Mixed Results

Pomalyst Study Cycle 69
Thursday, June 27, 2013:

M-Spike and IgG:

IgG went up 21% in the last 28 days, from 1070 mg/dL last month to 1300 this month. M-spike comes in later but usually follows IgG closely, so I left Mayo for home assuming that the cancer markers, with an up-and-down history, were going up again. After the 90-minute drive home, though, I checked into Mayo Clinic on line and M-spike had a value of 1.0 g/dL (1000 mg/dL), unchanged from the previous cycle. How could that be?

IgG is the sum of the "bad" IgG, the useless monoclonal proteins produced by the myeloma cells and measured by the M-spike, and the "good" IgG, which is an essential part of the immune system. Assuming that error in the the tests themselves could not be large enough to produce this discrepancy between IgG and M-spike, one explanation is that the "good" IgG is up this time, possibly because of a recent sinus infection. I'll go with that for today, and we'll see what happens next month.

All organic

Light Chains:

In recent months both the Lambda and the Kappa light chains have been creeping upward. Last month both were above their reference ranges, for the first time ever. Today, though, both are down a little, each almost exactly at the top of its reference range. I guess I like that better. The Kappa/Lambda ratio is smack in the middle of its reference range, which is a good thing. Whatever - I don't know what to think about the creeping light chains.

Heart:

Mayo performed an ECG on me this time, as they do every third month, and as always the doctor who reported on the ECG complained about the low heart rate of 44 beats per minute, but nothing else: "Marked sinus bradycardia, otherwise normal ECG." The heart, to quote a Timex advertisement, just "takes a lickin' and keeps on tickin'." I wonder how high it goes these days when I run. I should see if my 11-year-old heart-rate monitor still works after being shelved for years.

Most-Recent Test Results:

Test		Apr 04		May 02		May 30		Jun 27		Remarks
M-spike g/dL		1.1		1.1		1.0		1.0		\ Tumor marker
IgG mg/dL		1230		1060		1070		1300		/ Tumor marker
Lambda mg/dL		3.30		2.89		3.72		2.61		L free light chains
Kappa mg/dL		1.80		1.94		2.00		1.95		K free light chains
Ratio 0.26-1.65		0.56		0.67		0.54		0.75		Kappa / Lambda
Calcium mg/dL		10.0		9.4		9.3		9.5		OK
Creatinine mg/dL		1.5		1.2		1.3		1.2		Kidney, OK
HGB g/dL		15.5		14.9		14.8		15.1		Hemoglobin, OK
RBC M/uL		4.53		4.40		4.33		4.38		Red cells, lowish
WBC K/uL		5.2		4.5		4.8		5.1		White cells, OK
ANC K/uL		2.2		1.5		2.7		2.4		Neutrophils, OK

Related Links:

My Myeloma		A discussion of my myeloma, not very technical.
My Treatment History		Not technical.
My Test Charts		Graphic displays of several key test results over time.
My Test Result Table		Somewhat technical. Best with a wide browser window.
My Supplement Regimen		With links to where I buy them.

Very Bad Luck

Saturn Ion.  Their other
car looks just the same.

Our son and his sweet wife are enduring more than their share of tribulations lately, starting with her diagnosis of advanced ovarian cancer, then a house burglary on Easter Sunday, then the death of his grandfather (my Dad), and finally, on the very day of Dad's funeral, a lightning fire resulting in the total loss of their brand-new home.

Living Room

The local NBC station here, KARE 11, ran this story the day of the fire.

Friends asked if they could help, so the beleaguered couple established a 'Fire Recovery Fund'. Please feel free to pass it on if you know of someone else who might be interested in the story.

New Era

My dad died a few days ago, a wonderful gentleman, age 100, as sharp as anyone, still with more friends than most of us could ever hope to have. He was very handy and quite smart, and all his life he helped anyone who asked, with no expectation of a return.  He had ten visitors on the very day that he died.

He was also my best fan, apart from my sweeties, always asking for the itinerary of our next marathon trip, wanting to know the results, and appreciating the occasional news story about his marathoner with myeloma. His loss leaves an emptiness for many people and for me especially. I love you Dad, go with God.


Pomalyst Study Cycle 68

Thursday, May 30, 2013

M-Spike and IgG:

IgG was 1070 mg/dL, essentially identical to last month's measurement of 1060. M-spike was 1.0 g/dL, down from 1.1 last month and as low as it has been since February. That's good news - the myeloma appears stable.

Light Chains:

Maybe, though, something else is happening. I have IgG Lambda myeloma, meaning that the naughty cancer cells produce some extra Lambda light chains. The Pomalyst has kept those within the reference range most of the time, but they have been creeping up slowly over the last eight months or so, now higher than they have been since the Pomalyst treatment started in 2008. Furthermore, the Kappa light chains have also been creeping up, topping their reference range this month for the first time ever. The ratio is still normal, but both Lambda and Kappa are above their reference ranges and I don't know what that means.

Last month I asked Dr L about this, and she suggested that it may be due to kidney backup in older men with benign prostatic hyperplasia (BPH), which is a problem that I do have. Light chains in the blood are cleared by the kidneys. This theory does not explain why the chains are increasing, however, because my BPH has not changed perceptibly over the eight months and other kidney function indicators, such as creatinine clearance, have not changed either.

This month Dr YLH suggested that the increased chains might not be junk from the cancerous cells, but might be real chains, an important part of the immune system, responding to my infection - I have a cold. I like that theory, which implies that the chains will be back down next month when the cold is gone, but it doesn't explain why the levels of both chains have been rising over eight months.

Just today, at a seminar hosted by the International Myeloma Foundation, I spoke with another very knowledgable myeloma specialist who assured me that he had seen this before in people who were taking IMiD's for long periods, and that was not predictive of anything. Just a slightly-interesting artifact - I could ignore it.

I'm a worry-wart though, somewhat suspicious of such an easy answer, and I don't know what to think. This month's blood draw was just four days after a marathon, but next month's will be five days after a marathon, so if the light chains are affected by running I won't know for two months. Meantime I'll try to take the doctors' advice and forget about it.

On the other hand, if you have an idea, I'm all eyes.

High Blood Pressure:

Last month my blood pressure at Mayo was 155 over something, I can't remember the lower number. Dr L suggested that I get a monitor and keep track of it. After a little research I ordered an Omicron BP 652 "Automatic Wrist Blood Pressure Monitor." After keeping track off an on for most of May, these are the results for 57 readings at varying times of the day:

	Average systolic	132
	Average diastolic	72
	Maximum systolic	158
	Maximum diastolic	80

Average heart rate was 45, which is normal for me. I suppose that the BP readings are on the edge of high, or more, and maybe I should talk to my primary physician to discuss them.

Most-Recent Test Results:

Test		Mar 07		Apr 04		May 02		May 30		Remarks
M-spike g/dL		1.1		1.1		1.1		1.0		\ Tumor marker
IgG mg/dL		1290		1230		1060		1070		/ Tumor marker
Lambda mg/dL		2.84		3.30		2.89		3.72		L free light chains
Kappa mg/dL		1.46		1.80		1.94		2.00		K free light chains
Ratio 0.26-1.65		0.51		0.56		0.67		0.54		Kappa / Lambda
Calcium mg/dL		9.4		10.0		9.4		9.3		OK
Creatinine mg/dL		1.2		1.5		1.2		1.3		Kidney, OK
HGB g/dL		14.4		15.5		14.9		14.8		Hemoglobin, OK
RBC M/uL		4.26		4.53		4.40		4.33		Red cells, low
WBC K/uL		4.7		5.2		4.5		4.8		White cells, OK
ANC K/uL		2.50		2.20		1.50		2.70		Neutrophils, low

Related Links:

My Myeloma		A discussion of my myeloma, not very technical.
My Treatment History		Not technical.
My Test Charts		Graphic displays of several key test results over time.
My Test Result Table		Somewhat technical. Best with a wide browser window.
My Supplement Regimen		With links to where I buy them.