Jodi has officially finished her first cycle of chemotherapy. She had one week off of all medications and did well. On Monday of this week she started her second cycle of chemo and because her kidney function is stable and doing well, the doctors were able to increase the amount of chemotherapy she's receiving for her second cycle. This is a good sign because often patients with multiple myeloma have kidney failure from the cancer itself. Jodi's chemotherapy includes three medications and for their first cycle of chemotherapy she only received part of one of the medications given the side effect of that medication is kidney toxicity. Given the fact that her kidneys have remained strong and not declining in function the doctors were excited. They were able to increase the medication to its full dose for her second cycle of chemotherapy. The medications are Revelimid, Valcade, Dexamethasone.
The side effects of this kind of chemotherapy typically include severe body aches, general fatigue and malaise. Basically the patient aches and is extraordinarily tired, leaving them too tired to get out of bed. Some patients will also experience hair loss and eventually lose all of their hair. So far despite Jodi's continual lament and questioning about whether her hair is falling out, she appears to have a full head of hair. Jodi has been a trooper and although she's been extremely tired this week as she starts her second cycle of chemotherapy, she has been able to get up and get around and even go out a couple of times. She is however more tired in worn out. Another side effect of this cancer, not so much the chemotherapy, is pain. Jodi has been in pain however the pain has been considerably less significant than expected. Fortunately she has good medications and has been blessed with better health and strength than expected.
Jodi will will have a total of three or possibly four of these chemotherapy cycles, and then get ready for her bone marrow transplant. This is quick and brief update on Jodi's life as we know it today. We love having Jodi in the house she's an awesome grandmother and wonderful mother / mother in-law. We also thoroughly enjoy having Ed in the house, he is a great handyman and is busy taking care of Jodi, helping out the grandkids and all sorts of chores around the house. I'm wondering at what point I should break the news to Ed and Jodi that she actually doesn't have cancer and that this is all just a ruse to get extra help in our house.
Keep checking back in with this blog as I will continue to update it as Jodi continues her cycles of chemotherapy and gets ready for the bone marrow transplant. I will include a post that explains the autologous bone marrow transplant in great detail but for the meantime keep her in your prayers and know that she is in good spirits and doing well. Also, Jodi loves hearing from all of you and the phone calls and letter / emails have cheered lifted her spirits.
Friday, April 29, 2011
Wednesday, April 13, 2011
Jodi's Prognosis?
Often doctors are asked; "How long do I have?" "What is my prognosis?" Although this is a difficult question and most doctors avoid giving a direct answer, hopefully I can shed some light on this question regarding Jodi.
Multiple Myeloma for many years has been considered a chronic yet terminal illness. Most of what you read on the internet is outdated and not up to speed with the current rapidly progressing and changing treatment strategies of MM. Many oncologists will discuss amongst other doctors and state that in fact MM can be cured and has been cured for many patients. However there is not enough data with these newer aggressive treatments to officially call this cancer a "curable" cancer.
Many people live 10+, even 15 years or longer and ultimately die of other causes. Geraldine Ferraro recently passed away after living with MM for 12 years. I have seen many patients with 10+ years and these patients were treated with inferior and older medications. So the future looks bright and we suspect to have Jodi at Ivy's wedding and Ivy will not be allowed to get married prior to 23 and she is only 12 years old now.
Jodi has been blessed to be included in a couple of the most advanced cutting edge treatment strategies for MM and will certainly benefit from these treatments.
Did I skillfully avoid answering the question?
Multiple Myeloma for many years has been considered a chronic yet terminal illness. Most of what you read on the internet is outdated and not up to speed with the current rapidly progressing and changing treatment strategies of MM. Many oncologists will discuss amongst other doctors and state that in fact MM can be cured and has been cured for many patients. However there is not enough data with these newer aggressive treatments to officially call this cancer a "curable" cancer.
Many people live 10+, even 15 years or longer and ultimately die of other causes. Geraldine Ferraro recently passed away after living with MM for 12 years. I have seen many patients with 10+ years and these patients were treated with inferior and older medications. So the future looks bright and we suspect to have Jodi at Ivy's wedding and Ivy will not be allowed to get married prior to 23 and she is only 12 years old now.
