Friday, August 29, 2008

Good Update

My mom had her Zometa treatment this week and got back blood work results. After only a week on the Revlimid and Dexamethasone treatments, her cancer is responding and her numbers dropped from .7 to .4. (That's a good thing.) These new drugs aren't as toxic and so her body seems to be handling it well. Wednesdays are her Dexamethasone days. Usually Thursday she sees a slight rise in her blood sugars but nothing to worry about -especially since she isn't eating many bagels these days. Her energy level is pretty high and she's able to do all the activities she did before treatments started. I'll keep you posted on any other developments.

Thank you for all your prayers and support!

Monday, August 18, 2008

Mom's New Treatments Began

It's been an interesting few weeks. At the end of July, around when this blog started we found out my mom's cancer had grown a significant bit. We have known for awhile that it's been growing but it's been slow enough that the doctor's haven't been too concerned. At her last appointment with Dr. Cooper it almost doubled (I have to double check with my mom about that). So he wanted her to start treatments again. When we went to Dr. Hollister to discuss and begin the treatments, he wasn't as convinced so ordered the full sha-bang: MRI, skeletal scan, and more blood work. (I'm surprised there is any cancer left with all the blood she's had taken out of her lately.)

It took about two weeks for all the testing to be done and results to be in. They showed a small spike in the cancer count, not as high as Dr. Cooper's findings but still a jump. We also found out she has some new lesions, a pesky one in her right hip bone which explains a lot of the pain she's been having and a new lesion in her 'leg of steel' femur. Amazingly the old lesions have healed over-which I didn't know would happen. Praise God for that. So it is official, she'll begin treatments of Revlimid and Dexamethasone.

They have caught the cancer early this time. These treatments are to kill the cancer and are not done with an intention of then doing another stem cell transplant. It's been about a week on the treatments and my mom's biggest complaint has been fatigue (which is to be expected). Also, she's been having difficulty with her blood sugar due to the dexamethasone, but that to was some what expected as well. She's holding in there pretty well. I know this because last Wednesday she watched her three grand kids (two-3 year olds and a 20 month old) for the whole day. Not a task for the weary.

To learn more about her new treatments I'll send you to the MMRF once again because they have it written out pretty clearly. That link should take you directly to their Revlimid page.

On a side note: The tests also showed that all the pain she has in her back is due to arthritis not cancer lesions. For now that's the latest. Please keep her in your prayers.

Saturday, August 2, 2008

What the heck is Multiple Myeloma?

The question bares repeating...what the heck is multiple myeloma? Three years ago I knew all the lingo, I could explain almost anything you'd have a question on. Once my mom was 'better' and Bella came along, I needed that brain room for mom stuff. You know figuring out how to cook, clean and do laundry while entertaining kids and fending off tantrums...ahhh motherhood.

I confess this post is two-fold: to give you information and to jog my memory. Most of the following information was obtained from http://www.multiplemyeloma.org/: a great website and a great foundation.

Multiple Myeloma (MM) is a cancer of the plasma cells in the blood. The plasma cells are the part are the blood that produce antibodies. It was explained to us: when you get a vaccine as a child the body learns to fight off the weakened disease by producing antibodies which then float around in your blood-and are continually being reformed- waiting to attack the virus if it comes back. There are lots of different types of antibodies/plasma cells in the blood: Polio, Mumps, Measles, etc. In MM, some how the cells are genetically damaged and start producing malignant plasma cells or myeloma cells. They do not function properly and start increasing so rapidly that there is too much of this one, useless antibody in the body. They start 'crowding out' the normal, functional antibodies and prevent production of more normal, functional antibodies, so the immune system can't fight off the 'invasion.'

As the these tumors grow they invade the outer hard part of the bone and make holes or "lesions". They are normally found in the larger bones of the body: Vertebrae, Skull, Femur, and Ribs. My mom had two large lesions in her femur, several in her ribs and a large lesion in her lower vertebra. All the myeloma cells are the same and are called paraproteins. Which is what they are measuring during the blood test my mom gets on a regular basis. This is new knowledge for my precious brain. An important part of MM is being an involved patient. We are always being told to know your blood work. Well, we really wanted to be active and involved but we could never figure out what the heck the tests were called. Dr. Hollister and Dr. Cooper ran different tests so we could never get straight answers it seemed. But now we know we want the paraprotein measurement (and when we ask for that we are asking for the number of myeloma cells in her blood). I feel a little smarter right now-WHOO HOO.

Here's an example of an x-ray of someone who has MM lesions. My mom's x-ray looked similar to the right bone, only with two big 'bites' taken out.


I got this picture from www.multiplemyeloma.org and I hope it was okay to copy to this blog.

They still do not have a cause for this type of cancer. It happens more in the elderly (except my mom's case...she's still a spring chick:) ) so they think it might be related to the aging process or a build up of toxins in the body. We can't say for sure why my mom got this cancer because she doesn't fit the usually bill: male, African American, over 70, industrial worker or atom bomb survivor.

There really aren't any symptoms for early stages of MM, so usually it isn't diagnosed until later stages. Symptoms for later stages include kidney problems, pain (my mom), fatigue, recurring infections, and nervous system dysfunction (which I haven't heard of before).

Lots of tests are done for diagnosis, classification and staging (determining how bad). I won't go into the whole list because chances are you don't really care, unless you think you might have it. Basically, there are several different blood tests, urine samples, x-rays, MRI and a bone marrow biopsy. There are 3 stages and my mom's initial diagnosis was stage 3, meaning she had it pretty bad. This is reminding me to ask Dr. Hollister exactly what type she has and her current classification and stage and all that, hopefully my mom remembers. I gotta start making a list.

I hope this helped answer some questions about my mom's cancer. If you have anymore, feel free to email me and I'll hunt down some answers.

Friday, August 1, 2008

The Journey Thus Far, Part 3

Click Here To Read Part 1 or Part 2

The stem cell transplant was in August 2005, I believe. It was a month long process that required my mom to stay at a hotel in New Haven, in case there was an emergency. I was her caregiver during this time.

First off, going to Yale/New Haven was a eye opener. I'd never heard of this type of cancer and most people I talk to haven't either. Visiting Dr. Hollister's office wasn't a good judge because there are three doctors in the practice and I believe they all treat different types of cancer. But the Yale clinic was full of patients many whom has this type of cancer. Each day the chairs (at least 20 of them) were full of new people coming in for various treatments. This was just the out patient clinic, there were also people hospitalized due to reactions to treatments. Thank you Lord we never had to visit this section. My next post will be all about MM-for those who don't know what it is.

The stem cell process starts with moving the stem cells from the bone marrow to the blood. This is done through daily injections of a drug Neupogen. For about 3 or 4 days, we'd go to the hospital early in the morning to have blood work done to find out the number of stem cells in the blood. We'd wait and wait (I knitted, my mom slept) until the results came back. If it wasn't enough, mom got another injection and we'd go back to the hotel. The side effects of this process is bone pain because the stem cells are being drawn out of the marrow which just sounds painful. These days moved very slowly. I believe there were a few tests to make sure her body could handle the collection. Once her numbers came back in 'go' range she had a semi-permanent needle put in her neck/chest-I don't remember what this is called a PIC line or something like that. Then the next day we went to a new section of the hospital...Apheresis.

This is were her stem cells were harvested through a dialysis type process. She'd sit attached to a machine and rest while I did more knitting. The nurses here were SO nice, it made me want to go into this area of medicine. They'd process her cells, taking out the bad stuff and froze them to be injected later. Once they had enough, I think it took 3 days, it was time for the really hard stuff: high-dose chemotherapy. But before I get to that I wanted to add that we met two other women in the apheresis unit who were going through the same thing. The three amigos. It was such a blessing to have someone for my mom to share this part of the journey with. Unfortunately, both women had complications and were admitted into the hospital and we never saw them again.

When high-dose chemo day came I remember us both feeling nervous. When they came over with mom's 'jar' we apprehensively looked at each other and I think one of us said, "There no turning back now." I'm not sure what exactly I was expecting from the chemo. She got her injections, we did some more waiting and then went home. Her hair didn't fall out, she didn't start throwing up, there was nothing different about that day. Of course the effects came eventually and then my work began.

I can't remember if it was the same day or a few days later, but eventually her stem cells were put back in. I'll call that day "cream corn" day because one of the effects of the freezing/thawing process was a strong cream corn odor that lingered. No amount of warning prepared me for that. Once the smell hit my nose I just smiled, it really does smell like cream corn, it's amazing.

The next weeks were filled with daily hospital visits to check mom's blood numbers, lots of sleepless nights, complicated pill regiments, and a hotel room change. The effect of the chemo weren't fun for my mom and it was difficult at times knowing what pain she must have been in. There was lots of monitoring to be done, my main job was to keep watch for fever. And my mom will attest that I took my job very seriously. I did everything short of wake her up to take her temperature. We had to wait until my mom's blood count returned to normal and for a number of days she was just below. It seemed the day would never come, but finally it did approval to go home!!!

There were lots of doctor visits and blood work after we left the hospital but eventually we found out my mom was in partial remission. The only drugs she had to continue on were the Zometa injections (which she still gets).

The past 3 years have been spent in that partial remission. She's had to check in often with her regular oncologist and her transplant specialist. They've been happy with her progress but there has been a slow rise in the cancer numbers. This week they saw a bigger jump in her numbers and are considering starting treatments again. The numbers are still low but seem to be on a steady upward trend. We knew this would happen eventually and are now facing the next steps we have to take. Thus this blog started.

The Journey Thus Far, Part 2

Click Here To Read Part 1

Mom became bionic woman with her leg of steel. I'm still amazed she can move around with that inside. Anyways, now that she was more mobile it was time to start the serious work. We met with Dr. Hollister and he recommended a series of drug treatments followed by a stem cell transplant. He insisted that we get a second opinion from someone who could actually do the stem cell transplant. Quite a lot is involved and so they are usually done at cancer centers in hospitals.

Off we went to NYC to meet with Dr. Jaganaugh. He met with us (my sister, my mom and I) for a long time explaining MM and my mom's particular diagnosis. I remember it being really technical-though I also remember him trying to put it in terms we could understand and drawing pictures for us. Ultimately, my mom's insurance wouldn't cover him, so we had to find different doctor to get a second opinion from. Now looking back I think it was another moment of God's grace. All the traveling my mom has had to do to New Haven (where her current transplant specialist is) it would have been expensive and time consuming going into NYC that much. On top of that, I looked him up to figure out how to spell his name correctly and he is no longer at Sloan-Kettering. I'm glad the Lord lead us this direction, but at the time I remember being really annoyed that she couldn't go to her first choice. He was at the forefront of a lot of the successful research for treating MM. In comes doctor #3b, Dr. Cooper at the Yale Cancer Center in New Haven. His role in my mom's treatment was overseeing her stem cell transplant.

Before I go on I want to dispel any myths that maybe be going through your mind. My mom's particular stem cell transplant isn't the controversial kind you've heard about in the news with embryos being killed. It was an autologous stem cell transplant. Basically it is a bone marrow transplant but they harvest the stem cells differently. In a bone marrow transplant, they harvest the bone marrow from the hip bones using a needle usually performed as an operation. My mom had HER OWN cells harvested through her blood, similar to dialysis. I'll explain in more detail later of what she went through. But, for now, please know that no unborn babies were hurt during this process.

Dr. Cooper agreed with Dr. Hollister's assessment and sent her back to Hollister to begin drug treatment in preparation for a stem cell transplant. The plan was for her to take Thalidomide and Dexamethasone on a rotation schedule until enough cancer was killed off that they could do a stem cell transplant, which would hopefully 'reboot" her system. The side effects of these drugs were at times horrendous. Generally, the main concerns are drowsiness, peripheral neuropathy (numbness in arms and legs) and blood clots. But because my mom has a thyroid problem and is "pre-diabetic" (though my mom denied that one for a long time) there were other concerns that needed to be watch.

