuck, I’ve got the plague” sort of way.

It’s in asking “why.”  A LOT.

And hearing nothing but silence.

What I’ve noticed though is that when I talk to folks with this shared death sentence I feel better, even just a little.  I would hazard a guess that comes from there being so much helplessness with a diagnosis like this that the ability to even offer a tiny bit of hope to others is empowering, especially when all of the issues with this disease can be so emasculating.  While I’ve found a comfort of sorts in there really only being a few paths to take with this disease, sometimes it feels helpless.  A shitty job I could quit.  If my car turned out to be a lemon I could buy a new one.  But with cancer, at the end of the day, there’s not a lot you can do.  Eat better, get a new doctor, exercise or exercise more, pursue more holistic choices or supplements, etc.

Having an opportunity to even just listen and perhaps as importantly UNDERSTAND  someone else, which I’ve found is what most people just want to begin with, is cathartic.  So don’t get me wrong, I’m not bitching.

I knock it sometimes, but I do appreciate the awareness that people doing 5k’s and climbing K-2 or whatever “for cancer” brings.  However as a pragmatist there’s a large part of me that wishes instead of doing that stuff that those with our shared fate just helped each other more.  For all of the money raised have we cured any cancer, ever?  Does March being Myeloma Month (trust me I forgive you for not knowing that if you aren’t on Twitter specifically following like 1 of 50 or so people) matter?  I definitely could be showing my ignorance but have any of the countless anti-cancer organizations ever cured anything?

I’m sure they all do, or try, to do good.  Please don’t take this as a condemnation of those organizations as I KNOW they bring hope and other things to folks.  But when you are actually a cancer victim it’s pretty easy to slip into this thought process, you know?  Perhaps it’s just crass but as a cancer victim I think everyone has that thought one day similar to “well this sticker is cool and all, but STILL DYING OVER HERE.”

Sorry, but it’s true, admit it.

*crickets*

Damn it.

And sure, I know that sounds a bit downbeat.  Like I said it’s been a tough week and a lot of things have conspired to put me here, at least temporarily.  But to not end on a bummer note, I continue to do better off the massive Dex doses (again I still have to take a 4mg the day after and the day, um, after-after my Dara infusions, but I don’t feel that base level of just pure intolerance, impatience and anger from before that I associate with the Dex.  In fact now my biggest concern is that I feel like I can’t get angry or be impatient at anything, which makes dealing with a 5-year-old, um, “entertaining” and has me biting my lips much more than previously in life.  Especially on a weekend when the steroids (presumably) have kept me from sleeping for two days.  I raised my voice at my daughter this weekend when she was intentionally ignoring me and immediately got this “oh shit, he’s Dex’ing out” vibe from my wife.

My wife and I talked immediately, another thing that I think is helping things at home, but unlike before me being aware of her concerns before she even voiced them helped immensely.  We agreed that a good way to put me in check in case I even seemed like I was approaching DexRich (I really need a better name for that) would be to just ask me if I’m OK to insert a pause in there.  I suggested that.  See?  I am getting better.

I still have no idea what to do about disciplining my daughter, though.  We don’t do physical punishment so short of taking things away, which I do think teaches consequence if done right, I really have no alternatives besides going a bit R. Lee Ermey (drill sergeant from Full Metal Jacket) sparingly to express disapproval or initiate corrective behavior.  I’m afraid if I do nothing I’ll just get walked all over or put all of the disciplinary burden on my wife, neither of which are good answers.  We’ll figure it out, though.  As a family, which I’m here to tell you, before I got off the Dex, would not exist in the same house if things hadn’t gotten better.

BTW, THAT’S the kind of stuff talking to other patients gives you the opportunity to share with those who only have their doctors to go by.  We all know they whitewash things, and while I had plenty of warnings that Dex can make relationships difficult that’s the same sort of advice as “don’t touch the stove.”  It’s just an abstract concept until it’s too late because you experienced it yourself.

Instead, the last six weeks of being Dexamethasone-free things have been really amazing at home.  Everyone’s happier, including me, and my wife keeps telling me how grateful she is (that’s a definite first).  That her anxiety has all but vanished and my daughter and I are doing so much more together now means more to me than most of this stuff.  Which is awesome, but also opens the door for not only another shoe to drop but an ironic one at that since I’m the living embodiment, as I’ve mentioned before, of ironic outcomes.

So in other words I’ll probably get trampled to death by a herd of maddened pugs or something this year.

Fucking pugs.

One thing I would suggest is as a cancer victim if you really want to help another victim with cancer: TALK TO THEM.  Doctors will be doctors.  They speak differently, they detach themselves a lot for self-preservation, and they have different goals than we do.  That’s fine, it’s their job.  But for us?  Send money to pink license plate holders or whatever other thing is not curing breast cancer or run that marathon or climb that mountain but please, make time to just TALK to someone else with your disease (or any cancer, it’s all relative) as well.  Cancer patients don’t need to see other cancer patients doing superhuman things to feel normal.  We’re not normal and honestly for a lot of us it just makes us feel like shit if we can’t do that stuff.

Talk to one another instead.  It might be more helpful, to both of you, than you know.

Dara, latest concerns and general life updates.

I’m about to embark upon week three of the Dara treatments.  So far so good — I almost feel guilty saying that because I know some chemotherapies are truly toxic to patients, but this new cocktail hasn’t been terrible.

And yes I know Dara is not “technically” a chemotherapy.  I hate semantic games.  Besides taking Revlimid with it kind of makes it a chemo in my book.  As does getting it at a cancer clinic.  When I have cancer.  So if you are about to correct me in that really Dara is  immunotherapy and blah blah and then you get this sudden prescient feeling that I want to punch you in the nose, well, go with that warning.

So far only three side effects have really gotten on top of me, although this early in and with most of my previous treatments having cumulative effects who knows how long that will last.

One is just the fatigue — I blame Rev for that but for all I know it’s this Kraken of a disease letting its presence be known (hard to differentiate, but Rev and Pomalyst made me borderline narcoleptic).  Also the leg discomfort, although I think we figured that one out this week.  I had the monthly IViG infusion this past Monday and in talking to nurse Amy that day about it we decided to try just doing half the Benadryl dose to start (25 versus 50) to see if it worked and … it worked!  No more annoying leg tingling.  Going to ask Friday for the Dara IV if we can try the same thing.

The last side effect is my voice.  When I was doing weekly 40 mg of Dex I would lose my voice a day or so later for a few days.  Now with whatever the steroid is they are giving me with the Dara (not Dex) I lose it for a full week.  Kind of annoying but I’ll take that over being rewired into a psychopath.  My personal life continues to improve (knock on wood) since getting Dex out of my life so I’ll take that trade any day of the week.

BTW I’m still taking 2 4 mg Dex’s a week … one the day after treatment, then one two days after.  On infusion day however I get something else, the name of which of course escapes me.  I’ll try to remember to snag it and the doses tomorrow.

Last week I had severe back pain on Wednesday but it hasn’t repeated itself, so marking that one off the list of side effects for now.  GI’s doing really well, although I have really had little to no appetite since the January colon resection.  It occurs to me to question at this point whether I overate due to depression caused by the Dex/whatever else, if this is a function of my stomach bacteria being all messed up between the chemos and surgery, or something else.  Not complaining yet, however, as all of my clothes fit better.

On to deeper thoughts.  While we have no idea yet (too early, according to Dr. Matous) if the Dara is working, my brain finally put together the variables that led up to this decision and the conclusion is somewhat nerve-wracking.  The original plan was to wait to try to get into a clinical trial doing basically the exact same regimen we’re doing now.  Instead “we” just decided to move ahead several weeks ago.  Being an analyst by profession it’s odd that I didn’t run that decision through my usual gauntlet of why’s and wherefore’s , but something clicked on its own last week — I’m pretty sure the decision not to wait was made because my #’s jumped so high during that chemotherapy break.  I finally saw my M-Spike at my meeting last week with Dr. M. before the second Dara treatment and, um, “wow.”  Highest it’s ever been “wow.”  Like 6+.

The jump my pre-cancer mind would have immediately made that took me two weeks is the implications of that.  If this treatment doesn’t work, which we won’t even know about for another few weeks I think, I’m kind of fucked.  Well more fucked.  Fucked-er?

I like F-bombs by the way.  Sorry if that offends anyone or seems uncouth.  Fearing useful words seems silly to me but to each their own.  At least that’s the pseudo-intellectual response prepared for when my daughter inevitably releases a torrent of them at school someday and I have to explain how that’s pretty much my fault.

Digression reined back in … so that’s my interpretation, anyhow (“fucked-er”), but follow me here.  When my M-Spike was lowish (lowest I ever got was about 1.4, I believe), everyone seemed happy just treating this — well if not casually, then with the lack of ZOMG WE HAVE TO TREAT THIS NOW STAT BZZZ BZZZ HEWP HEWP that you always assume is the case with cancers (and sometimes is).  I was told again and again how it’s better to have a gradual trending down, although my understanding is that at least until recently about half the Myeloma experts wanted the lowest MRD (“minimum residual disease”) as possible and half were good with the gradual thing.  We had options, as well — if something didn’t work, like Ninlaro or the BiRD thing (mixing Rev/Dex with an antibiotic), no biggie.

However, now things are a bit more dangerous.  The bad #’s are super high, and presumably are going to go higher or stay at this heightened level if the Dara does nothing.  While there are certainly more options to switch to, that does tend to trim the choice and immediacy of treatment options a bit, logically.  Been pondering that a lot lately.  Our wiggle-room, as it were, has been significantly trimmed in that a failure at this point may take us to a place that we can’t come back from so easily (organ damage, etc.).  Up until now that has been more of a nebulous concern than a real one, but reality has a way of sharpening the picture on you at times.

Thankfully I’m in a good head space — I really do believe that Dex was the primary cause of most of my mental/emotional ills for the past several years, or at least the catalyst for quite a few.  So I take things in stride, I’m extra nice to folks and double-check everything I’m saying/doing before opening my trap.  I need to get back on the Androgel ASAP as well — kind of took myself off that, which was not a great idea but it is what it is.  I get into this self-sabotaging place sometimes where I know things are a bad decision and do them anyways, seemingly in spite of myself.  Never figured that one out.  I also need to get back on the calcium / vitamin D regimen as well — that one I do know why I stopped though, I was eating horse pills and got sick of it.  Have to remember to research that this week and find a better solution than giant chalky white pills I’m mentally balking at swallowing.

Back to the TRT (“testosterone replacement therapy,” sorry for the jargon), I was listening to a podcast this morning with a retired MMA fighter talking about how folks that were forced to stop using it when TRT was suddenly banned in the UFC (thanks Vitor Belfort!) after being allowed caused a lot of depression in those fighters who just stopped using it.  In case I forgot to mention it somewhere along the line my testosterone dropped way below where it was supposed to be so I started doing the Androgel thing but was terrible about keeping up with it.  Chemo may have done that or I had low testosterone before, no way of knowing now.  Either way I need to be more disciplined about this stuff.  I’m always on it with the chemo drugs, but the ancillary stuff not so much.

Still waiting for someone to do something about the sleep test I did … this is somewhat unprofessional at this point.  Need to remember to ask about that tomorrow at my infusion as well.

I know this is long but it’s been a week and I’ve done a lot of thinking lately, so excuse me a few more minor rambles if you will.

I hope I am not broaching a confidence here, but I received a message about a friend with cancer last week and it’s been on my mind a lot lately.  I’m going to repost it here, albeit with names removed, because it scared me more than a little.  It’s easy, at least after four years of this Myeloma existence, to forget that other types of cancers are not as treatable as mine can be:

Hi everyone. I wish I had good news to give you all, but unfortunately that’s not the case. The cancer is spreading all over and pretty fast. Each week I have new pain. I’ve tried everything that traditional western medicine has to offer, and there aren’t any options left.

I did receive a dose of Avastin, but one of its side effects is preventing me from getting it again. It weakens the intestinal walls and I have a tumor that is growing through my intestine.

So, I am planning to go to Germany for an immunotherapy treatment that isn’t available in the US. It’s costing me a huge portion of my life savings to do this, but I figure there isn’t really a better way to spend my money. I remember my mother once saying, “you can’t spend it when you’re dead!” [REDACTED] is coming with me and we leave in a week. We will be there for one week to start the 1st third of the treatment and then I will finish the last two thirds at home.

I’m very nervous about the precarious situation with my intestine, and I have so much cancer in me that this vaccine has to pretty much perform a miracle. I think it’s time to pray for a miracle everyone! I will update you all when I get back.

Sigh.  I know I’m being opaque here but I really don’t want to overstep a friendship by outing a friend, so please keep them in your thoughts.  And if you do read this I love you, kiddo, and I’ll have you in my thoughts.

On the bright side I was just this week corresponding with an old friend with prostate cancer who at least sounds like they are doing well (checkups every six months, if I remember right, so they’re either not too concerned or their insurance sucks).  Was more relieved than I thought I’d be at that news — I don’t see a lot of positive cancer news around me, so that was a pleasant surprise.  I hope people know that even if I’m not in touch as often as I used to be that they are always in my thoughts.  It’s a weird thing, this cancer life — so easy to disconnect accidentally.

On a slightly related divergent stream it’s strange as humans to contemplate the end of our existence.  I’ve been buried in Mass Effect: Andromeda since Sunday (thank God for gaming laptops when you have all-day infusion appointments) and one part of the story is the main protagonists mother dying from cancer and a memory of the parents discussing it.  Having lived 46+ years as the usual poster-child for ironic outcomes it concerns me that now that things are going well emotionally and mentally it’d be typical that I die from this now-ish.  Not that I’m looking for that outcome, mind you, I’ve just learned to read the tea leaves of my life a bit over the years.  Hopefully that’s just a thought and not a thing and we’ll leave it at that.

What else … oh.  Trader Joe’s is the greatest source of infusion-day snacks ever.  EVER.  Seriously, I got these amazing apple breakfast bars there and the cutest mini-bries ever.  Like a bite-sized full brie.  They’re adorbs, as a friend might say (and congratulations to you, NURSE Kate!).  LOOK YE AT THIS MINI BRIE AND DESPAIR.  OR JUST BE REALLY HUNGRY:

img_0719

Cutest.  Brie.  Ever.

I’ve probably mentioned it before but I have a hard time justifying the horrible snacks they have at infusion centers (full of chemical crap) with the fact that eating that stuff has probably given at least a few of these people the cancer they are there being treated for.  At this rate however I’m going to be the weirdo there in my infusion sofa chair working with a charcuterie and cheese plate.  I’ve started bringing Izze’s for the fridge too.  The nurses put an extra sticker from my blood tests or something on them so they look like prescription Izze.

Small things make me laugh.

Alright, brain dump complete.  More news as news becomes news.  BTW I’ve been linking some interesting, and more importantly understandable to mere mortals, articles on twitter.  Take a look sometime — I follow about 50 or so Myeloma experts and news sources and cut out the people that just retweet everyone else’s stuff, then pick the things I find interesting, so hope you do too.  Toodles!

 

Dexamizzle, mah nizzle.

Starting the new chemotherapy tomorrow.  Dara-um-something.

Daramububab?  Daramububabistan?

It’s bad enough that I have zero idea what these drugs even do, I can’t even say the name of the damn things.

“What are you doing for chemo?”  

“Daramummmmmhhhmmppphhh.”

“What have you tried previously?”

“Bortezommmppphh.”

“Lenalidommmmmppphhgrrrgg.”

“Pomalidocidemmppgggrggll.”

“Ixazomibibble.”

I sound like Snoop Dogg trying to explain this stuff.  “Dexamizzle, mah nizzle.”

You know what they should do?  Make the name based off of the worst and most common side effects to pressure the pharma companies to fix them.  If your drug was required to be named “Explosivediarrheamumab” you’d fix the goddamn thing, I bet.

Annnnnnywho, here’s a description of the new drug from the Wiki page.  If you understand any of this you win.  Also feel free to tell me about how you know what this says so you can feel special about yourself at my expense:

Daratumumab is an IgG1k monoclonal antibody directed against CD38. CD38 is overexpressed in multiple myeloma cells. Daratumumab binds to CD38, causing cells to apoptose via antibody-dependent cellular cytotoxicity or complement-dependent cytotoxicity.

For reference, here is what cheesecake is, also from the Wiki page:

Cheesecake is a sweet dessert consisting of one or more layers. The main, and thickest layer, consists of a mixture of soft, fresh cheese (typically cream cheese or ricotta), eggs, and sugar; if there is a bottom layer it often consists of a crust or base made from crushed cookies (or digestive biscuits), graham crackers, pastry, or sponge cake.[1] It may be baked or unbaked (usually refrigerated). Cheesecake is usually sweetened with sugar and may be flavored or topped with fruit, whipped cream, nuts, cookies, fruit sauce, and/or chocolate syrup. Cheesecake can be prepared in many flavors, such as strawberry, pumpkin, key lime, chocolate, Oreo, chestnut, or toffee.

Sigh.  Seriously, who the hell makes cheesecake with digestive biscuits?  That sounds gross.

I’m going to apologize for the following statement up front since I have heard from a few MM docs who read my blog now.  But sometimes I wonder if doctors are that much smarter than me that they just understand that first explanation like, well, the second one, or if it’s a language more designed just to keep us medical Luddites from questioning them.  I’ll admit that working in finance I’ve often felt the desire to jargon a client into shutting the fuck up, so I could understand that.  Regardless I’ll just be calling it “Dara.”  If anyone asks for an explanation of how it works I’ll just make up something like I do with my daughter, who may or may not still believe babies come from Costco (*innocent whistle*).  Like Daratumumabagofuckyourself or whatever the hell it’s called makes the cancerous cells watch a director’s extended cut version of that horrific reality show about the Kardashians until the myeloma gremlins commit premature apoptosis, which is what the process is called with the white smoke and stuff when they choose a new pope*.

* I could be wrong on the pope thing, I fell asleep the day they went over etymology in class.

So tomorrow morning I have to be at CBCI at 6:30 AM to get started … they have me there all day, which honestly is fine.  Living in Parker on the south side o’ Denver I can’t get any fun places downtown to deliver food, so if I get hungry (dubious) I can order something good to the CBCI office. Even if you’re not hungry the look on the delivery person’s face at a cancer clinic is usually priceless, sort of this combination of fear, desire to leave immediately and regret at having spit in your food.  Like most of my married life.  Whatever, CBCI has bitchin’ WiFi and I’ve already loaded up the Alienware LAPTOP OF DOOM with Ghost Recon: Wildlands and I can access my home theater server from anywhere.

As a total digression, one thing that’s actually fun about cancer (yes, I just said that, I try to be the glass half full guy when not Dex’ed out of my gourd) is that you rarely lose the argument with yourself over whether something’s too expensive or over-the-top.  That’s why I have a DS1515+ running at home on a 250 MB line with over 20 terabytes of storage.  I.e., there’s nothing too ridiculous.  I have my own Netflix, effectively.  “Hey me, think we really need this?”  “GODDAMN RIGHT, ‘MURICA!!!”  “Well that was easy.”

Anyways back to chemotherapy talk.  It’s funny how after a few years I don’t even stress about a new treatment as much as whether I’ll be able to game and/or watch a movie comfortably while they pump this shit into me.  In fact, my only real concern is watching myself like a hawk to make sure the Dex they have to apparently give me doesn’t change me back to “Dex Rich.”  Dara has become a standard of care already so I’m relatively sure they know what to expect and how to deal with it.  My job is to just sit back and entertain myself, and hopefully my nurse, all day.

Thank God, BTW, I wasn’t on Dex yesterday or the results would have gone viral.  First I get stuck on the highway for a good 30 minutes because apparently driving is too goddamn difficult for some people (major accident at 25 and Evans-ish), and then I get to University and some municipal worker has blocked and coned off one of the two lanes going north past Cherry Creek for no discernible purpose except to make me even more late.  How I did not open my window and, erm, “engage in some witty repartee” is solely due to the lack of steroids in my system.  Also I’m relatively sure not only would beer belly smoking worker guy not give a shit about causing a 3 mile traffic jam, he probably took the job just to cause that stuff.

I would.

This entry is as scatterbrained as I am today, sorry … too many things on my to-do list and random thoughts won’t stop popping up in my head while I’m writing.

Tomorrow’s the day and then I’m sure I’ll write something up either then or this weekend.  Toodles.