Jodi has been blessed to be included in a couple of the most advanced cutting edge treatment strategies for MM and will certainly benefit from these treatments.
Did I skillfully avoid answering the question?
The Treatment Plan Part: Bisphosphonates & Pathologic Fractures
There are many different treatments out there for Multiple Myeloma (MM) and there are constantly new medications being studied. There also several studies to test new drugs or new drug combinations occurring at any given time. There are multiple factors to why 1 combination may be good for a patient and not good for another patient even though they have the same cancer. It is a complicated and daunting task for newly diagnosed patients to figure out what options are even available. To further complicate issues, the experts disagree and often have varying opinions about the different treatments. There is also clinical data that is published regarding treatments and outcomes but these studies take time and are usually 5 years old by the time they get published. I guess what I am trying to convey is that treating any cancer can be very confusing and difficult. The treatment and strategies are constantly changing and improving.
One of the big problems / side effects of MM is pathological fractures. The overgrowth of plasma cells in the bone marrow causes enzymes to extract calcium from bones which causes the bone to become weaker and ultimately fracture from forces that would not normally cause a bone to break, hence the term "pathologic". Often MM is diagnosed when a patient comes to the doctor with a broken rib from "coughing" or "playing with the grandchildren". This makes the doctor think about MM and run appropriate tests to look for the cancer. Even in recent years individuals with MM would have a pathological fracture of the spine or hip which would lead to their early death. It was and is not uncommon for a patient with MM die from a pathologic fracture related deterioration of health.
Part 1 of Jodi's Treatment:
Jodi has been fortunate to be included in a study for a treatment for bone regrowth. bisphosphonates are a class of drugs that have been around for a while and are used to treat osteoporosis. Modern versions of these drugs have been highly adapted and a recent study that uses high dose bisphosphonates to treat people with boney metastasis from other cancers and people with multiple myeloma has taken treatment of these pathologic fractures and prevention of further fractures to a new level. The study is difficult to get included in as a patient, and has been extraordinarily well received by those in the study. Eventually this treatment will be the standard of care for these cancer associated bone problems.
Jodi has started this treatment and has already seen improvement in her bone pain and strength. At her time of diagnoses she had multiple small pathologic lesions and some fractures. Fortunately it was early on the the disease state that she had not developed any spine fractures or hip fractures or other more serious fracture. Due to acceptance in this study her bones have already started to improve and strengthen which eliminates 1 aspect of concern regarding her diagnosis.
One of the big problems / side effects of MM is pathological fractures. The overgrowth of plasma cells in the bone marrow causes enzymes to extract calcium from bones which causes the bone to become weaker and ultimately fracture from forces that would not normally cause a bone to break, hence the term "pathologic". Often MM is diagnosed when a patient comes to the doctor with a broken rib from "coughing" or "playing with the grandchildren". This makes the doctor think about MM and run appropriate tests to look for the cancer. Even in recent years individuals with MM would have a pathological fracture of the spine or hip which would lead to their early death. It was and is not uncommon for a patient with MM die from a pathologic fracture related deterioration of health.
Part 1 of Jodi's Treatment:
Jodi has been fortunate to be included in a study for a treatment for bone regrowth. bisphosphonates are a class of drugs that have been around for a while and are used to treat osteoporosis. Modern versions of these drugs have been highly adapted and a recent study that uses high dose bisphosphonates to treat people with boney metastasis from other cancers and people with multiple myeloma has taken treatment of these pathologic fractures and prevention of further fractures to a new level. The study is difficult to get included in as a patient, and has been extraordinarily well received by those in the study. Eventually this treatment will be the standard of care for these cancer associated bone problems.
Jodi has started this treatment and has already seen improvement in her bone pain and strength. At her time of diagnoses she had multiple small pathologic lesions and some fractures. Fortunately it was early on the the disease state that she had not developed any spine fractures or hip fractures or other more serious fracture. Due to acceptance in this study her bones have already started to improve and strengthen which eliminates 1 aspect of concern regarding her diagnosis.
 |
| This image is not an image of Jodi's spine fortunately. This is a severe pathologic fracture from an unknown patient with MM, ultimately leading to neurologic dysfunction. |
Friday, April 8, 2011
What is Multiple Myeloma?
Multiple myeloma (MM) is characterized by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow and often results in extensive skeletal destruction with osteolytic lesions, osteopenia, and/or pathologic fractures.
That is the medical jargon. Now for a simpler explanation: Bone Marrow contains all kinds of cells that are important for generating blood and all of its ingredients. One of those ingredients are called plasma cells. These plasma cells should make up less than 10% of the total ingredients. People who have multiple myeloma have an overgrowth of plasma cells. Too much of a good thing causes problems and can cause calcium imbalances which can lead to bone destruction and fractures that occur when they should not occur (pathologic fractures).
In Jodi's case she broke her ribs "from coughing" which was worrisome and ultimately helped lead to her diagnosis. One should not fracture ribs from coughing.
If MM is left unchecked the overgrowth of plasma cells will continue to wreak havoc on the blood which hurts the immune system as well. Ultimately individuals left untreated will have multiple fractures including debilitating spinal fractures and become immunocompromised which leads to infections.
Staging Multiple Myeloma
Fortunately, much progress has been made on the treatment of MM. In the 1970's there was a staging system created where patients were staged I, II or III. Stage I having the best prognosis and Stage III having the worst prognosis. For the most part this staging system has been abandoned for MM due to a better understanding of the disease itself and the realization that the staging system was not that accurate and looked at factors that ultimately do not relate to prognosis.
Jodi's case is not considered aggressive nor is it considered mild but rather somewhere in between closer to moderate to mild. Regardless her treatment will be the same.
In modern medicine / more cutting edge medicine MM now is not staged and all newly diagnosed patients are often put on aggressive treatments regardless of the degree of the disease. In Jodi's case she has been fortunate enough to be involved in a center that specializes in the treatment of MM and takes an aggressive treatment approach to quickly stomp out the disease and knock it into remission.
The treatment includes 3 medications that she will take in 3 cycles, 21 days on and 7 days off (3 months = 3 cycles) and then she will receive an autologous bone-marrow transplant, which is a bone-marrow transplant made from her own health stem cells. She will not require suppressive medication to avoid rejection since it will be her own healthy bone-marrow.
More on her specific treatment later.
This is a quick brief explanation and there will be more details to follow
That is the medical jargon. Now for a simpler explanation: Bone Marrow contains all kinds of cells that are important for generating blood and all of its ingredients. One of those ingredients are called plasma cells. These plasma cells should make up less than 10% of the total ingredients. People who have multiple myeloma have an overgrowth of plasma cells. Too much of a good thing causes problems and can cause calcium imbalances which can lead to bone destruction and fractures that occur when they should not occur (pathologic fractures).
In Jodi's case she broke her ribs "from coughing" which was worrisome and ultimately helped lead to her diagnosis. One should not fracture ribs from coughing.
If MM is left unchecked the overgrowth of plasma cells will continue to wreak havoc on the blood which hurts the immune system as well. Ultimately individuals left untreated will have multiple fractures including debilitating spinal fractures and become immunocompromised which leads to infections.
Staging Multiple Myeloma
Fortunately, much progress has been made on the treatment of MM. In the 1970's there was a staging system created where patients were staged I, II or III. Stage I having the best prognosis and Stage III having the worst prognosis. For the most part this staging system has been abandoned for MM due to a better understanding of the disease itself and the realization that the staging system was not that accurate and looked at factors that ultimately do not relate to prognosis.
Jodi's case is not considered aggressive nor is it considered mild but rather somewhere in between closer to moderate to mild. Regardless her treatment will be the same.
In modern medicine / more cutting edge medicine MM now is not staged and all newly diagnosed patients are often put on aggressive treatments regardless of the degree of the disease. In Jodi's case she has been fortunate enough to be involved in a center that specializes in the treatment of MM and takes an aggressive treatment approach to quickly stomp out the disease and knock it into remission.
The treatment includes 3 medications that she will take in 3 cycles, 21 days on and 7 days off (3 months = 3 cycles) and then she will receive an autologous bone-marrow transplant, which is a bone-marrow transplant made from her own health stem cells. She will not require suppressive medication to avoid rejection since it will be her own healthy bone-marrow.
More on her specific treatment later.
This is a quick brief explanation and there will be more details to follow
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