The dexamethasone can effect blood sugar levels so she was put on diabetic medicine and given insulin to inject herself with if needed. I remember one of the first outings after all this started she went to get her hair done. I went next door and got her a bagel (some sugar laden thing, I should have known better but she really wanted it). That night she tested her blood sugar, it was 300. (Normal blood sugars are like 80 I think.) So no more bagels for Mama. My mom had to be really careful with her eating. The dexamethasone was given in rounds so she's be on for 5 days off for 5 days, or something like that. When she was on she had to be careful of eating sugary foods. But when she was off, she had to be careful the levels didn't drop too low. Like at my nephews baptism. It was a nice day but long and my mom was off of the dexamethasone. By the time the reception came she was pretty weak. About 30 minutes into the reception my mom's friends came over to say that my mom needed to be taken home. I drove her home and checked her blood sugars, they were around 40. She was lightheaded, dizzy and tired. My mom told me to go back to the reception and I did for about 2 minutes, only to come back and stay the rest of the night with her. (I have learned, through all this, that my mom is a very strong & courageous woman. And I love her very much. But there are times that I have to ignore her words. I've since learned there were many times that she was quite sick but didn't want to bother anyone about it so said she was okay. MOM!)

These drug treatments went on from April to August 2005. She was also having Zometa injections amidst all this. Zometa is an IV drug given to slow the growth of the cancer, decrease bone pain and reduce fractures. Lots of months, lots of drugs, lots of blood work, lots of doctor visits. Then it was time for the transplant.

The Journey Thus Far, Part 1

This new phase in our lives started in April 2005. Actually, it had been several months before that that my mom, Betty, complained about pains in her leg and back. Her general doctor put her through a battery of tests, many of them unpleasant and downright painful. The one I remember most was when she came home to tell me that she had long needles stuck in her legs testing her nerves. I'm pretty sure that was the worst one. She went to physical therapy thinking maybe it was a muscular issue. She told me once, "They'd twist my leg all around. I'd be screaming in pain and they'd say I know it hurts but we have to do this." Thinking back it is truly by God's grace that they didn't break her leg with all that twisting, pulling and bending. Her doctor ran more blood work and finally the diagnosis was discovered: Multiple Myeloma (MM).

I remember the day I found out. My oldest daughter was 2 weeks old, my nephew was 2 months old. We were visiting mom, trying to help out, since her pain was so great. She got a phone call. I heard "I'm sitting down....oh....okay....okay....okay...." Her face fell flat and I knew something was wrong but I wasn't prepared to hear "I have cancer". (To be honest and I know this is going to make me sound really stupid, but for some reason I thought she might say "I'm pregnant". I don't know why that thought came to my mind - she's in her 60s - I guess since it seemed like everyone I knew was pregnant why not my mom as well.) Actually my mom didn't say "I have cancer" she said "My doctor says I have something called Multi Myeloma. It's kind of like cancer."

That diagnosis put our lives in a spin. Mom was going off to doctors and MORE tests it seemed everyday. Every doctor had to see her because the treatments would be hard on her body and they needed to make sure she could handle it. A few new doctor's entered our lives. First was Dr. Hollister, her oncologist. He is a very nice, gentle man who works in Greenwich, CT. Since this type of cancer effects the bones one of her first few tests (post-diagnosis) were an MRI and a skeletal survey. Those revealed two 4-inch holes in her femur, actually there was only a small amount of bone left. It's an amazing x-ray to see.

The first course of action was an operation to put a metal rod in her leg. It had to be done ASAP before her femur broke. They told her not to walk, not to drive, not to do anything until this surgery could be done. A few days later she met Dr. Nocek also in Greenwich. My first time meeting him was at the hospital, pre-surgery. He was a great doctor as well. (My mom is quite fortunate to have an amazing team working on her.) The surgery went smoothly. My mom said she was "aware" of the surgery going on. She could hear the drilling and banging and the doctor's talking. Sounds scary to me, but she wasn't scarred by that experience. I get the chills just thinking of it. OOOOOO. My mom went to The Jewish Home for the Elderly to recover. There her physical therapist made replica babies so she could practice carrying and picking up her grand kids. She was at The Jewish Home for a few weeks (I think). Now it was time to start the real journey, killing the cancer.

To be continued....

Welcome!

I wanted to start a blog so people have a place to come to see how our mom is doing. With our "busy" New England lives we don't always remember to let people know what's going on. Hopefully this will be an easy way to do that (I just have to remember to keep it updated:) )

Feel free to email me with any questions tiffany_ayres@yahoo.com.

Welcome!