Saturday, April 9, 2011

Boring Mayo Clinic Visit

Never. Even though nothing changed this month, I never feel complacent. Forty cycles on the pomalidomide (CC-4047) study are complete, and nothing changed this month, so I could have felt complacent. But I dread the inevitable day that the myeloma figures out how sidestep the pomalidomide - life will change when that happens, maybe not for the worse, there are other treatments, but life will change. Also, I suppose I don't want myeloma's reemergence to be a shock when it happens, and it can't be a shock if I'm always fully aware of the possibility.

Dr RH:

This visit was as routine as any we have. We don't know Dr RH very well, so after the medical stuff was done we chatted a bit, learned a little about each other. We like him - he'll do well for us, replacing Dr KDS, who really is gone now and whom we will miss. We also saw Dr L for a few minutes, a treat.

The Evolution of a Myeloma Recurrence:

With few exceptions, myeloma figures out how to defeat every medication. Maybe now, maybe later, even much later, but it does. I am definitely not a doctor or a biologist or anything of the sort, but I nevertheless have a simpleminded theory about that:
  • Some carcinogen alters the DNA of a plasma cell, or maybe a memory B cell, in such a way that the cell forgets how to die when it ought to, and perhaps with other DNA problems too, but without alerting the body's normal defenses. There may actually be MANY alterations of the cells, but most are detected and squashed, or cause that cell to die, or fail for some other reason, until one suceeds. This is how cancer starts, including myeloma.
  • That cell also has the ability to replicate itself or to produce other myeloma cells. I think there is still some dispute about how this happens - is the original progenitor a stem-like cell or an actual plasma cell? Anyway it multiplies.
  • A medicine (Revlimid, Velcade, melphalan, whatever) is able to kill the myeloma cells or reduce their rate of replication. The tumor burden goes down - yay!
  • But additional carcinogens, or the same carcinogenic influences, continue to make random alterations to the DNA of the remaining myeloma cells, which mat not be very stable to begin with. Most of these changes don't make any difference, or they may even cause the cell to die, but eventually one of those changes, by chance, makes a cell resistant to the current medications.
  • Now, that twice-altered cell is the strongest of the myeloma cells and is able to proliferate faster than the old ones in the face of the medication. It multiplies, replaces the old myeloma cells, and the drug is no good any more.
Anyway that's my theory and I'm sticking to it. If it were true, what would be the implications? Most important, REMOVE AS MANY CARCINOGENIC INFLUENCES AS POSSIBLE! We should do exactly the same things that we should be doing to PREVENT cancer in the first place:
  • Eat the healthiest foods, organic where that is important, to reduce the intake of pesticides.
  • Maintain a healthy weight - studies show that overweight alone is a carcinogen.
  • Exercise several times per week, to keep the body's immune system and other systems healthy.
  • Don't smoke, duh.
  • Stay away or protect ourselves from other common carcinogens such as gasoline, solvents, formaldehide in new construction or furniture, herbicides, pesticides, plus food additives such as nitrites and BHA/BHT.
I wrote more about cancer prevention in a previous post. It's how to live.

Gluten-free oatmeal with organic yogurt, organic strawberries, organic pear, pineapple, kiwi, walnuts. Might be some organic blueberries under there too.

Thursday, April 7, 2011

Calcium In Heart and Arteries

Recently I posted about remarks in two different PET scans. A PET scan uses two different imagining technologies, combining the results to show where cancer cells might be congregating. One of those is a CT scan, which shows clear images of bones and any other calcium in the body. Three years ago, in 2008, the radiologist who read the CT images said "There are scattered mild vascular calcifications in the aorta and coronary arteries." Calcification is an indicator of heart disease, but this didn't sound too bad. This year, though, the radiologist wrote "Coronary and vascular calcification. Bilateral renal calculi." Sounds worse, more definite, right? For sure, the kidney stones (renal calculi) were not mentioned three years ago, and no qualifiers like "scattered mild" appeared this year.

The scans were viewed by different radiologists, so was there really a difference, or was the apparent difference simply due to different personalities or reporting styles? I actually called the radiologist who did the recent report, and didn't get much help. He sounded very busy and, without looking up my actual report, said (1) he sees calcifications on many (most?) scans, (2) for sure all of the scanned images that he uses to make his report would be there for me to see on the DVD, and (3) I should trust the opinion of my oncologist rather than his, as he was "just" a radiologist.

PET Images:

I asked Mayo Clinic to send me a DVD containing both scans, so that I could provide them to local doctors but also so that I could peek at them myself. The DVD contains thousands of images and also the software necessary to view them. I believe I have identified several calcified spots in the heart, and I see no difference between last year's scans and those of 2008. Same spots in the same places. Similarly, I see very evident kidney stones, but not much difference since 2008. I've already reduced my calcium supplements to deal with those.

Doctor NB:

My new primary care provider (PCP) is just out of residency, but seems pretty sharp. He assured me that "almost all" of the CT scans he sees show vascular calcification. That is scant comfort, of course, when we know that heart disease is the leading cause of death among mature adults. But he also said that I am already doing everything that he would recommend. We eat a very heart-healthy diet, I run 20-30 miles per week, and get enough sleep. My blood pressure is fine, cholesterol is good except for HDL, which is chronically too low, always has been. We talked about ways to improve HDL, but I've tried niacin without success and he was reluctant to prescribe statins because the potential side effects might outweigh the benefit.

We've read that HDL can be related (inversely) to belly fat, and I have an extra 10 or 15 pounds of that. When I told Dr NB that I intended to take some of that off, to help increase HDL, he seemed a bit skeptical but certainly didn't discourage it.

Bottom Line: I'm done worrying about "calcification" for now. I'll do the Weight Watchers' thing, take the weight off, and then we'll see.

This is a CT "fusion" Image, from the PET/CT scan, looking at a slice of my body from the viewpoint of the feet. I'm laying on my back, so the spine is at the bottom of the image, the sternum at the top, upper arms outside right and left. The two large, dark areas are the lungs, with the heart appearing as a gray area between the lungs, slightly off-center to the left (our right). There is one bright spot in the heart - a calcification. There are a few others in other parts of the heart. Anyway, that's my very amateurish interpretation: