The University of Cancer

Grape Arbor in Our Garden

Grape Arbor in Our Garden

Last week, the first snow of winter arrived. All day, fine grains of powder squeezed through a sieve of cloud and fell like glitter on top of the fence posts and the shoulders of the shrubbery and filled the crevices between the tiles on the garden path. Above me, geese gabbled among themselves, heading south, blind and invisible in the overcast.

The clouds lifted after the snowfall. Streets glistened under sapphire skies. Temperatures plummeted. One day it was five degrees, then one degree, and now, today, a balmy seven degrees at dawn. The frigid weather lends itself to hibernating routines: I take short walks; I write; I tend to the woodstove; I read.

Lately, I’ve been studying immunoglobulins and enzyme blockers as they relate to my blood cancer, multiple myeloma. I’ve learned my immune system operates at less than 50% of the normal base range. It’s not something you can see by looking at me, but a simple lab test reveals the deficiency. Basically, malignant blood cells grow unchecked. They hog space normally reserved for healthy cells that protect a person from germs.

Oak and Maple Splits Stacked in the Wood Shed

Oak and Maple Splits Stacked in the Wood Shed

Having cancer is a bit like returning to school. I enjoy studying disease biology and I’m learning the intricacies of blood chemistry. The knowledge helps with managing both the cancer and side effects of treatment.

This month marks six years since diagnosis. My experience is typical of many others living with the disease. We share a variation of myeloma that develops slowly, but with predictable resilience. I’m fortunate we discovered the cancer before complications of bone or kidney involvement occurred. This allowed my doctors and I to proceed with the treatment philosophy of “less is more.”

Looking North at Mt. Adams the Day After the First Snow

Looking North at Mt. Adams the Day After the First Snow

Ironically, myeloma also goes to school once it inhabits a patient’s bone marrow. Drugs suppress the runaway growth but the cancer inevitably creates new mutations. MM learns to evolve in the crucible of chemotherapy.

Soon, I’ll begin a new drug treatment. The current maintenance program, which I’ve been on for three years, continues to wobble. The MM struggles to gain purchase in my marrow but there’s evidence of serological slipping. In other words, we can see my blood misbehaving even if I remain asymptomatic.

Hood River's First Snowfall of 2013/14 Winter

Hood River’s First Snowfall of 2013/14 Winter

The new treatment, though generally well tolerated, comes with a unique risk and side effect profile. With myeloma the strategy can be likened to a chess match. I have the black pieces. I’m playing defense. It’s my move. I must slow the advance of the latest mutations, while buying precious time as lines of counter attack develop.

Cancer patients don’t like change, especially when they feel well. But the blood labs act like those “pop quizzes” college students hate. Dr. L, my oncologist, doesn’t like the answers she’s been getting. That’s why I’ve cracked the books on the cellular biology of blood. I want to be ready for the next test. And, I want to see those geese return in the spring.