On Monday of this week I reached, with some delays, my halfway point in chemical and chemotherapy treatment. Under the adjusted schedule, I will now finish at the end of the first week of December, instead of finishing in late November, as originally scheduled.
While I regard reaching the halfway point as a major milestone, especially since my cancer level has been reduced dramatically (as described below), it was demoralizing to realize that, having started the process in late June, I am only halfway.
First, the good news. Measured by a marker known as IgG, a particular type of immunoglobulin (or antibody) which is produced by plasma cells that are cancerous (and therefore serves as an indicator of the level of cancer a patient has at any time), my level of cancer has reduced dramatically, from an IgG level of 6600 (which is extremely high) to approximately 500 at present. (Immunoglobulins are gamma globulin proteins that are found in the blood and are used by the immune system to identify and neutralize foreign objects, like viruses, and cancer.)
While I don't believe an indivdual's IgG level can be reduced to zero (because it is a protein in the blood cell) , it can be reduced to a very low level, reflecting the destruction of cancerous plasma cells. In any event, the objective of the chemical and chemo therapy is to reduce the cancerous plasma cells to zero.
The second item of good news is that, in resuming my treatment, Dr. Coleman decided to reduce the dosage level of the two most powerful chemicals with which I'm treated, Decadron and Velcade. Both have very powerful side effects, which are dimished in their effects as dosage levels go down.
Decadon, a steroid, at high dosage levels shuts down an individual's natural production of hormonal steroids, which is a primary source of energy for everyone, every day, and also "disarms" a patient's immune system. (It serves, effectively, as an "accelerant" for Velcade, which can funtion more efficiently if unobstructed by a patient's immune system.) By shutting down the production of natural steroids at a high dosage level, the patient's system simply shuts down, which doctors and their staff refer to as "crashing". Speaking from my own experience, approximately 24 hours after receiving a high dose of Decadron (which I did twice a week, every week for three weeks in a row, and only one week off), I became unable to function. I felt severely fatigued, way beyond anything I had every previously experienced. Conventional functioning became an enormous challenge. As a practical matter, for about 24 hours I had little or no energy, and a very finite tolerance for any physical exertion. After that, a more natural level of energy returned, until the next treatment.
My Decadron level has been reduced by half, and it makes an enormous difference: I no longer "crash" after each treatment, but can funtion very effectively, with a normal energy level.
Now the unfavorable news. Velcade, which is the most important anti-cancer drug I take each week, and targets and poisons myeloma cells, has several significant side effects, the most troublesome of which is "peripheral neuropathy". Perhipheral neuropathy is a term used to describe damage to the nerves of the peripheral nervous system (or neurons), which can be caused by diseases of the nerve, or from the side-effects of illness or medication used to treat illness.
Velcade produces neuropathy in patients, which manifests itself either as a burning sensation in the hands and/or feet, or the loss of sensation, or numbness. By destroying neurons in the hands and feet, Velcade interferes with the natural transmission of nerve signals through the neurons. In my case (and I'm sure most patients), it means that your feet feel quite numb, all of the time, making it impossible (or nearly impossible) to job or run, and requiring that you exercise caution when walking, so that your feet are always on a flat surface.
It is reversible, once the treatment stops, but in the meantime its a nuissance, and feels quite strange. It doesn't prevent me from rowing, biking, or using the stairmill (that's the one you can't cheat on), but it does prevent me from running, which is frustrating, since the fall is the most enjoyable running season. You simply adopt coping strategies to deal with the loss of sensation in your feet, cautious not to exceed what you can manage, in terms of use of your feet.
Finally, Decadron also causes insomnia, which you also have to learn to cope with. It is manageable, but inconvenient. Like other cancer patients, I've adopted coping strategies which work fairly well.
Overall, my energy level is excellent, which is a nice turn of events, and my attitude is exceedingly positive, supported by my determination to get through this process successfully, and aided by the extradinary support of my wife, Denise, and by the extraordinary attention I receive from Dr. Coleman and his nursing staff. I have a long road to get all of my strength back, but that is simply a matter of time and effort.
Further entries to come.
