Recent Developments

I've refrained from making any entries for some time, since there were no material developments to discuss, until recently. However, there have been several recent developments, most of them favorable, on balance.

My chemical and chemotherapy treatment cycle will end in the middle of December, and the markers for the level of my cancer continue to be very favorable: my IgG level is below 500, and reducing. The goal, in the vernacular of oncology, is to reach "complete response", or "CR", following which the goal is to keep the patient in CR through reliance upon maintenance therapy (which is another way of saying that the patient will continue to receive chemical and/or chemo therapy, but in pill format, avoiding the need to visit the doctor's office to receive intravenous treatment). All of the current indications are that I am headed toward a Complete Response with my current level of treatment. Achieving Complete Response is obviously a watershed event, since it allows the patient to go on maintenance therapy, consisting of drugs that, in general, are less toxic, and have fewer side effects than the drugs I presently take.

By changing the "cocktail" of drugs that are used in frontline therapy (which, in my case, include weekly treatments with Velcade, Deccadron, Doxil and Cytoxsin), in favor of less toxic drugs, the patient's immune system can start to rebuild, as both the white and red blood cell levels start to increase. That means, among other things, that I will be less susceptible to opportunistic infection (which has caused me to avoid travelling and crowded situations), which can be very debilitating, and potentially dangerous, for a patient with a compromised immune system. As a practical matter, it means that I can start to travel again, without fear of infection, several weeks after completion of my last treatment cycle.

However, I am not free of the side effects of myeloma, and the treatment I've been undergoing. The principal adverse side effect of my condition and its treatment is peripheral neuropathy, which causes a loss of sensation in the patient's feet and hands. (Neuropathy is caused by damage to the nerves, or the insulation around the nerves, called myelin. In either case, it adversely affects the transmission of electronic signals from the brain to the feet and hands, and results in degrees of numbness, tingling, and - for some individuals - pain in the hands and feet.)

In my case, I currently have significant numbness in the bottom of both feet, and a slight degree of numbness in most of my fingers. It is a very strange sensation, which is a continuous reminder of the fact that you have cancer, and are being treated with toxic drugs which, in the case of Velcade, cause or contribute to neuropathy. For someone who enjoys running, like me, and is accustomed to running severday days each week, the condition is especially frustrating, since I find that jogging or running now is difficult, because of the lack of sensation in my feet.

As an alternative, I try to go to the gym every day, where I use the stairmill (which is the one machine in the gym where you cannot cheat), which I find very beneficial, and alternatively a stationary bike. My neuropathy doesn't interfere with the use of either machine, and the exercise stimulates the circulation in my feet, which is beneficial.

In an effort to get better grasp of the extent of my neuropathy, I arranged to see Dr. Samuel Rappaport, a neurologist at New York Hospital to whom I was referred by Dr. Coleman. I underwent an initial neurological exam, which indicated, among other things, that I had neuropathy which was affecting my balance and reflexes, and then went back, today, for a two-hour nerve conduction study. In the exam the doctor attaches wires to the feet, legs and hands of the patient, and then administers a series of mild electric shocks, the effects of which are measured and observed on a computer which indicates the speed with which electric impulses are conveyed through the various nerves in those parts of your body. In addition, the doctor inserts a needle into various nerves, which transmits an electric impulse to the computer, providing an additional measurement of the conduction of impulses through the patient's nerve system. The entire process is somewhat uncomfortable, but quite bearable, and lasts a little over two hours. After the testing was completed, Dr. Rappaport analyzed the results of the study, and then shared his analysis with me. Again, the news was favorable and encouraging.

In my case, the test results indicate that my nerves have not been damaged, but the insulation around my nerves, in my feet and hands, has been. Since it takes longer for a nerve to regenerate than it takes to regenerate insulation around a nerve, that is favorable news. My degree of neuropathy is mild, according to Dr. Rappaport, and the condition is reversible, as my myelin regenerates over time. He believes that the destruction of the nerve insulation is being caused primarily by the cancer itself, and less by the toxicity of the Velcade (although neuropathy is a very common side effect of Velcade). He noted that, in the case of myeloma, cancerous cells can attack the sheathing on the patient's nerves, resulting in the gradual destruction of the insulation, and causing neuropathy.

Dr. Rappaport believes that my neuropathy is unlikely to become materially worse than it is at present, and he also believes that, as my cancer level continues to fall, my condition will start to reverse itself, which was welcome news. He also indicated that regeneration of nerve insulation, and the corresponding reduction in the level of neuropathy, generally takes about six months.

I take encouragement from his analysis, because it holds out the prospect of no longer experiencing numbness in my hands and feet, and being able to run again, which for me has significant physical and pychological benefits.

In an effort to combat the effects of neuropathy, I have also started to receive accupunture treatments at the Memorial Sloan Kettering Integrative Medicine Center, which have been proven to be effective with certain patients who experience the condition. The jury is still out, in terms of their effectiveness on my condition.

In the meantime, going to the gym on a daily basis in one of the most important parts of my therapy, and is essential to regaining the conditioning that I lost through almost four months of inactivity, when I was going through the most intense part of my chemotherapy. I have a long way to go, but I am making a determined and disciplined effort each day.

More entries to follow, as I reach the end of my current treatment cycle.