Good news: enormous progress since November

Since the date of my last entry, in late November, a great deal has occurred in my battle with Myeloma, but all of it favorable, on balance, bearing in mind that Myeloma is an aggressive cancer that requires aggressive treatment to be successful.

The high-dose part of my chemotherapy lasted from June through mid-December, during which time I was receiving intravenous treatment twice-weekly. The effect of the chemotherapy was pronounced: my cancel level was falling rapidly, but not without significant side effects from the toxic qualities of the drugs.

Among the drugs I was taking, Doxil is perhaps the most toxic, and it builds up in your system cumulatively over time. In my case, it resulted in "hand-foot syndrome", a common toxic side effect which causes painful swelling of the hands and feet, and cracking and peeling of the skin. By early December, the discomfort was chronic and painful. In addition, Velcade causes neuropathy, and my neuropathy had become pronounced by late November, affecting both my hands and feet, in which I experienced a pronounced loss of sensation. It was not pleasant.

My oncologist, Dr. Morton Coleman, recognizing the toxic side effects from which I was suffering, and my need for some relief, discontinued my last intravenous cycle in early December, and allowed me to go several weeks without any chemotherapy. In that period the worst of the toxic side effects subsided, and I began to regain my strength, going to the gym daily, and focusing on cardiovascular exercise (which has become my most important source of non-medical therapy). I also took a vacation with Denise in Florida for a week, together with my brother, Duncan, and my sister-in-law, which allowed me to put some perspective on what I had gone through for six months, and look beyond the "crisis treatment stage" of the disease. It was the first time I had travelled in six months, and it was a relief.

In January I started an entirely new chemotherapy regime, in pill format, consisting of Revlamid, a "miracle drug" manufactured by Cellgene, which is one of the new generation of drugs used to treat Myeloma, in tandem with Decadron (the steroid that I have already been taking) and a daily megadose of Biaxin, a powerful antiobiotic which, when taken in combination with Revlamid, enhances the efficacy of Revlamid, and acts as an "accelerant" in the suppression of Myeloma.

None of these drugs, in tandem, are nearly as toxic as the drugs that I was taking intravenously, which was perhaps the best development (although each of these drugs has toxic side effects). Revlamid is taken on a 20-day cycle, with ten days off before beginning the next cycle. While Revlamid does not cause neuropathy, it can cause thrombosis, and requires the patient to take a daily dose of aspirin to reduce the liklihood of that condition.

Decadron is taken in a high dose (40 milligrams), once a week. As a steroid, Decadron has a number of toxic side effects, including a tightening of all of the patient's muscles, requiring a constant effort to stretch to maintain flexibility. Incidentally, it also causes insomnia for several days. Biaxin, which is taken daily, has a variety of side effects, especially if taken without a meal, so most patients take Biaxin in the morning with breakfast.

The best news, however, is that these drugs, in this combination, are highly effective in fighting Myeloma, and my lab results reflect the progressive, favorable results: my cancer level is down dramatically, and headed toward what oncologists call "complete response".

However, the fact is that Myeloma is an aggressive cancer, and any oncologist who specializes in plasma cancers will tell you that the challenge is to keep the patient in "complete response", once achieved. For patients in my situation, the common prescription is "maintenance therapy", which is continued chemotherapy in pill format, at a less toxic level, indefinitely. It is, on balance, a small price to pay for keeping cancer in suppression.

With few exceptions I go to the gym every day in the morning, spending about half an hour stretching (to counteract the effects of the steroids), and at least half an hour doing cardiovascular exercise. Because of the persistent neuropathy I experience, I tend to spend most of my time either on the stairmill, described above, or on a spinning bike, both of which are quite manageable. The effect of cardiovascular exercise, in my case, is instant: it increases my circulation, which diminishes the effects of neuropathy, and immediately increases my energy level.

So now it is almost mid-March, and I have just completed my second full Revlamid cycle. My cancer level is way down, which is by far the best news. The toxic side effects are quite manageable. Subject to the views of Dr. Coleman, I will either go through one more full Revlamid cycle, or start to transition to a chemotherapy combination which is less toxic than the one I'm currently on. In either event, I continue to have absolute confidence in his judgment, and share in his confidence about the treatability of the disease, in my case.