Relapsed High Risk Myeloma - Update August 15 2013

Drove to St. Luke's Hospital MSTI, in Twin Falls. Had my bard power port accessed and my blood drawn and sent to the lab by RN Ann.

My white blood cell count is up to 5.1 (norms 4.5-110) and my ANC (Absolute Neutrophil Count is 2.76 (norms 1.9-8.8) to 2.26. This is very good news because it means I can have my tandem chemo of intravenous carfilzomib/oral pomalyst/oral Dex 10 mg every other day beginning Cycle 2 today.

My hemoglobin is 8.3 today, and my threshold for packed red blood cell transfusion is 9.0., so I will be getting one unit of blood today. My platelets are only sitting at 7 today (norms 140-440). So, I will be getting one unit of platelets today too.

My LDH continues to climb at 2440 (norms 313-618) from 2206 last week (8 Aug 2013). Remember, last week, I did not receive any chemo because my ANC was just 0.8 and the threshold for chemo is 1.0 or higher.

My Chem Panel was out of range this morning - especially my blood glucose level at 592 (norms 60-950). I've noticed that my eyesight is a tad blurry this morning.  They gave me 10 units of insulin sub-cutaneous insulin and rechecked my blood glucose.

So,  now I  am a TYPE 1 DIABETIC - oh Joy~

My repeat blood glucose was just 576 and I received an additional 10 units of insulin at 3 pm, so Dr. Padavanjia is going to hospitalize me tonight at St. Luke's Hospital in Twin Falls and get my blood sugar back under control by tomorrow morning. We are going to lower my every other day dex dose to 6 mg instead 10 mg every other day.


Glucose Readings - 15 Aug 2013
Thurs, 15 Aug 2013 AM - Blood Glucose: 592 - 10 units regular insulin 
Thurs 15 Aug 2013 PM - Blood Glucose: 576 - 10 units regular insulin
Thursday 15 Aug Blood Glucose: (inpatient check 7 pm 473) 4 hundred something - to get 2 types of insulin
Thursday 15 Aug Blood Glucose: (inpatient check 9 pm 211)

My creatinine was normal at 0.9 (norms 0.52-1.04); BUN high at 29 (norms 7-17); and my GFR normal at greater than 60.

My M-Spike was 1.8 (norm zero) from 1.2 (norm zero) on 2 July 2013.

My IgG is high 2406 (norms 700-1600)
IgA  <13  (norms 70-400)
IgM 9  (norms 40-230) 
My IgG was at 1765 on 4 June 2013.  Remember, my cancer is carried on the IgG.

Beginning Friday, 16 August 2013, we will reduce the Pomalyst from 4 mg to 2 mg.  

History of All Platelet Transfusions Since Diagnosis May 24 2011

1. Platelet Transfusion March 24 2012 (UCH- University of Colorado)
2. Platelet Transfusion March 27 2012 (UCH)
3. Platelet Transfusion March 29 2012 (UCH)
4. Platelet Transfusion March 31 2012 (UCH)
5. Platelet Transfusion May 20 2012 (UCH)
6. Platelet Transfusion May 22 2012 (UCH)
7. Platelet Transfusion May 10 2013 (St. Luke's Hospital)
8. Platelet Transfusion Jul 12 2013 (St. Luke's Hospital)
9. Platelet Transfusion Jul 23 2013 (St. Luke's Hospital)
10. Platelet Transfusion Aug 15 2013 (St. Luke's Hospital (inpatient)

History of All Blood Transfusions Since Diagnosis May 24 2011

1. Aug 15 2013 (1 unit)
2. Aug 2 2013 (1 unit)
3. Jun 26 2013 (2 units)
4. Jun 11 2013 (1 unit)
5. May 14 2013 (2 units)
6. May 7 2013
7. Apr 19 2013
8. Apr 10 2013
9. May 16 2012 (2 units)
10. April 2 2012  (2 units)
11. Sept 22 2011 (2 units)

Left St. Luke's MSTI after my blood transfusion and platelet transfusion to be admitted to their Medical Unit 3232. Developed a headache and a SEVERE SORE THROAT. They gave me throat lozenges and that helped, but I was still having BAD PAIN even trying to swallow m own saliva.

My experience in-patient was not fun. I didn't have any food because no one was sure I could have food with "my new diabetes", but they were checking my blood sugar and and giving me insulin (14 units of Lantus); and various amounts of NovoLog (short acting insulin). Finally  managed to get them to give me a pail pill around midnight.

Relapsed High Risk Myeloma - Update July 2 2013

Jani and I arranged to have Andrea Marinac come and stay at the house with our 3 dogs and her cute little dog, Koko since we were anticipatingag a 2-day stay in Twin Falls, Idaho with a motel stay to begin Cycle 3 of Bendamustine, Revlimid 5mg/Dex 40 mg. 

My chart below may not be correct - I have to study the original documents.

We arrived in Twin Falls just in time for my 9:40 AM appointment. Everything was running late in the MSTI Infusion Center. Had my blood drawn and then we waited in the examine room while they searched for the results of my bone marrow biopsy done 26 June 2013.

Dr. Padavanija came in and said the bone marrow biopsy results weren't any better - at least 95% and/or 100% plasma cells. However, the M-Spike had dropped from 1.3 to 1.2. I didn't get any hard paper copies of the bone marrow biopsy results and will have to wait until next week.

My white blood cell count (fights infection) is low, but okay for me at 1.9 (norms 4.5-11); ANC (absolute neutrophil count determines if I should wear a mask or not) is low, but okay for me at 1.24 (norms for 1.9 to 4.8); platelets MISERABLY LOW at 17 (norms 140-440) and I have not been on any chemo for the last week. They don't like to intervene with a platelet transfusion until the platelets drop below 10 because you make antibodies against platelets and they only last 1-2 days in your body; They did not draw a LDH today.

My Chem Panel was good for my kidney function - continued mild kidney failure.

I continued back to the MSTI Infusion Room for my monthly Aredia 30 mg intravenously. I remembered to take my Claritin and Tylenol by mouth. This always helps the aches and pains that Aredia can cause post-infusion. They cannot tell you take Claritin/Tylenol because no evidence based (research) data exists on its use - but, IT has ALWAYS helped me with Zometa, Aredia, and Neupogen infusions.

While I was infusion, Dr. Padavanija called Clay Smith, MD at the University of Colorado Hospital. He was involved in an emergency, but did get back to Dr. Padvanija. Since the Bendamustine/Revlimid/Dex doesn't seem to be working, they decided I should switch to:

Option: carfilzomib intravenously 2 days in a row/pomalidomide 21 out or 28 days orally/dex 40 mg weekly

I've been on both of these chemotherapy medications before, but not in his combo.

Summary of Chemotherapy Agents I've Had Since Diagnosis 23 Months Ago:

1. Revlimid (lenalidomide)
2. Velcade (bortezomib) 
3. Decadron (dexamethasone)
4. Thalidomide (took a couple of days and discontinued due to neuro complications)
5. Cisplastin
6. Adriamycin
7. Cytoxan
8. Etoposide
9. Carmustine
10. Cytarabine
11. Melphalan
12. Vorinostat (Zolinza)
13. Carfilzomib (Kyprolis)
14. Pomalidomide (Pomalyst)
15. Bendamustine
16. Carfilzomib Kyprolis)/Pomalidomide (Pomalyst)/Dex

I will still require "rescue blood and platelet transfusions as my platelets are not not likely to recover on this chemo cocktail. They will have to get my medical insurance approval first. That, along with 4th of July 2013 Holiday probably will delay the start until next week. The carfilzomib (Kyprolis) is given intravenously 2 days in a row and the pomalidomide (Pomalyst) is given by mouth for 21 out of 28 days.

After the Aredia ran intravenously, Jani and I went to get my hair cut. My hair has been looking like a very messed up Einstein look.

Taco Bell and Shopko. I needed shorts for a "michelin-tire-sized" girl.

On the way home, we saw a grass fire near Richfield, Idaho, called the Jim Brown Fire (below).

Then, once in our Big Lost River Valley, there was a larger fire just south of the King Mountain roads (I think they are calling it the Beaver Creek Fire). It was raining north of the fire in Leslie, Idaho - so, hopefully the moisture will go south and put the fire out.

My post-hair cut look once home - my post-chemo hair continues to have its own curl and fuzz to it, so it is HARD to control - but, my ugly Einstein look is better.

We had dropped Jonah off at M&C Lube for an oil change when we left town, so we stopped so I could pick him up and drove him home.

Relapsed High Risk Myeloma - SPEP with M Spike, Immunoglobulins, and Free LIght Chains Update June 7 2013

My SPEP Results from blood drawn 4 June 2013. M-Spike is unchanged at 1.3 (it was also 1.3 last on 23 April 2013). However, it says in the "GAMMA" region and I've never had that comment before. In short, it says "essentially, unchanged since last assessment" - I'll take that! Better unchanged than increasing!

My IgG immunoglobulin is slightly increased from the 23 April 2013 when it was 1702

IgG is at 1765 now on 4 Jun 2013. Remember, my cancer is carried on the IgG.

IgM is LOW at 10

IgA is LOW at <13

My free light chains are 3.50 and I'm not sure how that has changed yet, if it has. This is the lab value that might not show much since I am a non-secretor. 

Relapsed High Risk Myeloma - Update June 6 2013

Slept pretty well last night if I don't dwell on how upset my stomach was - sorry, whine, whine, whine. The intravenous Bendamustine dries my mouth and tongue out, alters my taste buds significantly, and gives me a moderate sore throat. I think, I remember having all of this during Cycle 1 Bendamustine too - but, I cannot find any documentation of it in my blog.

Worked all morning on getting "lists" made of things I need to get done with my paperwork, bills, etc. Just when I think I have it all worked out, I think of something else. Don't want to leave Jani and my family with a paper mess. Met with the Mackay Fire Department Chief, Randy Ivie, to share with him the IDAHO POST NOTE (singed by my oncologist, Jani, and I) - a document that indicates I do not want to be transported out of Mackay if I cannot speak for myself. 

Randy and I  had a good visit. He and his family have been friends forever in my memory. Randy was the EMT with my Gram, Hazel Lundberg, when she died in October 1985 and Randy's son, Justin, was the paper boy that found my Uncle Rex Lundberg passed away in his home in December 1991.

I went for mail and had really nice visits with a number of friends in front of the Post Office. I love that Mackay people take the time to visit and no one "really seems in a hurry".

Kenadi called me from St. Luke's Hospital in Twin Falls, Idaho this morning to tell me my SPEP was ready.Stopped at the Mackay Library and picked up my faxed SPEP Results from the blood drawn 4 June 2013. RN  My M-Spike is still 1.3, but has a  note that it was in the "gamma region", when I have always had "kappa region" myeloma. I'll have to study my past M-Spike reports and call Dr. Padavanija to figure this out.  More on the free lights, immunoglobulins tomorrow.

Beautiful lilac bush in full bloom by the Mackay Library. Our spring and summer weather usually does not arrive until now - so, we are right on time.

Jani worked all day on my lawn with the string trimmer and mowing the two wild habitant fields I have on either side of my house.

Somewhere in there, I squeezed in a two hour nap on the sofa after lunch...slept hard and probably snored LOUDLY~

My Barton Flat Churndasher Ranch Johnson family stopped by with  a treat for me - red licorice! They also had 2 sleeping baby grandsons, Otto, age 2, and Owen, age almost 2 months, in the back seat with the cutest 3 year old granddaughter babysitter, Kinley, in the middle. Kinley has the brightest light eyes - SO CUTE! Their other two granddaughters, Kelsey and Kassidy stayed on the ranch to help their Dad tonight. I've known this family for my whole life and I love watching them grow!

Jani and I went to the Mackay Outlaw Dinner Theatre tonight at the school.  The dinner was pizza and spaghetti. The monies raised are used to put on the annual Halloween Carnival for the school kids each year. The play entitled, "Every Little Crook and Nanny" was terrific fun and the cast did such a nice job with the production. I laughed a lot and that CANNOT BE BAD! Sitting in stadium-like auditorium chairs was hard on me for 2 hours!

I sat next to good friend, Cora Lockie and Lana Pehrson on the other side (missed getting her photo). This is the FIRST activity that I have attempted and completed in the evening in MONTHS and MONTHS. My back hurt from all the sitting in the stadium-like chairs, but I made it through the entire performance. 

Relapsed High-Risk Myeloma Update with Bone Marrow Biopsy - April 26 2013

Lana picked me up at 6:30 AM and we were off to St. Luke's Hospital in Twin Falls, Idaho for my ELEVENTH (11th) Bone Marrow Biopsy (my 3rd under conscious sedation) in 23 months since my high-risk 4:14, 1q21 and others cytogenetic changes multiple myeloma diagnosis on 24 May 2011. I am a non-secretory and my myeloma does not show up well in my blood tests - hence, requiring frequent bone marrow biopsies. I feel well today!

Bone Marrow Biopsy History:

1. 24 May 2011 (Diagnosis, Dr. Moore in Ft. Collins, Colorado; traditional trocar)
2. 20 Aug 2011 (1st at UCH with Glen, NP; traditional trocar)
3. 1 Sept 2011 (Karley, NP, UCH, traditional trocar)
4. 2 Nov 2011  (Karley, NP, UCH, tradition trocar)
5. 9 Mar 2012  (Karley, NP and 1st with OnControl Driver, UCH)
6. 3 May 2012 (Shannon, NP with OnControl Driver, UCH)
7. 12 July 2012 (Trish, NP with OnControl Driver UCH)
8. 17 Oct 2012 (Angela, NP with OnControl Driver UCH)
9. 20 Dec 2012 (Kirk Peterson, MD, St. Luke's Hospital, Twin Falls, Idaho) Conscious Sedation; traditional trocar
10. 20 Feb 2013 (Kirk Peterson, MD, St. Luke's Hospital, Twin Falls, Idaho) Conscious Sedation; traditional trocar
11. 26 Apr 2013 (John Gray, MD, St. Luke's Hospital, Twin Falls, Idaho) Conscious Sedation; traditional trocar

Checked in the Cancer Center to have my Bard Power Port accessed and a CBC (complete blood count) drawn. RN Rhonda took good care of me. I saw RN Kenadi (Dr. Padavanija's nurse) and asked her to ask Dr. Padavanija if my platelets were greater than 50, if I could re-start Pomalidomide and they decided I could at 2 mg daily, but she wanted me to know that my myeloma was progressing and she didn't think it work. Turned out to be a non-issue since my platelets were only 39.

My IgG on 23 Apr 2013 continues to soar upward to 1,701 (up from 1,247 in less than a week).  My IgG at diagnosis was 3,422 (24 may 2011).

My M-Spike also continues increase to 1.3 on 23 Apr 2013 from 0.8 (norms ZERO) on 16 Apr 2013. My M-Spike at diagnosis was 3.0 (24 May 2011).

My white blood cell count is way up, but still low to 4.0 (norms 4.5-11); ANC (absolute neutrophil count) is NORMAL at 2.83 (norms 1.9-8.8), so no mask this week!; hemoglobin low at 9.7 (norms 140-440); and platelets STILL MISERABLY LOW at 39 (norms 140-440). 

We walked over and checked in to Interventional Radiology for my 11th bone marrow biopsy. I had RN Shanna an she works knowledgeable and "HAPPY" so, it was great. Pathologist, John Gray, MD came to do my bone marrow biopsy. They let Lana watch.

After the bone marrow biopsy procedure, Lana drove me home to Mackay. I didn't feel as drugged as I have in the past and we chatted away the whole way even though I received a little more Fentanyl and Versed (conscious sedation intravenous drugs) than I have in the past. 

I do have quite a bit of post-procedure pain a the site on the left side with pain radiating down the back of my left leg - WHICH BETTER BE TEMPORARY!!!!! I decided to take my Saturday 10 mg Dex dose tonight to decrease any inflammation around the bone marrow biopsy site. It helped some.

Now, I just have to wait until 9 May 2013 for the bone marrow biopsy results AND, hopefully, come up with some kind of chemo plan to beat the myeloma down again - may only be wishful thinking on my part. I'm going to guess that my plasma cell percentage (myeloma cancer) in my bone marrow today will be at 85 percent (my plasma cell percentage on diagnosis was 80 percent on 24 May 2011). It was at 63 percent on 20 Feb 2013 - just 2 months ago.

I'll be getting my CBC checked next on 2 May 2013.

Lana had me home in Mackay by 2:30 PM and Dianne brought Kemmer home.  Dianne was lucky this evening and saw a bull moose on her walk right here in town.

Relapsed High-Risk Myeloma Update with M-Spike - April 19 2013

Arrived St. Luke's Hospital, Twin Falls just before my 9 AM appointment. Only had to dodge mule deer twice near Leslie, Idaho. One crossed right in front of me at Lockie's.

Triage RN Sandy helped me get this appointment yesterday and she really listened to me which I am so appreciative. She was able to get an order for type and cross for my blood type and an order a unit of packed red blood cells at the new higher threshold for transfusion of 9.0. They sent 0 Positive blood which is fine for my A Positive Blood Type.

 AGAIN, thankful for volunteer blood donors!

She also got the ball rolling to have a bone marrow biopsy scheduled next week under conscious sedation. I will have the bone marrow biopsy next Friday, 26 Apr 2013.

My white blood cell count today is 2.1 (norms  4.5-11); ANC up to 1.25, but still low (norms 1.9-8.8; Hemoglobin down to 8.3 (norms 12-16); and platelets up to 45 from 39 (norms 140-440).

My M-Spike came from the University of Colorado Hospital this morning from 16 April 2018. It has doubled in 3 months from 0.4 to 0.8...not so good. Remember, I'm non-secretory, so an M-Spike of 0.8 may not look impressively bad until I have the percent of plasma cells in my bone marrow biopsy next Friday.

My M Spike was 3.0 on 18 May 2011 (just before my formal diagnosis).

Went food shopping and drove home in a light rain off and on. Really felt good while shopping and no shortness of breath.

High-Risk Relapsed Myeloma Update University of Colorado - April 16 2013

Met with Clay Smith, MD right on time. He is always such a good listener. We went over my lab values for today. My LDH is high at 367 (norms 98-192).

My Immunoglobulin G value is sky-high - NOT GOOD at 1247. Looks normal according to the norms of 700-1643), but my cancer is carried on the IgG. My IgG value was 3,422 on 18 Jun 2011 just after my initial diagnosis on 24 May 2011 prior to any treatment.

 My immunoglobulin is still way too low at 10 (norms 66-436).

 My immunoglobulin M is still way too low at <25 (norms 43-279).

My CBC shows white blood cells low at 2.3 (norms 4.5-11); ANC (absolute neutrophil count low at 1.00); hemoglobin low at 8.5 (norms 12-16); platelets very low at 39 (140-440); LDH 367 high.

 My Chem Panel shows mild kidney failure with creatinine at 1.28 (norms 0.52-1.04); BUN 18 (norms 7-17); and GFR 53 (norms > 60). My glucose is high at 192 (norms 70-112), but they won't want to intervene until the glucose exceeds 200. I can control the glucose by reducing my sugar intake.

I will have to wait for my SPEP myeloma test results, but since I'm a non-secretory patient, they are not that valuable. Dr. Smith wants me to schedule a bone marrow biopsy with Dr. Padavanija at St. Luke's Hospital in Twin Falls, Idaho as soon as I return to Idaho on 18 April

2013

He thinks my low wbc's, platelets, and hemoglobin are due to either too much pomalidomide suppression and/or my cancer plasma cells are unresponsive to the pomalidomide and growing uncontrolled and squeezing out the the normal bone marrow elements (wbc, platelets, and hemoglobin). Only a bone marrow biopsy will determine this.

For now, we hold the pomolidomide. So, I won't be on any chemo for now. Dr. Smith will also discuss with Dr. Padavanija raising the low threshold of hemoglobin for packed red blood cell transfusion. I'm not sure what hemoglobin value he was thinking of. Typically, they do not transfusion until the hemoglobin is less than 7.0. But, since I am symptomatic with shortness of breath, it merits raising the hemoglobin value for transfusion for me. Will give me more energy - hopefully.

If the pomalidomide is not working, Dr. Smith admitted that I'm in a "tough situation". If this is the case (as determined by bone marrow biopsy), I could look for a clinical trial somewhere that does NOT require total relocation to the trial location and see if they would accept me or I could opt to just stop all treatment. However, Dr. Smith warned that many of the clinical trials have minimum lab value requirements and I might not meet those at this time. He is will to help me with the clinical trial application if I go that way. He will also contact Mayo Clinic-Scottsdale for any suggestions they might have. I told Dr. Smith I didn't think I was ready at this point to stop treatment.

As far as the Dex 40 mg and spreading it out over 4 days goes - this is not optimal, but he said I could do it. Might want to switch to Prednisone in the same dosage taking it every other day. Will discuss with Dr. Padavanija.

Dr. Smith does not want me doing much until my platelets recover to at least 60 - currently at 39. (Norms 140-440). No riding the 4-wheeler.

Dr. Smith did a thorough physical exam and I told him about my left-sided neck and head pain and how it responded to migraine medication, Frovea. He worried it might be due to the low platelets and warned me about Fragmin use with such low platelets.

Discussed the right eye "floater" deal and he also worried that his was due to low platelets and encouraged me to see the ophthalmologist again if it changed at all. It persists as a brownish blotch in the shape of "Africa".

Just before we left, we met Dr. Smith's RN Sare.

All the snowy roads were dry on the way home to Greeley and we made it just before 4 PM...long day. Stopped for take out Chinese Food - yum!

SO, How Will I Know If the Pomalidomide (Pomalyst) Helps My Current Relapse?

After I have completed 2 full cycles of pomalidomide, I will have another bone marrow biopsy to see if it has helped my relapse to 60 % plasma cells noted after the bone marrow biopsy on 20 Feb 2013. 

Remember, I have non-secretory multiple myeloma and the SPEP blood tests (m-spike, free light chains, and immunoglobulins IgG, ImG and IaG) are of little value in interpreting where my myeloma is at, yet they continue to draw these tests. Hence, the need for bone marrow biopsies every 2 months.

So, although not scheduled at present, I will have my next bone marrow biopsy at the end of April 2013.

Pomalidomide is depressing the normal elements in my blood (red blood cells, white blood cells, and platelets), so I can only hope it is killing off myeloma plasma cells TOO!

Bone Marrow Biopsy Results and MORE - February 27 2013

Drove to Twin Falls, Idaho in very cold Minus 2 temperatures, which gradually warmed up as I left the Big Lost River Valley and approached the Magic Valley.

Highway 93 to Carey, Idaho. Look in the middle and you'll see an avalanche chute.

I delivered my 24 hour urine collected from 26-27 Feb 2013 kept in a cooler with ice to the St. Luke's Hospital Lab. 

My appointments at St. Luke's Hospital, Twin Falls was all mixed up and they didn't have me down for a lab draw prior to my doctor's appointment and no Infusion Room appointment. So, I waited while very nice receptionist Pamela got it figured out for me.

My hair is growing again and I actually have bangs!...me and Michelle Obama!  However, my hair is WILD and won't do anything I try to do with it. I had to shave my legs for the first time this morning for a very little stubble.

They finally drew my blood from my Bard Power Port and and waited while the results were done. Dr. Padavanija came in and told me my 10th bone marrow biopsy results "weren't good". 

Evidently, I have been looking at the apples to oranges vs apples to apples on my previous bone marrow biopsy results. When I reported that my plasma cell percentage in my bone marrow was 60 percent on 16 Oct 2012 and then down to 40 percent on 20 Dec 2012, I was reporting TWO DIFFERENT methods - flow cytometry for plasma cells and a manual count of plasma cells from the slides. Evidently, the manual count for plasma cells is the most accurate. You'd think I know this before the 10th Bone Marrow Biopsy!!!

On 16 Oct 2012, the flow cytometry was 27 % plasma cells and the manual count was 60 %.
On 20 Dec 2012, the flow cytometry was 40 % plasma cells and the manual count was not done. Dr. Padavanija sent Pathology a request to do it today, and the manual count was 50 %.
On 20 Feb 2013, the flow cytometry was 26 % plasma cells and the manual count was 64 %.

On the cytogenetics report, I have two lines of abnormalities with a final note indicating, "This result is indicative of persistent disease. The findings of abnormal metaphases in a patient with myeloma is also an indicator for increased cell proliferation, which has been shown to be predicative for shorter event-free and overall survival (Haematologica, 96(1): 87'11). Clinical correlation is required."

