We three headed off to Rochester for my every-28-day early-morning blood draw at Mayo Clinic, part of the Phase II pomalidomide study. Highway 52 was dry and clear of ice, until suddenly we found ourselves in a snow squall at 65 mph. Traffic slowed, the road was wet, the flying snow swirled in our headlights. Then, in less than a minute, the snow disappeared again, giving way to a clear, starry sky. Why? During that little storm we passed by a refinery, and apparently the zero-degree air was turning the refinery’s abundant water vapor exhausts into a local micro-mess for travelers. I’ve never seen that before. I don’t mind if I never see it again.
The Mayo visit went OK, the end of the 37th 28-day cycle. After a 6:30 am blood draw I was scheduled for a 3:15 pm visit with Dr L, but got in to see Dr KDS (yes, she’s still here!) instead at about 10:15, which got us home hours ahead of the original schedule.
Test results, however, were no better than so-so. IgG went up about 8%, from 1080 to 1170 mg/dL, and M-spike skyrocketed 20% from 1.0 to 1.2 g/dL. Converting units, this puts M-spike at 1200 mg/dL, which is a physical impossibility because M-spike is the monoclonal (bad) part of IgG and therefore must always be lower than IgG. So which measurement is wrong? I’m of the opinion that IgG, measured by immunofixation, is more accurate than M-spike, measured by electrophoresis, so I’ll take that IgG value. In fact, I think that Mayo’s M-spike measurements have always been high. When I changed from Minnesota Oncology to Mayo three years ago, my M-spike jumped up 32% even though IgG sat still. I don’t know which is wrong, MOHPA or Mayo, but there is certainly something fishy today. Anyway the cancer markers are up a little, but they do bounce around, and I don’t need to get my shorts in a twist about it.
Calcium and Creatinine:
Dr KDS is just a little concerned about calcium at 10.3 mg/dL and creatinine at 1.4 mg/dL, both slightly above the reference range. Calcium has been that high before, but creatinine, which is a measure of kidney function (malfunction?), has never been quite so high. She gave me an order to have those tested again in a week, at the local clinic. She couldn’t think of a medical reason why BOTH calcium and creatinine would go high at the same time. Vitamin K2 helps calcium to deposit in the bones instead of circulating in the blood, and I had been out of it for a couple of weeks, so I’ll take that for the calcium and lots of water for the creatinine and see if those numbers go down.
Pomalidomide drives neutrophils down, including mine. If they go below 1000 cells per microliter, I have to go off the study, at least until they come back up. As in recent months, I had neutrophils checked (CBC with Diff) the day before the Mayo visit, in the afternoon at the local clinic, instead of in the morning at Mayo when all of the other blood tests are done. At 1:00 pm on Wednesday, neutrophils measured 1800, well above the threshhold and actually into the “normal” range. Unknown to me, though, Mayo had accidentally scheduled another CBC, to be done with the other tests at 6:30 am Thursday. Since it was the more recent test, it would override the previous test if it were under 1000. Happily, it was 1190. Note, though, that the afternoon neutrophil count was 51% higher than the morning count. I also do some vigorous exercises just before the blood draw, because adrenaline helps too. These are not tricks – the neutrophils are real – they just hide in the morning. It doesn’t work for everyone, I’m told, but it’s working for me.
Some Current Test Results: