Wednesday, August 25, 2010

Afternoon Delight

Neutrophil Count:

I'm still taking pomalidomide (CC-4047), participating in a trial of that new drug. It has kept my tumor burden low and stable for two and a half years, but in the last half year it has also suppressed my neutrophils enough that they tend to fall below the cutoff of 1000 cells per microliter (1.0 K/uL). In each prior case we have drawn the initial (failing) blood sample in the morning. But in another blood draw in the afternoon, usually a few days later, the count was always plenty high, sometimes almost double the morning count. In the meantime, though, there was a question whether I should get the pomalidomide pills or not, and more than once the treatment actually slipped a few days.

So this time we finally got smart and did the blood draw (CBC with differential) the AFTERNOON BEFORE the Mayo visit, at the local clinic. I ran up and down a few flights of stairs first, as usual, trying to work up a little adrenaline to chase some neutrophils out of their hiding places. The clinic did a very professional job, running the CBC and manual differential so quickly that I had the printout in my hot fist less than an hour later. It showed a neutrophil count of 1400, so I went to Mayo the next morning, August 24, knowing that there would be no drama about the neutrophil count and the pomalidomide. A saving of money, time, and stress. Whew.

IgG dropped about 5% this time, from 1160 to 1100 mg/dL, which is good. M-spike, however, remained the same at 1.1 g/dL (1100 mg/dL), which is technically impossible. M-spike measures the BAD (monoclonal) portion of immunoglobulin G, whereas IgG measures the total of both good and bad. They cannot be equal unless the good portion is zero, which is quite unlikely. Both measurements have tolerances, however, especially M-spike, and I suspect that they just happened to lean toward one another this time. In any case the result is either stable or down a little, which is good. Lambda light chains are up quite a bit, but so are Kappa light chains and the ratio is virtually unchanged. I'm happy - on to Cycle 33!


I hate taking supplements. I admit it. I take a LOT of them, but I have to make myself do it. This time my 7-day pill minder ran out on the same day that the cycle started, and I didn't fill it right away. When it's empty, I don't take any supplements, and for ten days I just didn't take the time to fill those little plastic boxes, though I religiously took the pomalidomide. When I did fill the boxes again, I cut back the number of different supplements significantly. I dropped the curcumin, feverfew, flaxseed oil, pancreatic enzymes, resveratrol, bromelain, milk thistle, and half of the CoQ-10 (ubiquinol). Later I put one or two of those back - the current supplement regimen is here.

Results of the supplement holiday:
  • Tumor burden: Nothing happened, at least nothing bad. I conclude that those dropped supplements have not contributed to the myeloma treatment.
  • Neuropathy: It did seem to get a little worse. Previously, I felt some numbness in the right thumb and the left pinkie finger. Now, though, I feel it in both thumbs, both pinkies, and both index fingers. In addition, the backs of both hands feel a little numb. I think that my feet are a little more numb too, athough I haven't tested them as carefully. PLEASE NOTE: My neuropathy is insignificant compared with what many people feel. I'm not complaining about it (much); the important point is that the neuropathy did seem to get worse during the ten days with no supplements and has not improved since resuming them.
  • A bodily function unique to males actually seemed to improve during the ten days without supplements. Is there one particular supplement that I am still taking which tends to suppress that function? More research is indicated.
Some current test results:

Test    May 27    Jun 29    Jul 29    Aug 24     Remarks
M-spike g/dL 1.1 1.0 1.1 1.1 Best tumor measure
IgG mg/dL 1110 1120 1160 1100 Good tumor measure
L FLC mg/dL 2.58 1.74 1.86 2.79 L Free light chains
Calcium mg/dL 9.9 9.9 9.9 10.1 Below 10.2 is best
Creat mg/dL 1.3 1.2 1.0 1.3 Kidney, normal
HGB g/dL 14.7 14.5 14.0 15.7 Hemoglobin, good
RBC M/uL 4.36 4.30 4.16 4.39 Red cells, low
WBC K/uL 3.6 3.4 2.8 4.4 White cells, OK
ANC K/uL 0.92 1.09 0.93 1.41 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.

That's canned salmon a'la Sweet Pea. Big strawberries, small plate.
Salmon Dinner

1 comment:

  1. My husband's doc told him that white cell counts do differ at different times of the day. They are usually higher in the afternoon than the morning, I think.