My peripheral blood on 20 Feb 2013 was summarized as:
1. Moderate anemia with slight macrocytosis (oxygen carrying ability and energy)
2. Severe leukopenia/neutropenia (ability to fight infection)
3. Moderate thrombocytopenia (ability clot blood)

SPEP Blood Values from 20 Feb 2013:

My M-Spike was sligthtly down to 0.3 (20 Feb 2013) from 0.4 (22 Jan 2013 and 20 Dec 
2012).
M-Spike Hx since 2nd ASCT (autologous stem cell transplant):
20 Feb 2013      0.3 (Idaho)
22 Jan 2013      0.4 (UCH)
20 Dec 2012     0.4 (Idaho)
27 Nov 2012     0..5 (Idaho)
20 Nov 2012     0.5 (Mayo Scottsdale)
16 Oct 2012      0.3 (UCH)
2 Oct 2012        0.4 (Idaho)
4 Sep 2012       0.3 (Idaho)
13 Aug 2012     0.1 (Idaho)
8 Aug 2012      <0.1 (Idaho)
18 May 2012     2nd ASCT (UCH)

My M-Spike history is not very valuable since I am a non-secretory myeloma patient where the bone marrow values are more valuable than the blood values.

Total Protein: normal at 6.3 (norms 6-8.2)

IgG low at 556 (norms 700-1600)
IgA low at <13 (norms 70-400)
IgM low at <8 (norms 40-230)

Lamba Qnt FLC results BELOW reportable range of 1.9 (norms 5.7-26.3)
Kappa Qnt FLC 3.64 (norms 3.3-19.4)
Kappa/Lamba FLCR Unable to calculate ratio since values below reportable range.

Dr. Padavanija called Clay Smith, MD at the University of Colorado while I waited today, 27 Feb 2013 and they decided my bone marrow biopsy results mean I have failed on carfilzomib/dex/revlimid with a couple of cytoxan doses. I will discontinue carfilzomib/revlimid/ and cytoxan today. 

They will attempt to get approval to put me on pomalidomide (Pomalyst) 21 out of 28 days and Dex 40 mg (Days 1, 8, 15, 22. The approval of the pomalidomide may take weeks, but they wanted me to start the Dex 40 mg today. I asked if I should continue Revlimid 10 mg until the decision is made on the pomalidomide and Dr. Padavanija said no. So, I will continue off chemotherapy for another week or 2. Hopefully, my lab values will have time to recover during this time. 

The good news is that pomalidomide (Pomalyst) is a pill taken daily at home and I will not have to go to St. Luke's Hospital two days a week with a motel stay like I have been doing for carfilzomib chemotherapy. I will have to week blood tests once I start pomalidomide.

The Myeloma Beacon had an article about a French study on polalidomide today [French Study Provides Further Insights Into Pomalyst’s Efficacy, Safety, And Dosing
[ by Virginia Li | Feb 27, 2013 4:47 pm |] which was interesting. Click here to go to article:
http://www.myelomabeacon.com

Today's lab values:
White blood cells (WBC) continue low at 2.1 (norms 4.5-11); Absolute neutrophil count (ANC) continues low at 1.25 (norms 1.9-8.8); hemoglobin continues low at 9.8 (norms 12-16); and platelets continue low at 128 (norms 140-440).
My LDH was up at 633 (norms 313-619), a gross indicator of inflammation and rapid cell growth.

My kidney function blood test showed an increase in creatinine again to 1.11 (norms 0.52-1.04).

I received my monthly bone building medicine, Aredia 30 mg intravenously. I took over-the-counter Claritin and 500 mg of Tylenol to decrease the headache, body aches, and flu like symptoms of Aredia. 

I received the  40 mg of dex intravenously today since my stomach has been so upset. Dr. Padavanija said the IV Dex would also upset my stomach. She gave me a prescription for Carafate 1 GM/10 ml Suspension to be taken 4x per day which will be hard for me since it has to be taken on an empty stomach not within eating for 1 hour before or 2 hours after eating and not within 30 minutes of taking any antacids...we'll see how I do...because I'm a snacker.

They were able to schedule the MRI of my hip and pelvis for tomorrow morning, 28 Feb 2013, so I kept my motel reservation for tonight, 27 Feb 2013 even though I didn't get any chemotherapy today and I won't get any tomorrow. 

I also got a new prescription for oxycodone 5 mg immediate release tabs to replace my use of Tylenol and Percocet (which has Tylenol in it). They are very small pills, but I think I can cut them in half for a 2.5 mg dose.

Happily went to Taco Bell for dinner!  :) That part of my life GOOD!