Saturday, 5 August 2017

Crepuscular

Infinite sunrise (Blelelele-lelelele-leleleleh. Aha ha ha. Ah ha ha. Ooh yeah.)
Perpetual Dawn - The Orb

Checkup ... KFLC = 464 ... Hb = 11.2 ... Neutros = 1.1 ... κ/λ = 82 ...

Every myeloma journey is different. Mine appears to be quite considerably a mind game. I walk down to clinic having steeled myself for the inevitability of restarting treatment, and concerned primarily with when it will begin and what protocol I'll be on.

To be told that my light chains have dropped (by nearly a third) is - to put it mildly - a surprise. This means the treatment conversation can wait a little longer, my κ/λ having dropped well below the 100 threshold. The registrar doesn't have anything to offer on the whys and how-comes, and I'm beyond asking. It just is.

I have no energy, either, for guessing the next instalment. Maybe this result is a blip and next month I'll be preparing for chemo. Maybe the last few months were the blip and my light chains will go up slowly again from here. Maybe this is a new trend and my light chains will fall further. No-one can know, and I don't much care to pretend to have any inkling. We'll find out, soon enough.

The doc signs me up for another MRI and a BoMB in a couple of weeks. (So that's something to look forward to!) I've been feeling intermittently well and not, of late. I'm certain the myeloma is lurking about, but if it chooses to keep its distance, I'm OK with that.

"Sunrise with phone mast" (view from my bedroom window)
My myeloma is challenging to comprehend and process. It leaves me permanently on edge, perpetually a month away from treatment. I've been relapsing now for 2 whole years. But I'm not complaining. It's better than some of the alternatives. With absolute horror I discovered, a few weeks ago, that one of my friends, whose myeloma journey started simultaneously with mine, and who I have always considered to be my 'myeloma twin', has died. I'm horrified for her: she was younger than me; and at the end she endured plasma cell leukaemia - a tough way to go. And I'm horrified as much for myself; one can't have a much more intrusive reminder of one's own mortality. I will miss her companionship. I hope her family and friends can find some peace.

After clinic, we drive to Sussex. I'm just unloading our bags in the rain when a car careens greasily down the mud flecked lane, mounts the verge opposite me, rolls onto its roof and then cartwheels end over end down the hill. It lands on its wheels, but the roof is stove in, and much of the contents of the car - papers, CDs - are strewn across the road among the smashed glass, light fittings and bumpers. I walk towards the steaming wreck, with a sick feeling in my stomach of what I'm about to witness and have to deal with. And then - improbably - the door opens, and the driver just steps out. He is very dazed, and has a lot of superficial lacerations, but he is basically unhurt. As he walks toward me he casually picks his phone up from where it is lying in the road. I take him into our house, to sit down, stop the bleeding, and wait for police and paramedics. It is chaotic: our luggage is all unpacked and underfoot; there's blood on the floor and on the buttons of the telephone. Our very new puppy is somewhat awed by all the high vis jackets of the procession of visitors who proceed to walk in, accompanied by plenty of rain and mud. But as the driver sits and calm returns, I'm reminded that life always has space for miracles (and of the amazing safety specification of modern cars).

I hope he enjoys waking the following morning as much as I do.

Wednesday, 21 June 2017

Psychophysical

Destiny is calling me. Open up my eager eyes
Mr Brightside - The Killers

I decided this week's update should come before my clinic appointment. After all, 99.8% of my life occurs between appointments. I live life merely reaching from one appointment to the next.

It's been a strange - and not always easy - few weeks, accompanied by a sense of foreboding of what is ahead. I've felt increasingly tired, run down and achy. The weird thing about symptoms is that even with many years of self observation I am no closer to being able to separate physical from psychological. I guess it is simply not possible. Consequently, I am unable to tell for certain if I am suffering anaemia or depression. They could both deliver the listlessness; the lack of energy, interest and concentration that I have been feeling.

Then again, I have been feeling much better the last few days, so maybe it was just a virus. Anything is possible. It's not nice feeling watered down. I'm glad its gone again.

Marisa sent me to the GP to get some better painkillers (back on codeine), and to have my repeated complaint of possible kidney stone problems checked out. The Dr gave me the impression that she thought my symptoms were more likely bone pain than anything else. But a urine test showed positive for blood, so maybe I am right. Either way, I will at least get a referral to have my kidneys checked over.

Life feels even more hand to mouth than normal because if this week's appointment is a bad one - another +100 - that's basically the signal for going back in to treatment. I do so want to make it through the summer first. But the waiting is killing me almost more than the myeloma, right now.

As I'm preparing to post this, the hospital calls. This week's clinic is cancelled. I ask for my blood results over the phone. My light chains (KFLC) are 654. That's +50 on last month - just little enough, I would imagine, to tide me over another month. And my Hb level is back up to 12.0, so no dramatic anaemia, either. I'm grateful, really. But if you are hit by a speeding car, you have a lot less time to think about it than if you are flattened by a road roller like Otto in A Fish Called Wanda.

"I'm going to k...k...k...kill you!"


Friday, 26 May 2017

Recidivism

Think of all the roads; think of all their crossings.  Taking steps is easy; standing still is hard. Remember all their faces; remember all their voices. Everything is different, the second time around.
You've Got Time - Regina Spektor (theme from Orange Is The New Black)

KFLC >600 ... Hb = 11.5 ... mood = low

I'll save us all the witty chat. Today's appointment is mercifully punctual and brief. Those are its redeeming features. The little plateau on which I have been resting, precariously, for a while, seems to be at an end. My light chains have jumped 50% in the last 2 months. In theory, this is all irrelevant because clinical symptoms - of which I have none - are the only sure basis on which treatment decisions will be made.

But.

My haemoglobin levels are dropping. Nothing dangerous yet, but there's only one direction of travel. If they continue the way they are going, anaemia will become a clinical symptom in its own right. And anyway, the doctor is increasingly concerned about the light chains themselves and the risk they pose to my kidneys. My kidney function is fine - as it has always been - but it's really not something where you want to wait until the damage has been done.

So, my springtime of skipped appointments and long intervals is abruptly over. I'm back on a 4 week review cycle. If my light chains do again in the next couple of months what they've done in the last couple, it will be time to begin planning my return into chemo. Maybe I'll string it out another month or two. Maybe.

For reasons it's not appropriate to dwell on here, I've spent a bit of time this week revisiting the process of diagnosis, and the terror and confusion that went with it. It's very different second time around. No confusion. Less terror. More dread.

Thursday, 16 March 2017

Live more

I'm on a different kind of high. A rush of blood is not enough. I need my feelings set on fire
I dare you - The xx

You know the rules round here. DialM is about mm, with the rest of me sort of squeezing through uninvited. Usually in the form of music and travel. Because that's who I am... (oh, and KFLC = 421)

I went to Brixton Academy last week, to see The xx in concert. It was only once I was there that I recalled I had seen them, in the same place, sometime a little over 4 years ago. I know last time round I had to simply stand rigid through the pain until eventually my back went numb. Maybe the morphine had dulled my senses back then, because the gig seemed so much richer and more alive this time round. Echoey guitar; deep rhythmic bass; haunting vocals. Splendid. I love concerts - not least the feeling of having no regard to being the wrong side of 40 (though I take my hat off to the 2 friends who went Sunday afternoon clubbing last weekend. I'm not sure I'd be up for that even if I didn't have children as an excuse.)

In 2 weeks, Marisa and I are taking the kids to Japan (新幹線温泉寿司). There's a sense of urgency for us about making adventures, which is definitely a consequence of myeloma. It's 18 months since we were planning our time in Central America, which really did feel like a snatched opportunity. And yet... time passes and I don't have a real sense of how long the good times will last, any more. But the longer they do, the more trips we'll pack in, no doubt, unless something else stops us. Myeloma has made me live more, now, than I suspect I would have otherwise.

Live more, myeloma less. Or something like that.

Having bunked my last hospital appointment, because I was on a business trip (New York, Toronto, Bogota and Mexico City), I had to book this week's appointment on the phone. The receptionist would only put me in for the end of the Wednesday clinic, which meant 2 hours sitting waiting, and a different doctor. I have to smile my sweetest to get put back on Friday's appointment list for next time. Friday's clinic is only for clinical trial patients, a category into which I do fit, technically. But more importantly, if I turn up early on Friday mornings, I'm spared the endless wait.

My light chains are up, but only a little, within the range where variation in results makes the difference insignificant. The κ/λ ratio is pretty much unchanged. All of which suggests nothing much is happening. The κ/λ has moved in a couple of jumps, doubling abruptly in July 2015, and then again in April last year. But since then it has risen only 50%, and been static now for several months. The myeloma is unquestionably there. And unquestionably returning. But beyond that? Pfff. The doctor is happy enough not to see me for another 10 weeks.

We do have a discussion about treatment options. She mentions bortezomib again, possibly in conjunction with a clinical trial drug (venetoclax? - which I hadn't previous heard of), before another stem cell transplant. (I guess it depends on how long I hold off treatment, as all these trials have recruitment windows. But if not this one, there'll be another, no doubt.) And after that I'd still be "naive" (her word) to so many drugs - thalidomide and lenalidomide being obvious ones. Which means I've potentially 3 lines of what are, by current standards, very conventional treatments, ahead of me. And that could take a number of years to work my way through.

The UK myeloma group on fb, of which I am one of a group of admins, has had a punishing few months. Relapses. Horrid experiences. Deaths. Partly that's the toll of winter, and many of the patients are older than me (not that this makes things any better, just maybe less relevant to my prognosis). Some of the stories are shocking. Vicious, callous and abrupt. And being young is no guarantee of a better outlook. I am profoundly grateful, and humbled, by my own relatively benign experience of myeloma, and the massive amount of disease free time I have been blessed with.

Myeloma's horizon seems to be receding, for now, for me. Though it continues to menace. And when it does return it could do so abruptly, I'm under no illusion about that. In the mean time:

今を生きる
後で骨髄腫

Monday, 6 March 2017

Tasty

The taste just slips away
Taste - Ride

Anyone for high dose gin therapy?

On March 6th 2013, 4 years ago today, I had a drip infusion of "high dose" melphalan; the first part , and really the main event, of my stem cell transplant. (The actual transplant, a day later, was merely a salvage therapy to stop the melphalan from killing me.) Its consequences were physically gruelling, and it was the beginning of a month's forced separation from my family (we weren't finally reunited for 6 long, desolate weeks, during which time I missed Lyndon's first birthday). But it was also the beginning of my recovery from the illness which had consumed me over the previous year.

And much to my amazement, my recovery seems, for now, to continue. I am feeling well. I haven't succumbed to immune-compromised infection at all this winter. The pains in my bones seem all mechanical, rather than myelomal, and not getting noticeably any worse.

For the first time ever, I bunked a hospital appointment, last month. I was overseas, working, and I didn't remember to cancel/reschedule in time. So I'm currently on just about the longest break I think I've ever taken from the haematology waiting room. I'm going back in next week, so I will get an update on the numbers then. But to be honest, up down or level I really do not care, as long as I feel well.

The only drip infusion I've had recently was this gin one, in a dubiously themed bar in Herne Hill. Gin tastes A LOT nicer than melphalan. And gin takes less time to recover from, too, no matter how high the dose.

Wednesday, 11 January 2017

Compassion

I had to phone someone so I picked on you. Hey, that's far out, so you heard him too?
Star man - David Bowie

I'll be sharing this video with my kids. The virtue of being nice, in a metaphor they'll understand. No fun living, if you live on the dark side.

Friday, 6 January 2017

Sitting pretty

Sitting pretty in the prime of life. I'm so tasty and the price is right
Take a slice - Glass Animals

Today's reading is taken from the book of Crapulous, chapter 94

An appointment with a sole purpose: to discuss my MRI results. (No new blood test results to look forward to.) So it is typical of the limitations of the NHS that, when DrC opens up my notes, the full-body MRI report is still not there. We're left - hardly for the first time - to chat on the basis of what little we know. We warm up with small talk about Christmas, the relative merits of Rome and Copenhagen (I've had the pleasure of visits to both, over the holiday season), and international job opportunities for myeloma specialists. We even touch briefly on brexit. When we get on to Putin, we realise it's time to return to the matter in hand.

So... reading the runes. There's new evidence of damage in my upper thoracic spine, and in my lumbar region. But no evidence of progressing myeloma. DrC thinks it is unlikely that the full-body report will show up pockets of mm, given that the spine does not, and I'm happy to accept this as entirely plausible. He describes this as
"Good news"
But I'm a little more sceptical. I explain my concern. Worsening kyphosis? Chronic pain? Is my spine going to keep slowly crumbling? DrC promises we won't let that happen and says that I could go through more vertebroplasty. I don't think my current symptoms are sufficient to begin that process. At the same time, I don't entirely buy the promise. I make a mental note: I must continue to recognise that my spine is weak so... definitely no return to running; avoid heavy lifting or arduous manual activity; and I must do more regular back exercises. That way I hope I can avoid my back getting much worse. At least, slow the process. And maybe I'll go back to my gp and ask for some more strong painkillers - so when I have a bad day, at least it doesn't hurt.

At the risk of getting into crystal ball territory, I ask DrC, in light of last month's KFLCs, whether it is possible for myeloma to plateau after progressing for so long. I'm rewarded with another parable*.
Cancer gang tattoo?
"Cancer, is not one thing, it is a number of gangs. One gang may be stronger than the others, and so that gang grows bigger. But it is possible the father of that gang is not a stem cell, but one level lower than a stem cell..."
(the metaphor has somewhat broken down, I feel, but let's roll with it)
"...in which case it may not be immortal, and after growing, that gang may die. In which case, in a low-malignancy disease, it is possible to see progression stop or even appear to reverse".
It's why, he tells me, it's best to be cautious about treating mm - avoiding treatment that is too early or unnecessary.

Picking up on the 'low-malignancy' reference, I risk a question about prognostic indicators, specifically the contrast between my 'high-risk' genetics (del17p / TP53, for those who know what that means), and my 'low-risk' ISS staging ('stage 1' due to low levels of ß2-M). He rolls his eyes as doctors normally do when faced with evidence of patients who have been mugging up. He taps away and confirms I'm right about the genetics (ha!) and that this is indeed bad. But he says his reference to low-malignancy was about mm generally - for example in comparison to plasma cell leukaemia. He also says that my response to transplant has been very good. Average (median) time to progression ("PFS" - progression free survival) is 29 months and average time to treatment is 3 years. Although I've been relapsing for ages, I am now nearly 4 years treatment free, and I'm beginning to wonder how much longer I will eke this out. It may be longer than I think.

It is weird living with this complex, mysterious, menacing thing. But while it doesn't actually bite it is a mental, not a physical battle. And it does at least spur me to live my life.

I stop at phlebotomy on the way out, to have some blood taken. As I leave I wish the nurse a happy new year.
"2017, they say it may be hard year", she replies.
"But hopefully not for me", says I.
I head home and research flights to Japan.

* I reckon doctors reading patient blogs would be like actors reading reviews: probably inadvisable. But if DrC happened to read DialM, I hope he would recognise that, over the last few years, I've appreciated our exchanges, and his efforts to answer my questions. I quite enjoy the metaphors. (Maybe I could gather all these parables up into a 'Book of Crapulous'). I certainly value his expertise in his subject, and his continuing to see me. He is the hospital's head of clinical trials for myeloma. And I am not even in treatment, let alone on a trial. But one day I will be, and I hope I'm still in his care when that day comes. If I seem facetious, it is a product of the ongoing weirdness of a life in myelomaville.

Wednesday, 4 January 2017

Janus2017

Today is the greatest day I've ever known. Can't wait for tomorrow; I might not have that long
Today - Smashing Pumpkins

And a Happy New Year

By some reckonings, 2016 was a bad, bad year. Brexit. Trump. Syria. Arctic temperature anomaly. Zika. Truck massacres. Celebrity death toll (though I'm a little sceptical about whether more people actually died, or just that it somehow became a meme).

By another reckoning, 2016 was a miracle. Chemo free for me. And most importantly, as one of my myeloma buddies posted on fb on New Year's Day:
"Still here"
The year even finished with my light chains on a plateau.

Who knows what 2017 will bring - for the world or for me. It's hard to be optimistic, but pointless to be pessimistic. Realistic? Apathetic? Pragmatic? Indifferent? Whatever. I'll take my chances.

The world, for all its many many faults, is still a beautiful and inspiring place.

Dawn, this morning. The view from my bedroom. #lovelondon