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!

2nd ASCT - Day 108 - September 4 2012

Drove to St. Luke's Hospital MSTI in Twin Falls this morning. Got there early and stopped at Sportman's Warehouse which is located just on the edge of the canyon with a great view of the Twin Falls Bridge that I have to cross over to get to Twin Falls.

Twin Falls Perrine Bridge over the Snake River today September 4 2012. Double click to full-size.

 RN Kenadi, me and my oncologist, Dr. Padavanija. September 4 2012

Had a good visit with Dr. Padavanija. She thinks I should continue Augmentin (antibiotic for one more week to make sure the root canal is totally bacteria free). I was scheduled to get Aredia (bone building medication) this week, but Dr. Padavanija thinks I should forego Aredia for this entire month in light of the root canal. So, I  only got subcutaneous Velcade today in my left arm. I was in and out of the Infusion Area in just minutes since I didn't get the 3 hour Aredia intravenous drip. I took my Zolinza 400 mg (four 100mg capsules) while I waited for the Velcade along with 10 mg of dex. I ate a peanut butter and jelly sandwich.

My blood values are good this afternoon. WBC normal at 4.7 (norms 4.5-11); hemoglobin 13.5 (norms12-15); and platelets 258 (norms140-440). They also drew a LDH and Beta2 Microglobuins along with my SPEP (includes the M-Spike) and free lights. I also gave them a urine sample.  I won't get those results until the end of the week via fax or during my Friday Velcade administration.

My comprehensive metabolic panel has a slightly abnormally high Creatinine which is NOT good - a measure of kidney function. I've been taking a lot of Advil for the root canal and I'm going to stop that now. However, my BUN is normal (another kidney function measure) - so, I'm probably alright.

Stopped at Taco Bell - yum.

Back home in Mackay, Idaho located in the smokey Big Lost River Valley by 2:45 PM. The Halstead Fire has grown to 135,779 acres and only 7 percent contained. Our air is just THICK with fire smoke - so, no walk for Kemmer and I. Can't even see the Mine Hill and it is less than 1 mile away. The sun was a bright orange, but not in my photo.

Lab Results March 12 2012

My lab results just prior to my Velcade subcutaneously and Dex intravenously March 12 2012. My white blood cell count is low at 3.2 (norms 4-11.1). My hemoglobin is NORMAL at 12.6 (norms 12.1-16.3) and my platelets are low at 112 (norms 150-400).

My white blood cell differential (types of white blood cells) are pretty normal, except my lymphocytes are a little low at 13.5 (norms 20-50).

My LDH remains within normal limits March 12 2012

My 24 hour urine results - not sure how to interpret. Still need the urine protein fractionation for the 24 hour urine and not sure how long this takes.

My SPEP Results from March 8 2012 are still not completed.

24 Hour Urine Results from November 16 2011 Are Back - Day 64

The Urine Protein Fractionation from my 24-hour urine collected November 16 2011 show no monoclonal gammopathy (cancer of the plasma cells). 

Day 64 - 24-Hour Urine Results - November 16 2011

My 24-hour urine results remain unchanged at less than 6 mg/dL.

Day 64 - Halleluyah, I Think~ November 16 2011

UCH called with my appointment to have my Trifusion Hickman Catheter removed - Tuesday, November 22 2011 - Halleluyah~!  Now, I'll just think POSITIVE about the blood clots (I have 2, one larger and one smaller) in my heart not causing any problems during the catheter removal.

I drove myself to UCH to take my 24-hour urine in and to get my Trifusion Hickman Catheter dressing changed. Afterwards, I stopped to pick up some insurance forms from Amy, the Social Worker. Amy has really been helpful.

I was in and out of UCH in less than 40 minutes - a RECORD~

Day 63 - M-Spike Value Results from November 9 2011 Back - November 15 2011

They repeated my SPEP on November 9 2011. The results came today, November 15 2011. My M-Spike remains at 0.1 (IgG kappa). However, now I have "hypogammaglobulinema" listed on it also. I'm not sure if this is of concern or just part of recovering from stem cell transplantation. The report also lists: Mild elevated alpha-2 fraction (alpha-2 macroglobulin). Again, not sure what that means.

 The M-Spike over time from June 15 2011 to November 9 2011.

I stayed home all day today because I had to do a 24-hour urine test that I will be taking in to UCH tomorrow.

24 Hour Urine August 23 to 24 2011

I'm on a 24 Hour Urine, so I have to call the nurses each time I void to empty the urine out of a hat in the toilet to a collection container that has to be kept on ice.

And while I'm here in the large bathroom, I'll show you the shower and sink.

 The hospital provides this Medline Remedy Foaming Body Cleanser for showering.

 The hospital also provides this salt/baking soda that I mix with water and gargle 4 times at day. Helps in reducing mouth sores and ulcers from chemotherapy.

On the road again to the University of Colorado Anschutz Cancer Center in Aurora Colorado July 6 2011

Jani drove me to the University of Colorado Anschutz Cancer Center in Aurora Colorado early today, July 6 2011. 

I had to have my blood drawn for an infectious disease work-up as part of the medical insurance pre-approval for a stem cell transplant. Nurse Cara in the BIC Center drew a dozen tubes of my precious blood. We decided not to use my intravenous Bard Power Port (which I had pre-treated with EMLA cream) because they have to waste blood when they first draw back and they needed to take so much blood for the tubes. The peripheral blood draw from my left arm went well on the first poke. I also had to give them a urine sample.





24 Hour Urine Test for Monoclonal Protein Results May 26 2011

Heading home to Mackay, Idaho May 26 2011

Dropping off my 24-hour urine in Ft. Collins and heading home with Kemmer.

24 Hour Urine Test for Protein Electrophoresis May 25 2011

I started the 24 hour urine test this morning. You have to discard the first void of the day and then save all the urine you make for 24 hours until the first void of the next day which you save. All of the urine has to be cooled - so, they suggest a cooler in the bathroom with ice. They gave me this hat to catch the urine in and 2 big bottles to collect it in.