Just Starting to Feel Better After A Very Rough Week

 I came down with a bad cold and it has really knocked me on my ass, I have been bed-ridden the past few days, its all sort of a blur. Greg and the roomies have been taking awesome care of me, as usual. I don’t even remember chunks of time. The last time I was this sick was when I had chicken pox back in March 2007. I am at least getting better and able to sit up and actually feeling a bit restless.

We got light chains numbers back and they have risen throughout treatment, chart below.

—– Message —–
Sent: 6/9/2010 6:02 PM
To: Office of Larry D. Anderson, MD
Subject: Latest light chains. : (

What are you thinking? I know it’s not looking good for Cytoxan but we should give it a few more rounds. Should we start looking at stem cell in October? After my cruise Sept 11-19?

6/10/10 9:17 AM

At least they were not a lot different from a couple of week ago and on the optimistic side still lower than on 4/27. I was hoping the cytoxan would be working better but let’s not give up yet since it is still pretty early in the cycle and you just got the 3rd dose of the cycle this week (If I am not off in my counting). I will plan on checking them again on 6/22 during your “week off” from velcade and If they are at least a little improved we can try the same regimen again with the next 5 week cycle. If the light chains are rising at that time we may consider adding one dose of Doxil to the next cycle (Vel/Cy/Doxil/Dex) on day 8 to give it a little more boost. If that is still not helping or stops helping during the next cycle, we could change cytoxan to Vorinostat (the one we have a clinical trial for but is also available for other indications off study so we can get it without putting you on the study), which is a pill once daily for 14 days in a row and one week off. The potential side effects of note for that are diarrhea and low platelets so I would prefer to avoid for now. Then, yes, we can consider a transplant in October but we will have to talk more about the risks and benefits of that during one of our clinic visits. (and if your counts for some reason are looking really good next week we could consider a 4th dose of oral cytoxan per cycle but I doubt your platelets and neutrophils will be able to take it right now so let’s just see what happens and be glad at least the light chains aren’t ).
Dr. A