Hanging by a Thread

It has been a busy week.

We have done CT-scans (me), bone marrow biopsies (C), job interviews (me), track meets without running (K), riding bikes to school (J), more job interviews (me), clinic visits (C), dog to the vet (S), plus all the normal stuff like shopping, cleaning, cooking, homework, doo-dah, doo-dah.

Now it is Friday. The kids are at school (we hope), C is upstairs eating her yogurt and pills, and I am down here writing an update.

The bone marrow biopsy for C marked number thirteen in a long line of fairly painful procedures. The biopsy itself went well and without pain (at least none that made it past the potent medication that C gets before the start), but what wasn’t there at the start made up for it later.

Wednesday was a lost day for our poor girl. She spent the day in bed and not feeling very well at all. The biopsy was part of it, but she was also dealing with the ever persistent nose bleed, bone pain, and the approach of what she thinks is a cold. All in all, she was not a happy camper.

Thursday was a bit better as we headed down to the clinic for the weekly checkup. C received another dose of platelets and had the normal bloodwork done. Her creatinine levels were up a bit over the last reading which is never good news. Part of that might be due to dehydration from the day before when it was a struggle to get food and water into her.

Her other numbers also moved a bit in the wrong direction. Her white blood cell count and hemoglobin numbers were down and some other kidney function numbers were on the upswing when we would rather see them go the other way. The transplant doc stopped by to check on us briefly and relayed some preliminary biopsy numbers. C’s bone marrow is now 90 percent plasma cells.

For some, this will be a review, so bear with me. Plasma cells normally constitute 0 to 2 percent of the bone marrow population. Victims of multiple myeloma start to see the percentage of plasma cells grow uncontrollably in their marrow, crowding out the other very important marrow citizens that serve as factories for all the needed blood cell types. Without these factories, the body cannot make red blood cells, white blood cells, platelets, and all of the other constituents that make up a healthy blood supply. In short, the patient does not do very well.

This is one reason why C has to get so many infusions of platelets. Anyway, this news was not good, but not unexpected. We knew that the myeloma has been progressing in an unchecked manner after the halt of the last chemotherapy attempt. As you may recall, we stopped that regime when C went into the hospital with acute kidney failure a couple of months back.

Since then, we have been laying back and seeing if her kidneys might heal themselves a bit and allow us to try one more treatment.

There is a new variation of an old drug that has shown some positive results in the treatment of myeloma. It is called Revlimid and it is a cousin of thalidomide which C has taken in the past. The use of Revlimid in conjunction with dexamethasone is a treatment program that is in its infancy – so much so that it is not yet widely approved for multiple myeloma patients and is requiring special applications be made with the insurance company to get backing.

The hope is that this new treatment will knock the myeloma back far enough for C’s bone marrow factories to begin making the necessary products she needs to survive.

That brings us up to date. We are waiting on word from the insurance company to see if we can begin the Revlimid treatment. We will let you know.

P.